Global experts call for a review of obesity diagnosis framework

A newly proposed framework could change the way obesity It is diagnosed by assessing body fat distribution and organ health beyond body mass index (BMI), according to the committee published in . Lancet Diabetes and Endocrinology.¹ This global commission, supported by more than 75 healthcare organizations, aims to improve clinical care and challenge the misconception that obesity is a disease.²

The committee recommends the use of additional measurements such as waist circumference and direct body fat assessment to complement BMI and reduce diagnostic errors. |Image credit: Vitalii Vodolazskyi – Stock.adobe.com

Current approaches to diagnosing obesity rely heavily on BMI and have faced increasing criticism for a variety of reasons.¹ BMI is a simple measure for estimating body fat, but it cannot take into account differences in fat distribution or individual health status.

Critics argue that defining obesity based on BMI risks over-diagnosis, leading to unnecessary treatments and higher medical costs, and that many people with a high BMI do not show signs of disease, highlighting the heterogeneity of obesity. He claims to be emphasizing. For example, some patients may accumulate excess fat in the lower back or around organs such as the heart or liver, which poses a greater health risk than if fat were accumulated just under the skin on the arms and legs. Masu.

“However, a person's BMI with excess body fat does not necessarily indicate that they are obese, meaning that health problems may go undiagnosed,” says the study from the University of Colorado Anschutz Medical Campus. explains Robert Eckel, MD, professor of physiology and biophysics. and one of the authors of the committee.² “Furthermore, some people have high body mass index (BMI) and high body fat but have no signs or symptoms of ongoing disease and their organs and body function normally.”

It is estimated that more than 1 billion people worldwide are obese, and this discussion is leading to a more nuanced approach that considers body composition and organ health, rather than relying solely on BMI thresholds. There is a growing demand for diagnostic tools.

How is obesity measured?

Although not intended to replace BMI itself, the committee recommends the use of additional measurements, such as waist circumference and direct body fat assessment, to complement BMI and reduce diagnostic errors.

It introduces two new diagnostic categories. One is clinical obesity, which is characterized by a chronic disease with organ dysfunction due to excess fat, and the other is obesity, which is characterized by a chronic disease with organ dysfunction due to excess fat, and obesity, which is characterized by intact organ function but with long-term health risks such as diabetes and cardiovascular disease. Clinical obesity. It's getting expensive. This will help promote more individualized care, with people with preclinical obesity able to benefit from risk reduction strategies such as counseling and lifestyle interventions, while people with clinical obesity may be able to improve organ function. More active management is required to recover.

“This includes timely access to evidence-based treatments for people with clinical obesity that are appropriate for people suffering from chronic diseases, and risk reduction management strategies for people with preclinical obesity who are at increased health risk. There is no ongoing disease,” said Francesco Rubino, MD, professor and professor of metabolic and bariatric surgery at King's College, London and one of the committee authors. “This facilitates the rational allocation of medical resources and the fair and medically meaningful prioritization of available treatment options.”

Rather than focusing solely on weight loss, these individualized treatment plans also prioritize restoring the patient's health. By distinguishing between clinical and preclinical obesity, this new model allows for more efficient allocation of healthcare resources and ensures that patients receive care tailored to their specific needs. The report also highlights the stigma associated with obesity, which the new framework aims to reduce by promoting respect and clarity in clinical care.

How will this affect insurance?

The report's authors also called on health insurance companies to cover obesity treatment as a stand-alone condition, without requiring comorbidities such as type 2 diabetes, and that clinical obesity justifies coverage. He said there shouldn't be a need for another disease.¹

It also requires insurance companies to recognize clinical obesity as a chronic and potentially life-threatening disease, provide comprehensive coverage for evidence-based treatments, and reduce risks. It called for providing counseling, screening, and monitoring for patients with preclinical obesity. Suppression of the development of clinical obesity and related diseases.

Under this framework, professional and academic institutions should also prioritize educational initiatives that provide health care providers with the tools to implement clinical obesity diagnostic criteria in practice. Addressing weight bias and increasing understanding of modern obesity science are also important factors. When it comes to public health, rather than blaming individuals, we need to develop evidence-based strategies and promote a balanced approach between prevention and treatment for more efficient resource allocation. .

By adopting a more nuanced diagnostic approach, the committee will set the stage to improve patient outcomes while reducing the stigma and oversimplifications that have long hindered progress in obesity management.

“While thinking about obesity comprehensively as a disease can raise legitimate concerns about the risk of overdiagnosis with deleterious outcomes for both individuals and society, clinical obesity is an objectively ongoing disease. Because it reflects the disease, it provides a rational and medically meaningful goal for diagnosis and treatment prioritization,” the committee said. “We hope that such reframing can inform public health policy, facilitate the identification of appropriate targets for prevention and treatment strategies, and contribute to overcoming weight-based stigma and misconceptions that reinforce stigma. .”

References

1. Rubino F, Cummings DE, Eckel RH, et al. Definition and diagnostic criteria of clinical obesity. lancet diabetes endocrine. Published online on January 14, 2025. doi:10.1016/ S2213-8587(24)00316-4
2. The Lancet Diabetes and Endocrinology: The Global Commission proposes a major overhaul of obesity diagnosis that goes beyond BMI to define whether obesity is a disease. News release. Lancet. January 14, 2025. Accessed January 14, 2025. https://www.eurekalert.org/news-releases/1069985