A global commission endorsed by over 75 medical organisations worldwide has proposed revamping the diagnosis of obesity to make it more effective and appropriate.
The new definition proposes several measures of excess body fat, rather than solely relying on body mass index (BMI), as well as objective signs and symptoms of ill health at the individual level.
The experts hope that the new definition, published in The Lancet Diabetes & Endocrinology, will provide a more nuanced approach to treating obesity, aid clinical practice, and lead to improved healthcare policies. It is suggested it would also offer a universal, medically coherent framework for diagnosis.
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The commission chair, Professor Francesco Rubino from King’s College London, explained that the work aims to settle the ongoing dispute over obesity as a disease.
‘The question of whether obesity is a disease is flawed because it presumes an implausible all-or-nothing scenario where obesity is either always a disease or never a disease. Evidence, however, shows a more nuanced reality.’
Obesity can affect individuals in a wide variety of ways, with some individuals maintaining normal organ function and overall health, while others have severe illness as a result of being overweight, the commission described.
The new proposals suggest diagnosing obesity in one of three ways:
- At least one measurement of body size (waist circumference, waist-to-hip ratio or waist-to-height ratio) in addition to BMI
- At least two measurements of body size (waist circumference, waist-to-hip ratio or waist-to-height ratio) regardless of BMI
- Direct body fat measurement (such as by a bone densitometry scan or DEXA) regardless of BMI.
The experts also suggest recognising two categories of obesity: clinical and pre-clinical. Clinical obesity is associated with objective signs and/or symptoms of reduced organ function or significantly reduced ability to conduct standard day-to-day activities, such as bathing, dressing, eating, and continence, due to excess body fat.
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The report outlined 18 diagnostic criteria for clinical obesity in adults and 13 specific criteria for children and adolescents. These include symptoms such as breathlessness, heart failure, and joint pain caused by fat around the major organs and joints. The experts advise treating and managing clinical obesity as an ongoing chronic disease.
Pre-clinical obesity is defined as obesity where organ function is not impaired, and patients do not live with ongoing illness but are at risk of future health deterioration both physically and mentally.
Professor Rubino commented: ‘Considering obesity only as a risk factor, and never a disease, can unfairly deny access to time-sensitive care among people who are experiencing ill health due to obesity alone. On the other hand, a blanket definition of obesity as a disease can result in overdiagnosis and unwarranted use of medications and surgical procedures, with potential harm to the individual and staggering costs for society.’
The authors said that the new diagnostic criteria would ensure that people living with obesity received appropriate health care specific to their diagnosis, including regaining or improving body function in clinically obese patients through lifestyle changes, medication, and/or surgery, depending on an individual’s needs. For patients with pre-clinical obesity, strategies would focus on risk management instead of ongoing management of health conditions.
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Commissioner Dr Gauden Galea, WHO Regional Office for Europe, added: ‘The Commission’s new diagnostic criteria fill a gap in the notion of obesity diagnoses as they enable clinicians to differentiate between health and illness at the individual level. We hope that the broad endorsement of the new framework and diagnosis of obesity by many important scientific societies from around the world will ensure that a systematic clinical assessment of obesity becomes a requirement in health systems globally.’
