The way obesity is diagnosed and defined is changing – here's why and what it means for treatment

Obesity is linked to These include many common conditions such as type 2 diabetes, heart disease, fatty liver disease, and knee osteoarthritis.

Obesity is currently defined using a person's body mass index (BMI). this is calculated Weight (kilograms) divided by height (meters) squared. Obesity in people of European descent has a BMI of 30 kg/m2 or higher.

But risks to your health and well-being aren't determined solely by your weight, or BMI. For the past two years, we have been part of a global collaboration discussing how this should change. Today we're sharing our thoughts on how obesity should be defined and why.

As outlined in lancetJust because you're large doesn't mean you're diagnosed as “clinically obese.” Such a diagnosis should depend on the level and location of body fat and whether there are any associated health problems.

WIs hat wrong with BMI?

Disease risk depends on the relative proportions of fat, bone, and muscle that make up a person's body weight, and where the fat is distributed.

For example, athletes with relatively high muscle mass may have a high BMI. Even if an athlete has a BMI greater than 30 kg/m2, their weight gain is due to excess muscle, not excess fat tissue.

People with excess fat tissue around their waists These are the people most at risk for health problems associated with obesity.

Fat stored deep in the abdomen and around internal organs can release harmful molecules into the bloodstream. These are then cause problems Also in other parts of the body.

However, BMI alone does not tell you whether a person has health problems related to excess body fat. People with excess body fat do not always have a BMI above 30. This means that health problems associated with excess body fat have not been studied. This can occur in people who are very tall or who tend to store body fat in their abdomen but are of a “healthy” weight.

On the other hand, people who are not athletes but carry excess fat may have a high BMI but may not have associated health problems.

Therefore, BMI is an imperfect tool to help diagnose obesity.

What is the new definition?

The goal of The Lancet Diabetes and Endocrine Committee on the Definition and Diagnosis of Clinical Obesity The aim was to develop an approach to this definition and diagnosis. The commission, established in 2022 and led by King's College London, brings together 56 experts on aspects of obesity, including many with extensive experience.

of the committee Definitions and new diagnostic criteria Shift your focus away from BMI alone. Incorporate other measurements such as waist circumference to check for excess or unhealthy distribution of body fat.

We define two categories of obesity based on objective signs and symptoms of poor health due to excess body fat.

1. Clinical obesity

People who are clinically obese have signs and symptoms of ongoing organ dysfunction and/or difficulty with activities of daily living (such as bathing, toileting, and dressing).

There are 18 diagnostic criteria for clinical obesity in adults and 13 in children and adolescents. These include:

• Shortness of breath caused by the effects of obesity on the lungs
• obesity-induced heart failure
• blood pressure increased
• fatty liver disease
• A bone or joint abnormality that limits a child's movement.

2. Preclinical obesity

People with preclinical obesity have high levels of body fat but are not causing disease.

People with preclinical obesity have no evidence of obesity-related decline in tissue or organ function and are able to carry out daily activities without difficulty.

However, people with preclinical obesity generally have an increased risk of developing diseases such as heart disease, some cancers, and type 2 diabetes.

What does this mean for obesity treatment?

Clinical obesity is a disease that requires access to effective medical care.

For people with clinical obesity, the focus of medical care should be on improving the health problems caused by obesity. People should be offered evidence-based treatment options after speaking with their health care provider.

process intention include Management of obesity-related complications may include certain obesity treatments aimed at reducing fat mass, such as:

• support for behavioral changes around it Eating, physical activity, sleep, and screen use
• Suppress your appetite, lose weight, improve health Results such as blood sugar level and blood pressure
• metabolic bariatric surgery To treat obesity and reduce weight-related health complications.

Should preclinical obesity be treated?

For people with preclinical obesity, medical care should focus on risk reduction and prevention of obesity-related health problems.

This may require health counseling, including support for health behavior changes and long-term monitoring.

Depending on a person's personal risks, including family history of the disease, body fat levels, and changes over time, one may choose one of the above obesity treatments.

Distinguishing between those who do not have the disease and those who already have it allows for a personalized approach to obesity prevention, management and treatment with better and more cost-effective allocation of resources. .

What happens next?

These new criteria for the diagnosis of clinical obesity should be adopted into national and international clinical practice guidelines and various obesity strategies.

Once introduced, training of health professionals and health service managers, as well as education of the general public, will be critical.

Reframing the obesity narrative may help eradicate misconceptions that lead to stigma, such as making incorrect assumptions about the health status of people with larger bodies. A better understanding of the biology and health implications of obesity should also mean that larger people are not blamed for the condition.

People who are obese or larger should expect personalized, evidence-based assessment and advice, free from bias and stigmatization.

Louise Baur is a professor of child and adolescent health at the University of Sydney.

John B. Dixon is an adjunct professor in the Iverson Institute for Health Innovation at Swinburne University of Technology.

Priya Sumitran is the Head of the Obesity and Metabolic Medicine Group in the Department of Surgery, Faculty of Translational Medicine, Monash University..

Wendy A. Brown is Professor and Chair of the Department of Surgery in the Faculty of Translational Medicine at Monash University Alfred Health..

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