There is a risk that too many people are diagnosed as obese when a more “accurate” and “nuanced” definition is needed, report of world experts he says.
Doctors should consider the overall health of patients with excess fat, not just their body mass index (BMI) measurement, it says.
Those with chronic diseases caused by their weight should be diagnosed with ‘clinical obesity’ – but those without health problems should be diagnosed with ‘preclinical obesity’.
It is estimated that more than one billion people worldwide live with obesity, and prescription weight loss drugs are in high demand.
The report, published in The Lancet Diabetes & Endocrinology journal, was endorsed by more than 50 medical experts worldwide.
‘Reframing’
“Obesity is a spectrum,” says Professor Francesco Rubino of King’s College London, who chaired the group.
“Some have it and manage to live normally, function normally.
“Others cannot walk or breathe very well, or are confined to wheelchairs with significant health problems.”
The report calls for a “reframing” of obesity to distinguish between patients with a disease and those who remain healthy but are at risk of future disease.
Currently, in many countries, obesity is defined as the existence of obesity BMI over 30 – a measurement that estimates body fat based on height and weight.
Access to weight loss drugs 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 medical condition.
But BMI reveals nothing about a patient’s overall health, the report says, and fails to distinguish between muscle and body fat or explain the more dangerous fat around the waist and organs.
Experts are pushing for a new model that considers the signs of obesity that affect the body’s organs – such as heart disease, shortness of breath, type 2 diabetes or joint pain – and their detrimental impact on everyday life.
This means that obesity has become a clinical disease and requires drug treatment.
However, those with ‘preclinical obesity’ should be offered weight loss advice, counseling and monitoring, rather than drugs and surgery, to reduce the chances of developing health problems. Treatment may also be required.
‘Unnecessary treatment’
“Obesity is a health risk – the difference is that for some it is also a disease,” said prof. Ruby.
The redefinition was sensible, he added, to understand the level of risk in a large population, rather than the current “murky picture of obesity”.
Waist-height ratios or direct body fat measurements, along with a detailed medical history, can give a much clearer picture than BMI, the report said.
Child obesity expert, prof. Louise Baur 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 over-diagnosis and unnecessary treatment.
At a time when drugs that reduce body weight by up to 20% are widely prescribed, the report says this “reshaping” of obesity is “even more relevant” as it “improves the accuracy of diagnosis”.
‘Limited Funding’
The Royal College of Physicians said the report lays a strong foundation “for obesity to be treated with the same medical rigor and compassion as other chronic diseases”.
Differentiating between preclinical and clinical obesity would be an “important step forward” and “highlight the need for early recognition and intervention” while providing appropriate care to patients whose health is already severely affected, the college said.
But there are concerns that pressure on health budgets could mean less money for those in the ‘obese’ category.
Professor Sir Jim Mann, co-director of the Edgar Diabetes and Obesity Research Center in Otago, New Zealand, said the focus was likely to be “on the needs of those defined as clinically obese” and that limited funding was “very strong”. likely” to be directed towards them.
