The latest global report highlights the need for a refined definition of obesity, suggesting that reliance solely on Body Mass Index (BMI) is inadequate in evaluating an individual's health. According to a panel of over 50 international experts, not every person with excess body fat is necessarily unhealthy—many can lead active lives despite having a higher BMI.
Central to the report, published in The Lancet Diabetes & Endocrinology, is the proposal to categorize obesity into two distinct types: "clinical obesity," designated for those suffering from chronic illnesses due to their weight, and "pre-clinical obesity," for those without health problems. This classification aims to prevent unnecessary labels and treatments while promoting appropriate health management.
Professor Francesco Rubino from King's College London, who led the committee, asserts that "obesity is a spectrum." He emphasizes the diverse lifestyles of individuals with obesity, highlighting that some may experience significant health challenges while others may thrive.
Current global standards consider a person obese if their BMI exceeds 30, a metric that does not account for overall health, muscle-to-fat ratios, or fat distribution. The report underscores the limitations of BMI, as it can overlook critical factors such as visceral fat surrounding organs, which poses higher health risks.
The panel advocates for a model that evaluates how obesity is impacting organ health—looking at issues like heart disease, breathlessness, and diabetes—to guide treatment decisions more effectively. For those categorized under pre-clinical obesity, the focus should be on preventive measures like counseling and lifestyle changes, rather than expensive medications.
While the report is welcomed for its innovative approach to obesity management, concerns linger about how health budgets will allocate funds between clinical and pre-clinical cases. Pressure on health systems may lead to prioritization of those with severe obesity, overshadowing the needs of individuals who could benefit from early intervention.
The Royal College of Physicians supports the report, calling it an important step towards viewing obesity as a chronic disease deserving of thoughtful medical attention. The proposed framework not only aims to provide better care for patients but also seeks to alleviate the burden of misdiagnosis and inappropriate treatments amid the rising demand for weight-loss medications.
