Doctors urge people to diagnose obesity based on health risks rather than BMI

An international panel of experts is calling on doctors to move away from relying on BMI to diagnose obesity and take a more individualized approach to a person's actual health risks.

The Lancet committee concluded that a “fundamental overhaul” of body fat measurements is needed to avoid underdiagnosis and overdiagnosis of obesity.

The researchers added that current guidelines, which rely heavily on BMI, could prevent people from receiving the evidence-based treatments they could benefit from.

A panel of 50 experts led by British clinicians also called for two new diagnostic categories for obesity.

Clinical obesity should be defined as a “chronic systematic disease” in which excess fat can cause organ damage and lead to “life-altering and potentially life-threatening complications.”

People with clinical obesity may have shortness of breath, joint pain, and other metabolic and metabolic disorders.

In contrast, they suggested that preclinical obesity is a state of obesity with normal organ function.

Affected people have a variable but generally increased risk of developing conditions such as type 2 diabetes, cardiovascular disease, and certain types of cancer in the future.

Committees published in Lancet Diabetes and Endocrinology We recommended several options other than BMI to measure excess fat mass and its distribution throughout the body.

This will look like this:

• BMI plus at least one measurement of body size (waist circumference, waist-to-hip ratio, or waist-to-height ratio)
• At least two measurements of body size (waist circumference, waist-to-hip ratio, or waist-to-height ratio), regardless of BMI
• Direct body fat measurement via scan regardless of BMI

However, in people with a very high BMI, for example over 40 kg/m,²excess body fat can be practically expected, the committee said.

Chair of the committee, Professor Francesco Rubino, Head of Metabolic and Bariatric Surgery at King's College London, said: 'The question of whether obesity is a disease is flawed, because obesity is always a disease, or obesity is always a disease. This is because it assumes an impossible all-or-nothing scenario in which either one or the other is the case.” It's not a disease.

But the evidence points to a more nuanced reality. Some people with obesity are able to maintain normal organ function and overall health even over long periods of time, while others show signs and symptoms of serious illness in the here and now. Masu. ”

He added: “Considering obesity only as a risk factor and never as a disease can unfairly deny access to time-limited care to people whose health is in poor health due solely to obesity.” he added.

“On the other hand, a blanket definition of obesity as a disease can lead to overdiagnosis and unwarranted medication and surgical procedures, which can harm individuals and result in huge costs to society. .”

NICE recommends that GPs measure the waist-to-height ratio of people with a BMI of less than 35kg/m2 However, referral to specialist services and access to treatment on the NHS is based on a BMI cut-off that takes into account other comorbidities to some extent.

NHS is Weight loss drugs are slow to roll out This is because the number of people covered has a “significant impact” on general practitioners.

The Royal College of Physicians supported the approach set out by the committee.

Dr Kath McCullough, RCP's Special Adviser on Obesity, said: 'For too long we have relied on BMI as a simple measure of obesity, which often misrepresents obesity status and “It does not fully reflect how body fat affects a person's health.”

“The committee's distinction between preclinical and clinical obesity is an important step forward and highlights the need for early identification and intervention, while providing appropriate care to those already experiencing serious health effects. I am doing it.”