News: New Commission redefines obesity diagnosis, less emphasis on BMI

Last week, The Lancet Commission on Obesity published in The Lancet Diabetes & Endocrinology has redefined obesity by classifying it as either “clinical obesity,” a disease, or “preclinical,” a health risk factor, and determining the classification using factors beyond body mass index (BMI). The report was endorsed by more than 75 medical organizations, and provides guidance on management for the two obesity conditions that emphasizes a personalized and stigma-free approach, Medscape Medical News reported.

The Lancet Commission was made up of 56 experts in relevant fields including endocrinology, surgery, nutrition, and public health, along with people living with obesity. In the report, authors call for obesity to be diagnosed through confirmation of excess adiposity, which can be measured through things such as waist circumference or waist-to-hip ratio in addition to BMI. To determine between the disease “clinical obesity” and “preclinical obesity,” a clinical assessment should be made of signs and symptoms of organ dysfunction due to obesity and/or functional limitations.

“We propose a radical overhaul of the actual diagnosis of obesity to improve global healthcare and practices and policies,” said Professor Louise Baur, chair of Child & Adolescent Health at the University of Sydney, Sydney, Australia, during a UK Science Media Centre (SMC) news briefing. “The specific aims were to facilitate individualized assessment and care of people living with obesity while preserving resources by reducing overdiagnosis and unnecessary or inadequate interventions.”

The new definitions aim to overcome limitations posed by many in the field over the current BMI-based definition of obesity (greater than 30 for people of European descent, with other cutoffs for specific ethnic groups), as BMI doesn’t reflect a person’s fat versus lean mass, fat distribution, or overall health on its own. The document also seeks to settle the debate about whether obesity is a “disease.”

Editor’s note: To read Medscape Medical News’ coverage this story, click here. To read the Lancet Commission, click here.