Rethinking Obesity: Global Experts Call for New Definitions

Researchers advocate for a clearer distinction between 'clinical obesity' and 'pre-clinical obesity' to improve health outcomes.

A landmark report published in The Lancet Diabetes & Endocrinology journal emphasizes the need for a refined definition of obesity as the global epidemic continues to affect more than a billion individuals. Experts believe that current diagnostic standards, primarily reliant on Body Mass Index (BMI) measurements, can lead to misdiagnosis and inappropriate treatment for many individuals. They argue that a more nuanced approach should prioritize overall health and well-being over mere weight metrics.

The report suggests that patients with chronic weight-related illnesses should be classified as having "clinical obesity," while those without health problems might be better categorized as having "pre-clinical obesity." In cases of clinical obesity, medical interventions, including prescription weight-loss medications, may be warranted. However, for individuals diagnosed with pre-clinical obesity, the report recommends lifestyle modifications, counseling, and careful health monitoring instead of immediate drug treatments.

Prof. Francesco Rubino, who led the research, remarked, "Obesity is a spectrum; some people can manage a normal life without significant health issues, while others may struggle with severe medical complications." The proposed reframing aims to draw necessary distinctions in patient care and treatment options, particularly in environments such as the NHS where access to weight-loss drugs is frequently limited to individuals with a BMI over 30.

Current practices focus heavily on BMI, a metric that does not differentiate between muscle and fat or account for visceral fat, which carries higher health risks. The panel of experts advocates for alternative measurement methods, such as waist-height ratios and comprehensive medical histories, to provide a more thorough assessment of an individual's health.

While the Royal College of Physicians supports the report's findings, noting that it could lead to more compassionate and medically rigorous treatment of obesity, concerns over funding limitations arise. Prof. Jim Mann of Otago, New Zealand, pointed out that health budget constraints could lead to prioritization of resources for patients categorized as clinically obese, overlooking the needs of those deemed pre-clinically obese.

As weight-loss drugs like Wegovy and Mounjaro gain popularity, the timely call to "reframe" obesity through clearer diagnostic criteria aims to create more accurate health interventions and ultimately, improved health outcomes.