Doctors are proposing a “radical overhaul” of the way obesity is diagnosed worldwide, amid concerns that reliance on body mass index could lead to millions of people being misdiagnosed.
More than 1 billion people are believed to suffer from the condition, which has been diagnosed for decades by measuring a person’s BMI (the ratio of height to weight) to estimate the amount of excess body fat.
However, there are concerns that BMI in itself is not a “reliable measure” of an individual’s health and could result in both under- and over-diagnosis of obesity, with “negative consequences” for those affected and wider society.
Dozens of the world’s leading 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 the condition that is wreaking havoc and cost dearly on every continent. countries billions.
Relying solely on BMI is “ineffective” because it is not a direct measure of fat, does not reflect fat distribution across the body and does not provide information about a person’s health, a report says published by experts in the journal Lancet Diabetes and Endocrinology.
The proposed shake-up, endorsed by more than 75 medical organizations around the world, puts forward new ways to diagnose obesity based on other measurements of excess body fat besides BMI, such as waist-to-hip ratio or waist-to-hip ratio. height ratio, as well as objective signs and symptoms of ill 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, others with a high BMI may be diagnosed with obesity despite maintaining normal organ and body functions, without signs or symptoms of ongoing disease.
Prof Francesco Rubino, chairman of the Lancet committee that authored the report, said the changes would provide healthcare systems worldwide the opportunity to adopt a universal, clinically relevant definition of obesity and a more accurate method for its diagnosis.
He said: “The question of whether obesity is a disease is flawed because it assumes an unlikely all-or-nothing scenario in which obesity is either always a disease or never a disease. However, evidence shows a more nuanced reality. Some people with obesity are able to maintain the normal functioning of their organs and their overall health, even in the long term, while others show signs and symptoms of serious illness here and now.
“Considering obesity only as a risk factor, and never as a disease, can unfairly deny access to time-sensitive care to people who experience poor health due to obesity alone. On the other hand, a blanket definition of obesity as a disease can result in overdiagnosis and unwarranted use of medications and surgical interventions, with potential harm to the individual and staggering costs to society.”
The experts recommended two new categories of obesity: clinical obesity and preclinical obesity.
Clinical obesity would be defined as obesity accompanied by objective signs and/or symptoms of impaired organ function, or a significantly reduced ability to perform standard daily activities, such as bathing, dressing, or eating, as a direct result of excess body fat. Patients with clinical obesity should be considered as patients with a chronic disease and should receive appropriate treatment and treatments, such as weight loss medications, the experts said.
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Preclinical obesity would be defined as obesity with normal organ function. People with preclinical obesity therefore do not have persistent disease, although they have a 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 possible diseases, the experts said.
“Our reformulation 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 Advisor on Obesity, said: “For too long we have relied on BMI as a simple measure of obesity, which often misrepresents and does not fully reflect how excess body fat affects a person’s health .
“The committee’s distinction between preclinical and clinical obesity represents a crucial 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 obesity, “rather than focusing solely on how it is measured”.