A global report warns that many people may be wrongly diagnosed as obese due to the lack of a more accurate and nuanced definition. Experts believe that doctors should assess a patient’s overall health, rather than relying solely on body mass index (BMI).
The report suggests that those with weight-related chronic illnesses should be labeled with “clinical obesity,” while individuals without health issues should be classified as having “pre-clinical obesity.” This distinction would help identify those at risk of future health problems.
Over a billion people worldwide are living with obesity, and the demand for prescription weight-loss medications is rising. Published in The Lancet Diabetes & Endocrinology journal, the report has the support of more than 50 medical professionals from around the globe.
“Obesity is a spectrum,” said Prof. Francesco Rubino from King’s College London, who chaired the group of experts. “Some people live normal lives despite their obesity, while others face severe health issues, such as difficulty walking or breathing.”
The report calls for a “reframing” of obesity to better differentiate between patients with the disease and those who are simply at risk. Currently, many countries define obesity as a BMI over 30, a measure of body fat based on height and weight. However, BMI does not account for overall health, body fat distribution, or the dangerous fat around the organs.
The experts propose a new model that focuses on the impact of obesity on the body’s organs, such as heart disease, diabetes, breathlessness, or joint pain, and the negative effects on daily life. This approach would allow for better treatment options, including prescription medications for those with “clinical obesity.”
For those with “pre-clinical obesity,” the report recommends offering weight-loss guidance, counseling, and monitoring to prevent future health problems, rather than jumping to drugs or surgery.
Prof. Rubino emphasized that while obesity is a health risk, it is a disease for some individuals. He added that redefining obesity would provide a clearer understanding of risks in the population, instead of the current vague classification.
Waist-to-height ratios, fat measurements, and a detailed medical history could offer a more accurate diagnosis than BMI, according to the report.
Prof. Louise Baur, an obesity expert from the University of Sydney, noted that the new approach would ensure better care for both adults and children with obesity. It would also help reduce the number of people being over-diagnosed and given unnecessary treatments.
The report is particularly relevant as drugs that can reduce body weight by up to 20% are being prescribed more widely. “Reframing” obesity would improve diagnosis accuracy and ensure proper treatment.
The Royal College of Physicians supports the report, calling it a strong step toward treating obesity with the same medical rigor as other chronic conditions. The report highlights the importance of distinguishing between pre-clinical and clinical obesity, which would allow for early intervention and appropriate care for those with severe health complications.
However, there are concerns that the pressure on health budgets could lead to reduced funding for individuals in the “pre-obese” category. Prof. Sir Jim Mann, co-director of the Edgar Diabetes and Obesity Research Centre in New Zealand, expressed worries that resources would likely be directed toward those classified as clinically obese, leaving fewer resources for others.
