middle There is a growing buzz around Ozempic and similar weight-loss drugsa group of 58 researchers braving the way obesity It is defined and diagnosed, arguing that current methods fail to capture the complexity of the condition. They provide a more precise approach.
Group Revised definitionpublished in Lancet Diabetes and Endocrinology On January 14, it focuses on how excess body fat, a measure called obesity, affects the body, not the body Relying only on body mass index (BMI)Which links a person’s weight to his height. They suggest two categories: preclinical obesity, when a person has excess body fat but their organs function normally, and clinical obesity, when excess fat damages the body’s organs and tissues.
This shift could improve clinical care, Public health policies And societal attitudes toward obesity, says Elizabeth van Rossum, an endocrinologist at Erasmus University Medical Center in Rotterdam, the Netherlands.
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“The idea now is: Eat less, move more, and you will lose weight,” says Van Rossum, who was not involved in the work. She adds that although a healthy lifestyle is important, “if it were that simple, we wouldn’t have an epidemic, and this paper represents an excellent contribution to the discussion about the complexity of obesity.”
A global problem
More than a billion people worldwide suffer from obesity, and this condition is linked to approximately 5 million deaths each year due to disorders such as Diabetes and Cardiovascular diseases.
Because it is easy to measure and compare, BMI has long been used as a tool for diagnosing obesity. But it doesn’t provide a complete picture of a person’s health, because it doesn’t take into account differences in body composition, such as muscle versus fat.
For people of European descent, obesity is usually defined by a BMI of 30 or higher, which is associated with a high level of body fat. However, a muscular athlete may be labeled obese based on their BMI, while someone with a “normal” BMI may have excess fat that increases their risk of heart problems or other serious health problems, says Francesco Rubino. , an obesity surgeon at King’s College. London, who led the group that proposed the new approach.
He says traditional methods lead to unnecessary treatment for some people while missing others who need help. To address this problem, Rubino and his colleagues propose a system for diagnosing obesity that goes beyond the BMI, and combines it with other methods such as measuring waist circumference, an indicator of obesity, or body scans using low-level X-rays, which can measure obesity. Measure fat mass directly.
Although there is no fixed threshold for obesity, body fat is usually considered excess when it exceeds 25% in men and 30-38% in women. The researchers say that measuring obesity directly may be impractical or expensive, so alternative health markers such as waist size, waist-to-hip ratio, or waist-to-height ratio are important. However, they add, it’s safe to assume that someone with a BMI higher than 40 has a high percentage of body fat.
A diagnosis of obesity should also take into account the results of standard laboratory tests, medical history, and information about daily activities to assess how excess body fat affects a person’s health, says study co-author Robert Eckel, an endocrinologist at the University of Colorado Anschutz Medical Campus. In Aurora. “These are objective diagnostic criteria, and they are standardized across global health systems,” he says.
Personal assessments that take into account age, gender and ethnicity are equally important, because some groups may face health risks at lower BMI thresholds than others, says study co-author Louise Power, a pediatrician at the University of Sydney in Australia.
Two categories
Although people with preclinical obesity have normally functioning tissues, they are more likely to develop health problems than people who are not obese. The group says they can benefit from counseling and preventive measures such as lifestyle changes to reduce the risk of developing more serious health problems.
Clinical obesity occurs when excess fat harms organs or seriously limits daily activities such as walking or dressing. People with clinical obesity may need treatments aimed at improving health and preventing complications.
Rubino points out that this approach is especially important with the increasing use of weight-loss medications, because it helps provide a more accurate diagnosis and makes treatment effective and cost-effective.
Challenging stigma
This approach, which has been supported by dozens of scientific and patient advocacy groups around the world, reflects growing evidence of the effects of obesity on health, says Van Rossum. Another framework, published last year, also recognized that the diagnosis of obesity should go beyond BMI to include an assessment of its effects on health.
However, many health care providers still view obesity as a willpower issue rather than a disease caused by excess fat, regardless of its underlying causes, which may include hormonal changes and genetic factors, van Rossum says. In the Netherlands, for example, a study I co-authored found that most people with obesity experience stigma in the health care setting. This stigma often prevents people from seeking care, highlighting the need for better education and communication about this condition.
Although the latter approach aims to give a more accurate picture of obesity, it is unclear whether it will lead to more or fewer diagnoses, or how it will impact management of the condition in the clinic. “Over time, we hope that this type of assessment will be included in clinical practice guidelines,” Burr says.
This article has been reproduced with permission First published On January 14, 2025.