A panel of global experts explains why BMI is not the most helpful measurement of body weight, and how else doctors can diagnose obesity.
- A
global group of experts has suggested a new approach to diagnosing and
treating obesity.
- Instead
of relying only on body mass index (BMI), which has some limitations, the
new framework introduces improved ways to identify and understand obesity,
for example, by separating early signs of obesity (pre-clinical) from more
advanced cases (clinical).
- This
approach seeks not only to improve outcomes for over one billion people
living with obesity worldwide but also to reduce stigma, optimise
healthcare resources and ensure fair access to effective treatments.
Recent research,
published in The Lancet Diabetes & EndocrinologyTrusted Source and
endorsed by over 75 medical organisations worldwide, introduces an innovative
and refined approach to diagnosing obesity.
This method incorporates
additional measures of excess body fat alongside body mass index (BMI), as well
as objective signs and symptoms of individual health issues.
The new framework aims
to improve how obesity is defined and diagnosed.
It also tackles the
problems with traditional methods, which have often made it harder for people
with obesity to get the care and support they need.
A debated
question: What is obesity?
By providing a clear and
evidence-based method to diagnose obesity, the experts also hope to settle the
debate about whether obesity should be considered a disease.
Researchers emphasized that viewing obesity as
either always a disease or never a disease is an overly simplistic approach, as
evidence suggests a more complex reality.
They noted that while
some individuals with obesity maintain normal organ function and overall
health, others experience significant signs and symptoms of illness.
The researchers
cautioned that considering obesity solely as a risk factor, rather than a
disease, may prevent individuals who are unwell due to obesity from accessing
timely care.
On the other hand,
labelling obesity as a disease for everyone could result in overdiagnosis,
unnecessary treatments and high costs for both people and society.
How can we
redefine clinical and preclinical obesity?
The new framework takes
a fresh approach by understanding that obesity is a complex condition and
promoting care that is personalised for each individual.
For people who show
clear signs of obesity, it recommends timely and effective treatments, similar
to how other long-term health conditions are managed.
For people at risk of
obesity but not yet showing active illness (preclinical obesity), the focus
would be on reducing risks and preventing the condition from progressing.
With over 1 billion
people worldwide estimated to be living with obesity, the Commission’s proposal
offers health systems a chance to adopt a universal, clinically meaningful
definition of obesity along with a more precise diagnostic method.
The current ways of
diagnosing obesity are seen as outdated and not very effective. Doctors and
policymakers often disagree on how well these methods work.
That is because these
methods can cause errors, such as incorrectly measuring body fat or
misdiagnosing health issues related to obesity.
A big part of the problem is relying too much on
body mass index (BMI), which is often used to define obesity as a BMI over 30
kilograms per square meter (kg/m²) for people of European descent.
Many countries also
apply specific BMI thresholds to account for ethnic differences in
obesity-related risk.
While BMI can help
identify individuals at higher risk of health problems, the Commission
emphasizes that it is not a direct measure of body fat.
Obesity: Why
using BMI as the sole diagnostic tool doesn’t work
BMI fails to account for
fat distribution and provides no insight into an individual’s overall health or
the presence of illness.
The researchers
highlighted that the health risks associated with excess fat depend on where it
is stored in the body.
Fat accumulation around the waist or within organs
like the liver, heart or muscles poses a greater health risk compared to fat
stored beneath the skin in areas such as the arms or legs.
The experts highlighted
that some people with too much body fat might not have a BMI high enough to be
considered obese, causing their health problems to be missed.
On the flip side, some
people with a high BMI and significant body fat might still have healthy organs
and no signs of illness.
This shows the need for
a better way to diagnose obesity. While BMI can be helpful as a first step, the
experts suggest it’s not enough on its own.
Mir Ali, MD,
board certified general surgeon, bariatric surgeon and medical director of
Memorial Care Surgical Weight Loss Center at Orange Coast Medical Center in
Fountain Valley, CA, not involved in this research, agreed.
Ali told Medical
News Today that this is “a well-written paper” and “addresses the
need to establish better guidelines for the diagnosis and treatment of
obesity.”
“The
implications are: BMI is currently the widely used measure of obesity; however,
it is flawed and sometimes a person who needs treatment for obesity, may not
get the optimal treatment due to BMI criteria alone. Adopting more clinically
relevant criteria for the diagnosis and treatment of obesity will allow for
treatment of a larger group of patients. Unfortunately, changing long standing
parameters will take some time.”– Mir Ali, MD
Accordingly, the
researchers have introduced a new framework for diagnosing obesity,
distinguishing between clinical obesity and preclinical obesity.
How to work
toward tailored therapeutic strategies for obesity
Clinical obesity is a
chronic disease where excess body fat impairs organ function or daily
activities. Researchers identified diagnostic criteria, including
breathlessness, heart failure, joint pain and organ dysfunctions, with separate
measures for adults and children.
Preclinical obesityrefers
to excess body fat without current health issues but with increased risks of
conditions like type 2 diabetes, heart disease, and certain cancers. Early
interventions can mitigate these risks.
This framework, endorsed globally, aims to improve
obesity diagnosis and management, promoting more effective and tailored
healthcare strategies.
Mark A.
Anton, MD, FACS, medical director at Slimz Weightloss, who was also
not involved in this research, found “the exploration of alternative metrics to
BMI for assessing obesity particularly valuable.”
“BMI
has limitations, as it doesn’t account for muscle mass, bone density, or
distribution of fat. The research suggests a more comprehensive approach,
considering factors like metabolic health and body composition, which could
lead to more personalized and effective treatment plans for patients.”– Mark A.
Anton, MD, FACS
For people with clinical
obesity, the Commission experts recommend treatments that focus on improving
how the body works, rather than just trying to reduce weight.
These treatments could
include lifestyle changes, medications, or surgery, depending on what’s best
for the individual.
For individuals with preclinical obesity, care
should prioritize risk reduction through counselling, monitoring or proactive
interventions based on risk levels.
This evidence-based
framework, developed by 56 experts in collaboration with individuals living
with obesity, also addresses the societal impact of obesity and the harmful
effects of weight stigma.
To reduce stigma, the
Commission calls for better training for healthcare professionals and
policymakers, along with a shift in how obesity is understood and discussed.
In conclusion, Anton
highlighted that, “by adopting a broader set of criteria, healthcare providers
can offer more tailored advice and interventions, ultimately improving patient
outcomes and reducing the stigma often associated with obesity.”
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