Call to revise obesity diagnoses amid fears of over-reliance on BMI | Obesity

Doctors are proposing a “radical overhaul” of how obesity is diagnosed around the world, amid fears that reliance on body mass index could lead to millions of people being misdiagnosed.

More than a billion people are estimated to live with the condition, which has been diagnosed for decades by measuring a person’s BMI (height-to-weight ratio) to estimate the amount of excess body fat.

However, there is concern that BMI itself is not a “reliable measure” of an individual’s health and may lead to both underdiagnosis and overdiagnosis of obesity, with “consequences negative” for those affected and society as a whole.

Dozens of leading global experts in a wide range of medical specialties – including endocrinology, internal medicine, surgery, biology, nutrition and public health – are now calling for a “reframing” of this disease that causes major damage on all continents and is expensive. billion countries.

Relying on BMI alone is “ineffective” because it is not a direct measure of fat, does not reflect the distribution of fat in the body, and does not provide information about one’s health. a person, according to a report published by experts in the Lancet Diabetes and Revue d’endocrinologie.

The proposed overhaul, endorsed by more than 75 medical organizations around the world, offers new ways to diagnose obesity based on other measures of excess body fat besides BMI, such as the ratio waist/hip or waist/waist. height ratio, as well as objective signs and symptoms of poor health.

Currently, some people with excess body fat do not have a BMI that indicates they are living with obesity, meaning potentially serious health problems go unnoticed and untreated. At the same time, other people with a high BMI may be diagnosed with obesity despite maintaining normal organ and body functions, without any signs or symptoms of ongoing disease.

Professor Francesco Rubino, chair of the Lancet commission which produced the report, said the changes would provide an opportunity for health systems around the world to adopt a universal, clinically relevant definition of obesity and a more precise method. for his diagnosis.

He said: “The question of whether obesity is a disease is flawed because it assumes an implausible all-or-nothing scenario in which obesity is either always a disease or never a disease. The facts, however, reveal a more nuanced reality. Some obese people can maintain normal organ function and overall health, even over the long term, while others experience here and now signs and symptoms of serious illness.

“Viewing obesity only as a risk factor, and never as a disease, may unfairly deny access to urgent care to people whose health is poor due to obesity alone. On the other hand, a blanket definition of obesity as a disease can lead to overdiagnosis and unwarranted use of medications and surgical interventions, with potential risks to the individual and enormous costs to society.

Experts have recommended two new categories of obesity: clinical obesity and preclinical obesity.

Clinical obesity would be defined as obesity associated with objective signs and/or symptoms of reduced organ function, or significantly reduced ability to carry out standard daily activities such as bathing, dressing or eating, in direct consequence of excess body fat. Patients with clinical obesity should be considered to have an ongoing chronic illness and receive appropriate management and treatment, such as weight-loss medications, experts said.

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Preclinical obesity would be defined as obesity with normal organ function. People living with preclinical obesity therefore do not suffer from ongoing disease, although they are at variable but generally increased risk of developing clinical obesity and other diseases in the future, including type 2 diabetes, cardiovascular disease, certain types of cancer and mental illness. People in this category should be supported to reduce the risk of potential illness, experts said.

“Our reframing recognizes the nuanced reality of obesity and enables personalized care,” said Rubino, chair of metabolic and bariatric surgery at King’s College London.

The Royal College of Physicians welcomed the report. Dr Kath McCullough, Special Adviser on Obesity, said: “For too long we have relied on BMI as a simple measure of obesity, which has often misrepresented the disease and does not reflect not fully understand the impact of excess body fat on a person’s health.

“The commission’s distinction between preclinical and clinical obesity represents a critical step forward, highlighting the need for early identification and intervention while providing appropriate care to those already experiencing serious health consequences. »

However, Katharine Jenner, director of the Obesity Health Alliance, said the priority should be supporting people living with excess weight, “rather than just focusing on how it is measured”.