New Delhi: A global group of medical experts has raised concerns about the current approach to diagnosing obesity, suggesting that too many people are being categorised as obese without a nuanced understanding of the condition.
The experts, who support a new framework for defining obesity, argue that a more comprehensive evaluation of health is necessary, beyond the widely used body mass index (BMI).
The report, published in The Lancet Diabetes & Endocrinology journal, calls for a shift in how obesity is diagnosed and treated.
The authors, including over 50 experts from around the world, argue that doctors should focus on the overall health of patients, rather than relying solely on BMI, which estimates body fat based on height and weight.
According to the report, while BMI remains a common measure, it fails to account for key factors like muscle mass or the more harmful fat that accumulates around the waist and internal organs.
Why obesity needs ‘reframing’
Prof Francesco Rubino, chair of the expert group and a professor at King’s College London, told BBC news that obesity should be understood as a spectrum. “Obesity is a spectrum,” he explained. “Some have it and manage to live a normal life, function normally. Others can’t walk well or breathe well, or are wheelchair bound with significant health issues.”
He called for a “reframing” of obesity to distinguish between those with the disease, who require medical treatment, and those at risk of developing obesity-related health problems in the future.
The report advocates for a two-tier classification: “clinical obesity” for individuals whose excess weight has caused significant health issues, and “pre-clinical obesity” for those whose weight may pose a future risk but who are currently healthy.
This distinction is crucial as the demand for prescription weight-loss drugs, such as Wegovy and Mounjaro, has surged, with many of these drugs being restricted to patients with a BMI over 30 or those suffering from weight-related health conditions. However, BMI alone does not adequately capture the risk factors associated with obesity or provide a full picture of a person’s health, the experts argue.
Rather than relying on BMI as a sole indicator, the report suggests that other methods, such as waist-height ratios, direct fat measurement, and a detailed medical history, would offer a more accurate diagnosis. This approach would help identify those in need of medical intervention and prevent the over-diagnosis of obesity, especially in children and adults who may not yet have developed health complications.
A bid to avoid unnecessary treatment
Prof Louise Baur, a children’s obesity expert at the University of Sydney, who contributed to the report, stated that this revised approach would allow both adults and children with obesity to receive “more appropriate care.” This would help to reduce the number of individuals diagnosed unnecessarily and receiving treatments that might not be needed. “We want to avoid unnecessary treatment,” Prof Baur noted.
In a time when weight-loss drugs are being prescribed to large numbers of patients—some of whom lose up to 20% of their body weight—the need for an accurate diagnosis has become even more pressing. According to the report, the redefined approach to obesity “is all the more relevant” as it improves diagnostic accuracy, ultimately ensuring that patients receive appropriate treatments based on their actual health risks.
The Royal College of Physicians has endorsed the report’s recommendations, stating that it provides a solid foundation for treating obesity with the same medical care and compassion as other chronic illnesses. “Distinguishing between pre-clinical and clinical obesity would be a vital step forward,” said the college, adding that the framework emphasizes the need for early identification and intervention while ensuring proper care for patients whose health has already been severely impacted by obesity.
However, there are concerns about the financial implications of the new classification, particularly regarding limited healthcare resources.
Prof Sir Jim Mann, co-director of the Edgar Diabetes and Obesity Research Centre in Otago, New Zealand, warned that the focus may shift toward treating those classified as clinically obese, potentially leaving patients with pre-clinical obesity without adequate support.
“The limited funding is very likely to be directed towards those defined as clinically obese,” he said.
