Obesity: Experts Call for New, More Nuanced Definition of Obesity to Improve Diagnosis and Treatment

Dr Bilawal Kamran

A new report from global medical experts warns that many people are being misclassified as obese due to the over-simplified reliance on the Body Mass Index (BMI) metric, urging a more accurate and nuanced approach. With over a billion people living with obesity worldwide, the medical community is pushing for a redefinition of obesity that better accounts for an individual’s overall health, not just their BMI score.

The report, published in The Lancet Diabetes & Endocrinology journal, highlights that while BMI is commonly used to diagnose obesity—defined as a BMI over 30—it fails to distinguish between body fat and muscle mass, nor does it consider the distribution of fat, particularly the more harmful fat around the abdomen and organs. The experts suggest that a person’s overall health and the impact of excess weight on daily life should be the key factors in determining whether someone is truly obese and in need of treatment.

The report, backed by more than 50 international medical professionals, advocates for distinguishing between two categories: “clinical obesity” and “pre-clinical obesity.” The former would apply to individuals whose weight is already causing chronic health problems such as heart disease, type 2 diabetes, or joint pain. These individuals would be eligible for treatment, including weight-loss drugs. On the other hand, those without existing health conditions but who are at risk due to excess weight should be diagnosed with “pre-clinical obesity.” For these individuals, the recommended treatment would be weight management advice, counseling, and lifestyle monitoring to prevent the onset of obesity-related health problems.

The redefinition of obesity is seen as a necessary shift towards a more personalized, accurate diagnosis that can lead to more effective treatments. According to Prof. Francesco Rubino, a leading expert from King’s College London who chaired the report, obesity is a spectrum. “Some individuals with obesity live normal, healthy lives, while others experience severe health problems and physical limitations.” He emphasized the importance of recognizing these differences and reframing obesity not as a one-size-fits-all condition but as a variable health issue that requires varying levels of intervention.

One of the key issues with the current system is that BMI doesn’t capture the complexities of obesity. For instance, two individuals may have the same BMI but vastly different body compositions and health outcomes. A person with a high muscle mass may be categorized as obese despite being in good health, while another individual with a higher percentage of fat and a higher risk for disease may not be diagnosed as obese under the current criteria. This one-dimensional approach could lead to unnecessary treatments for some and missed opportunities for care in others.

Prof. Louise Baur, a children’s obesity expert from the University of Sydney, who contributed to the report, expressed that this new diagnostic framework would provide better, more individualized care for both adults and children. She believes it could reduce the number of people who are over-diagnosed and unnecessarily prescribed medications or surgery. With drugs like Wegovy and Mounjaro gaining popularity for weight loss, this distinction between pre-clinical and clinical obesity is more important than ever. The report argues that not everyone who is overweight or obese requires medication, and treatments should be tailored to the patient’s specific health status.

The growing availability of weight-loss medications also underscores the need for a more accurate definition of obesity. These drugs, which can reduce body weight by up to 20%, are being prescribed more widely, but without a clearer definition of who qualifies for these treatments, there’s a risk of unnecessary prescribing, leading to higher healthcare costs and potential side effects for those who don’t need these interventions.

While the Royal College of Physicians has praised the report, calling it a strong foundation for treating obesity with the same medical rigor and compassion as other chronic illnesses, there are concerns about the financial implications. The redefined classification of obesity could result in less funding for those in the “pre-obese” category, as healthcare systems may prioritize individuals with clinical obesity, who are already experiencing serious health issues. Prof. Sir Jim Mann from the Edgar Diabetes and Obesity Research Centre in New Zealand pointed out that limited healthcare resources might mean that treatments and interventions are directed primarily at those diagnosed with clinical obesity, potentially sidelining those who are at risk but do not yet have health complications.

The report also calls for more precise measurements, such as waist-to-height ratios or direct fat measurement, to assess obesity more accurately. These methods, combined with a detailed medical history, would provide a much clearer picture of a person’s health risks than BMI alone. A patient’s unique medical history and current health status should be at the forefront of any obesity diagnosis, ensuring that only those who truly need medical interventions are prescribed treatments like weight-loss drugs.

This nuanced approach to obesity diagnosis is not just about redefining categories—it’s about improving outcomes for individuals and the healthcare system as a whole. By reducing unnecessary treatments for those with “pre-clinical obesity” and focusing on proactive interventions, we can potentially prevent a range of chronic diseases and help manage obesity more effectively. In a world where obesity is increasingly seen as a global health crisis, this report calls for a smarter, more compassionate approach that treats obesity as the complex, multifaceted issue it is, rather than just a simple number on a scale.

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