Global Commission Proposes a Nuanced Approach to Diagnosing Obesity

A new global commission, published in The Lancet Diabetes & Endocrinology, and endorsed by 75 medical organizations worldwide, has introduced a novel framework for diagnosing obesity. This approach incorporates criteria beyond body mass index (BMI) and considers objective signs and symptoms of ill health at the individual level. The aim is to address the shortcomings of the traditional BMI-based definition and improve access to appropriate care for those living with obesity.

New Framework Addresses the Limitations of BMI

The traditional BMI-based definition of obesity has long been criticized for oversimplifying the complexity of excess body fat and its health impacts. BMI does not differentiate between muscle mass and fat, nor does it account for fat distribution in the body. These limitations can lead to misdiagnosis and inadequate care.

Professor Francesco Rubino from King’s College London emphasized the nuanced reality of obesity: “Considering obesity only as a risk factor can unfairly deny access to timely care. On the other hand, a blanket definition can result in overdiagnosis and unnecessary interventions. Our reframing acknowledges this complexity and allows for personalized treatment plans.”

Proposed Diagnostic Criteria

The commission’s proposal recommends a more comprehensive approach to diagnosing obesity. Beyond BMI, it suggests using additional methods to confirm excess fat mass and its distribution:

• At least one measurement of body size (waist circumference, waist-to-hip ratio, or waist-to-height ratio) in addition to BMI.
• At least two measurements of body size regardless of BMI.
• Direct body fat measurement (such as DEXA scans) regardless of BMI.
• In individuals with very high BMI (typically over 40 kg/m²), excess body fat can be assumed.

Two New Categories: Clinical and Pre-Clinical Obesity

The commission introduces two new categories of obesity: clinical and pre-clinical. Clinical obesity is defined as obesity associated with objective signs and/or symptoms of reduced organ function. People with clinical obesity are considered to have an ongoing chronic disease and require specific treatments.

Pre-clinical obesity, on the other hand, refers to obesity with normal organ function. Individuals in this category are at an increased risk for future diseases but do not currently have health complications. They should be managed with strategies aimed at reducing future disease risk.

Personalized Care for Everyone

The new framework emphasizes personalized care. People with clinical obesity should receive treatment aimed at fully regaining or improving body functions compromised by obesity, including lifestyle changes, medications, and surgery. In contrast, those with pre-clinical obesity should focus on reducing risk through health counseling and monitoring.

Professor Louise Baur from the University of Sydney stated, “This nuanced approach will enable evidence-based and personalized approaches to prevention, management, and treatment. It will also save healthcare resources by reducing overdiagnosis and unnecessary treatment.”

The Impacts and Future Implications

The commission’s proposal could revolutionize how obesity is diagnosed and treated globally. With over one billion people worldwide estimated to be living with obesity, a more accurate and nuanced framework is vital. It has the potential to improve patient outcomes, reduce healthcare costs, and address the ongoing stigma surrounding obesity.

Commission member and Head of Monash University’s Obesity and Metabolic Medicine Group, Associate Professor Priya Sumithran, highlighted the importance of this new approach: “The proposed definition and diagnostic criteria will help clinicians provide personalized, timely, and appropriate care.”

Professor Wendy Brown, Chair of the Monash University Department of Surgery, added, “With the new criteria, we now have a medically meaningful way to diagnose obesity, allowing us to tailor treatment plans according to individual patient needs.”

Conclusion

The commission’s proposal represents a significant step forward in the field of obesity management. By moving beyond BMI and incorporating objective measures of health and illness, it aims to provide a more accurate and individualized approach to obesity diagnosis and care. This framework has the potential to improve health outcomes and reduce stigma, paving the way for better healthcare practices worldwide.

We encourage readers to share their thoughts and experiences regarding this new approach. Join the conversation and help shape the future of obesity management. Comment below, subscribe to our newsletter for more updates, and share this article on social media to spread the word.