Global report urges defining obesity more precisely than BMI

There is a risk that too many people will be diagnosed with obesity when a “more precise” and “nuanced” definition is needed. a report from global experts says.

Doctors should consider the overall health of patients with excess fat, rather than simply measuring their body mass index (BMI), he says.

Those who suffer from chronic diseases caused by their weight should be diagnosed with “clinical obesity,” but those without health problems should be diagnosed with “preclinical obesity.”

It is estimated that more than one billion people live with obesity worldwide and prescription weight loss medications are in high demand.

The report, published in the journal The Lancet Diabetes & Endocrinology, is supported by more than 50 medical experts from around the world.

“Obesity is a spectrum,” says Professor Francesco Rubino of King’s College London, who chaired the group.

“Some suffer from it and manage to live a normal life, function normally.

“Others cannot walk well or breathe well, or are in wheelchairs with significant health problems.”

The report calls for a “rethinking” of obesity to distinguish between patients with a disease and those who remain healthy but at risk of developing a disease in the future.

Currently, in many countries, obesity is defined as having a BMI greater than 30 – a measure that estimates body fat based on height and weight.

Access to weight loss medications such as Wegovy and Mounjaro is usually restricted to patients in this category.

In many parts of the UK, the NHS also requires people to have a weight-related health problem.

But BMI reveals nothing about a patient’s overall health, the report says, and does not distinguish between muscle and body fat or take into account the most dangerous fat around the waist and organs.

Experts advocate for a new model that looks at the signs of obesity that affect the body’s organs (such as heart disease, shortness of breath, type 2 diabetes or joint pain) and its harmful impact on daily life.

This indicates that obesity has become a clinical disease and needs pharmacological treatment.

However, those with “preclinical obesity”, instead of medications and surgery, should be offered weight loss counseling, counseling and monitoring to reduce the chances of health problems developing. Treatment may also be necessary.

“Obesity is a health risk; the difference is that for some it is also a disease,” Professor Rubino said.

Redefining it was sensible, he added, to understand the level of risk in a large population, rather than the current “fuzzy landscape of obesity.”

According to the report, waist-to-height ratio or direct measurement of fat, along with a detailed medical history, can give a much clearer picture than BMI.

Childhood obesity expert Professor Louise Baur of the University of Sydney, who contributed to the report, said the new approach would allow adults and children with obesity to “receive more appropriate care”, while reducing the number of overdiagnoses and unnecessary treatments. .

At a time when drugs that reduce body weight by up to 20% are being prescribed on a large scale, the report states that this “rethinking” of obesity “is all the more pertinent” because it “improves the accuracy of diagnosis.”

The Royal College of Physicians said the report laid a solid foundation “for treating obesity with the same medical rigor and compassion as other chronic diseases.”

Distinguishing between preclinical and clinical obesity would be “a vital step forward” and “highlighted the need to identify and intervene early” while providing appropriate care to patients whose health was already severely affected, the university said.

But there are concerns that pressure on health budgets could mean less money for those in the “pre-obese” category.

Professor Sir Jim Mann, co-director of the Edgar Research Center for Diabetes and Obesity, in Otago, New Zealand, said the emphasis was likely to be “on the needs of those defined as clinically obese” and that limited funding was “very “probably” heading their way.