Experts are calling for a major shift in how obesity is measured

Traditional notions of obesity may be undergoing a radical transformation. In a new report published this week, a widely supported group of scientists is pushing for fundamental changes in how obesity is diagnosed and classified.

The report was conducted by more than 50 obesity experts from around the world, as part of a panel supported by The scalpel. Among other recommendations, the group calls for phasing out BMI as the sole criterion for diagnosing obesity. They also argue that obesity should be classified into two distinct types, depending on how harmful the condition is likely to cause a person.

The specific goal of the committee was to establish objective but precise criteria for diagnosing obesity. Currently, obesity is diagnosed strictly by a person’s BMI, which is calculated using a person’s weight and height. People with a BMI over 30 are considered obese, with severe obesity seen as a BMI above 40 (some parts of the world use lower BMI limits to account for population differences in average population size).

Although BMI is an easily obtained and trackable measurement, it often fails to convey the whole picture, panel experts say — a criticism many other public health experts have faced. Express in the past. Obesity-related harm results primarily from excess body fat, and BMI may sometimes fail to correlate adequately with this. For example, a very fit person could have a high BMI but low body fat, while a person with a so-called “normal” BMI could carry a dangerous amount of body fat. The distribution of excess body fat can also vary from person to person, as can the health risks associated with that fat. For example, excess fat around a person’s waist or around vital internal organs such as the liver and heart is more dangerous than excess body fat in the skin under our arms or legs.

Experts are not calling for doctors to completely abandon BMI as a tool for diagnosing obesity, but rather it should be used alongside other body measurements. These include measuring people’s waist circumference, waist-to-hip ratio, or waist-to-height ratio. Researchers say medical professionals should use at least two measurements of body size to diagnose people with suspected obesity, and another measurement in addition to BMI. Alternatively, doctors may instead collect a direct measurement of a person’s body fat, such as performing a bone density test, known as a DEXA scan. They added that it can still be assumed that people with a very high BMI (over 40) have excess body fat.

“If implemented, people with obesity (BMI near, at or above obesity) should have at least one additional measure of body size (eg waist circumference in most cases or DEXA if available) to confirm detection.” “One confirms that the person is actually obese, and that it is not just, say, a person Muscle with a high mass index.

Rubino and his committee also recommend that doctors classify obesity into two broad categories: preclinical obesity and clinical obesity. Experts note that high body fat alone may not negatively impact your health, so they created a list of criteria (18 for adults, 13 for children) to determine when someone’s obesity is likely to cause other physical problems. For example, a person with obstructive sleep apnea, severe knee pain, or poor cardiovascular health suspected to be linked to excess body fat would be classified as having clinical obesity, while someone who is obese but not obese would be classified as having clinical obesity. There are signs of abnormal organ function that he is obese. The presence of preclinical obesity.

“Reframing the clinical impact of obesity is warranted, to explain how obesity can be both a risk factor for other diseases and a direct cause of disease. The definition of clinical obesity therefore addresses a gap in the characterization of obesity as a direct cause of ill health, and can be an effective way to address widespread misconceptions and biases.” Widespread and that mislead decision-making among patients, health care professionals and policy makers, the authors wrote in their report, published Tuesday in Lancet Diabetes and Endocrinology.

People with preclinical obesity may still be at higher risk for future health problems, but this distinction allows for more personalized obesity care, Rubino says. While people with clinical obesity should be treated immediately with effective treatments to reduce their weight, which can include: Newer medicines such as semaglutide (the active ingredient in Ozempic and Wegovy) or bariatric surgery, doctors can use a less invasive approach with someone with preclinical obesity, depending on their risk level.

“These strategies may be as simple as suggesting monitoring over time and lifestyle changes aimed at possible weight loss for people whose risk is low (even modest weight loss can go a long way in preventing obesity-related diseases), or include more active forms of exercise.” Obesity.” “The risks should be evaluated as particularly high (due to factors other than obesity itself, such as family history, excess abdominal fat, other conditions, and excess weight, especially a combination of the above),” Rubino said.

The group’s recommendations are ultimately just that. But their conclusions are widely endorsed by health-related organizations around the world – 76 in total, including the American Heart Association in the US, the Royal College of Physicians in the UK, and the World Obesity Federation. There are still important big questions to be answered about the nature of obesity, such as the exact prevalence of pre-clinical to clinical obesity (under the current definition of BMI alone, more than a billion people worldwide are thought to be obese). But according to report co-author Robert Eckel, an endocrinologist at the University of Colorado School of Medicine, the new guidelines should go a long way in helping doctors and people with obesity.

“The goal of our work was to improve and personalize patient prognosis, risk versus care,” he told Gizmodo. “We believe this characterization will benefit patients, health care providers, and healthcare providers to follow.”