As the interest in Ozempic and other weight-loss medications surges, a coalition of 58 experts is questioning current standards for defining and diagnosing obesity. They suggest a more detailed approach to understanding the condition.
The team’s updated definition, revealed in The Lancet Diabetes & Endocrinology on January 14, emphasizes the impact of excess body fat, or adiposity, on one’s health rather than just using the body mass index (BMI), which calculates weight relative to height. They introduce two specific categories: preclinical obesity, where an individual has additional body fat but maintains normal organ function, and clinical obesity, where the surplus fat negatively affects the body’s organs and tissues.
According to Elisabeth van Rossum, an endocrinologist at Erasmus University Medical Center Rotterdam in the Netherlands, this new perspective could enhance clinical care, influence public health initiatives, and shift societal views on obesity.
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“Currently, the prevailing belief is that simply eating less and exercising more leads to weight loss,” states van Rossum, who was not involved in the new study. She points out, “If it were that straightforward, we wouldn’t be facing an obesity epidemic. This paper makes a substantial contribution to the discourse on the complexities of obesity.”
A Worldwide Issue
Globally, over 1 billion individuals are affected by obesity, which is associated with roughly 5 million deaths annually from conditions like diabetes and heart disease.
BMI has been a longstanding metric for obesity diagnosis due to its simplicity. However, it does not fully represent an individual’s health status as it overlooks variations in body composition, such as muscle versus fat content.
In individuals of European descent, a BMI of 30 or more typically indicates obesity, reflecting a significant fat accumulation. Yet, this measure could mislabel a muscular athlete as obese or fail to identify someone with a ‘normal’ BMI who carries excess fat, thereby increasing their risk of heart disease and other serious health issues, explains Francesco Rubino, a bariatric surgeon at King’s College London, who led the expert group.
Traditional methods can result in some individuals receiving unnecessary treatments while overlooking others who need intervention. To refine this, Rubino and his team suggest a more comprehensive approach to diagnosing obesity that incorporates BMI along with other methods like waist circumference measurements or body scans using low-level X-rays to directly assess fat mass.
Although there is no absolute threshold for obesity, body fat is generally considered excessive when it exceeds 25% in men and 30–38% in women. Since directly measuring adiposity can be impractical or expensive, other health indicators such as waist size, waist-to-hip ratio, or waist-to-height ratio are crucial, the researchers note. However, they agree that a BMI above 40 almost certainly indicates high body fat.
The obesity diagnosis should also include standard laboratory tests, medical history, and details on daily activities to evaluate how excess body fat may be impacting an individual’s health, says study co-author Robert Eckel, an endocrinologist at the University of Colorado Anschutz Medical Campus in Aurora. “These criteria are objective and standardized across global health systems,” he remarks.
Tailored assessments that consider age, gender, and ethnicity are also vital, as certain groups may face health risks at lower BMI levels than others, points out Louise Baur, a pediatrician at the University of Sydney, Australia.
Identifying Two Key Categories
Individuals with preclinical obesity, while their organs function normally, face a higher risk of developing health issues compared to those without obesity. They could benefit from counseling and preventive measures like lifestyle adjustments to mitigate the risk of more severe health problems, the experts suggest.
Clinical obesity is identified when excess fat directly impairs organ function or significantly restricts daily activities such as walking or dressing. Individuals with clinical obesity may require targeted treatments to improve their health and prevent further complications.
Rubino emphasizes that this methodology is particularly crucial in the era of weight-loss medications, ensuring more precise diagnoses and facilitating effective, cost-efficient treatment.
Challenging the Stigma
This approach is endorsed by numerous scientific and patient advocacy groups worldwide, reflecting growing evidence of the health impacts of obesity, van Rossum explains. Another recent framework also acknowledges that the diagnosis of obesity should extend beyond BMI to include its health effects.
Yet, many health professionals still view obesity as a matter of willpower rather than a condition influenced by excess fat, hormonal changes, and genetic factors. In the Netherlands, a study co-authored by van Rossum found that many individuals with obesity had faced stigma in healthcare settings. This stigma often deters people from seeking necessary care, underscoring the importance of improved education and communication about the condition.
While it remains to be seen whether this new approach will lead to more or fewer obesity diagnoses, or how it will change management practices in clinical settings, “we hope that this type of assessment will eventually be incorporated into clinical practice guidelines,” Baur notes.
This article is reproduced with permission and was first published on January 14, 2025.
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