Global report urges a more precise definition of obesity than BMI

There is a risk that too many people will be diagnosed as obese when a 'more precise' and 'accurate' definition is needed. A report from global experts He says.

Doctors should take into account the overall health of patients with excess fat, rather than simply measuring their body mass index (BMI).

Those with chronic diseases caused by their weight should be diagnosed as “clinical obesity” – but those without health problems should be diagnosed as “preclinical obesity.”

It is estimated that more than one billion people suffer from obesity worldwide, and the demand for prescription weight-loss medications is increasing.

The report, published in The Lancet Diabetes and Endocrinology journal, is supported by more than 50 medical experts around the world.

“Obesity is a spectrum,” says Professor Francesco Rubino, from King's College London, who led the group.

“Some have it and are able to live a normal life, function normally.

“There are others who cannot walk well or breathe well, or are confined to wheelchairs due to major health problems.”

The report calls for a “reframe” of obesity to distinguish between patients who have a disease and those who remain healthy, but are at risk of developing the disease in the future.

Currently, in many countries, obesity is defined as Body mass index greater than 30 – A measurement that estimates body fat percentage based on height and weight.

Access to weight loss medications such as Wegovy and Mounjaro is often limited to patients in this category.

In many parts of the UK, the NHS also requires people to have a weight-related health condition.

But the BMI reveals nothing about a patient's overall health, the report says, and fails to distinguish between muscle and body fat or account for the more dangerous fat around the waist and organs.

Experts are calling for a new model that looks at the signs of obesity that affect the body's organs – such as heart disease, shortness of breath, type 2 diabetes, or joint pain – and its devastating impact on daily life.

This indicates that obesity has become a clinical disease and requires drug treatment.

However, those with “preclinical obesity” should be offered weight loss counselling, counseling and monitoring, rather than medication and surgery, to reduce the chances of developing health problems. Treatment may also be necessary.

Professor Rubino said: “Obesity is a health risk – the difference is that for some it is a disease.”

He added that redefining it makes sense to understand the level of risk in a large population, rather than the “current blurry picture of obesity.”

The report says that waist-to-height ratios or direct measurements of fat, along with a detailed medical history, can give a much clearer picture than BMI.

Childhood obesity expert Professor Louise Burr, from the University of Sydney, who contributed to the report, said the new approach would allow adults and children with obesity “to receive more appropriate care”, while reducing the numbers being over-diagnosed and given unnecessary treatment. .

While drugs that reduce body weight by up to 20% are widely prescribed, the report says “reframing” obesity “is even more important” because it “improves diagnostic accuracy.”

The Royal College of Physicians said the report laid a strong foundation for “treating obesity with the same medical precision and compassion as other chronic diseases”.

The college said distinguishing between preclinical and clinical obesity would be a “vital step forward” and “highlights the need for early identification and intervention” while providing appropriate care to patients whose health has already been severely affected.

But there are concerns that the squeeze on health budgets could mean less money for those in the 'pre-obese' category.

Professor Sir Jim Mann, co-director of the Edgar Center for Diabetes and Obesity Research, in Otago, New Zealand, said the focus was likely to be “on the needs of those who are defined as clinically obese” and that limited funding was “extremely severe”. It is likely directed at them.