The Lancet Commission on Clinical Obesity has proposed groundbreaking changes to the way obesity is defined and diagnosed, marking a shift from traditional BMI measurements to a more nuanced approach that considers fat distribution and organ function. The report, endorsed by 76 organizations and 58 global experts, introduces two new diagnostic categories: clinical obesity and preclinical obesity, aiming to provide personalized care and reduce stigma.
BMI, while a useful screening tool, is now deemed insufficient for a comprehensive obesity diagnosis. Factors such as waist circumference, waist-to-hip ratio, and direct fat measurement through tools like DEXA scans are recommended for a more accurate assessment of excess body fat. This shift reflects growing evidence that BMI alone does not account for ethnic variations, fat distribution, or individual health risks.
“Relying on BMI alone to diagnose obesity is problematic,” stated Dr. Robert Eckel, a commissioner from the University of Colorado. “Some people store fat in and around organs, which poses a higher risk, while others with high BMI might maintain normal organ function.”
The commission redefines clinical obesity as a chronic disease characterized by symptoms such as organ dysfunction or reduced ability to perform daily activities due to excess body fat. Conversely, preclinical obesity identifies individuals with excess fat but normal organ function, highlighting the risk of future health issues such as diabetes and cardiovascular diseases.
This reframing seeks to ensure timely, evidence-based care for clinical obesity while providing preventive measures for preclinical cases. The recommendations aim to reshape global healthcare strategies, particularly for populations like Asians, who face higher obesity-related health risks at lower BMI levels.
Experts predict the new definitions will improve patient care by helping physicians determine appropriate interventions, from lifestyle changes to medications or surgery. Dr. Francesco Rubino of King’s College London emphasized, “We cannot afford to not treat clinical obesity but (we also) cannot afford overdiagnosis of obesity."
With obesity rates rising globally, 43% of adults overweight and 16% obese as of 2022, this shift comes at a crucial time. India, with 28.6% of its population classified as obese, stands to benefit significantly from these revised diagnostic criteria.
