Obesity label is medically flawed
A report from global medical experts suggests that calling people “obese” is medically flawed, recommending that the definition of obesity be split into two distinct categories. The term “clinical obesity” should describe patients whose weight has led to a medical condition, while “pre-clinically obese” should apply to individuals who remain overweight but are still fit, though at risk of future health issues.
This proposed redefinition moves away from relying solely on body mass index (BMI) to determine obesity. BMI is a measure that relates weight to height and categorizes individuals as underweight, normal weight, overweight, or obese. However, the report argues that BMI is an incomplete metric, as it doesn’t account for muscle mass, fat distribution, or individual health factors.
The report, published in The Lancet Diabetes & Endocrinology journal, is endorsed by more than 50 medical experts worldwide. Professor Francesco Rubino of King’s College London, who chaired the expert group, emphasized that obesity should be viewed as a spectrum. “Some individuals with obesity can maintain normal organ function and overall health, even long term, whereas others display signs and symptoms of severe illness,” Rubino stated.
Current definitions, which broadly categorize anyone with a BMI over 30 as obese, often lead to over-diagnosis and inappropriate treatment. This blanket classification, the report says, prevents many from receiving care tailored to their specific health needs.
The report’s distinction between “clinical obesity” and “pre-clinically obese” aims to improve patient care. Clinical obesity refers to cases where the individual’s weight has led to tangible health issues like heart disease, diabetes, or joint pain, requiring intervention through medication or surgery. Pre-clinically obese individuals, while at risk of these conditions, have not yet developed them and should be advised on lifestyle changes and monitored closely to prevent disease onset.
Natalie from Crewe, who maintains a healthy lifestyle yet is classified as obese by her BMI, shared her experience. “I go to the gym four times a week, eat healthily, and my doctor says I’m fit and healthy despite my BMI indicating otherwise,” she said in a BBC interview. This scenario highlights BMI’s limitations in reflecting actual health status.
Richard from Falmouth also criticized BMI’s inadequacy. Despite a low body fat percentage of 4.9%, his muscle mass elevated his BMI to a level classified as borderline obese. “BMI doesn’t distinguish between muscle and fat, which is why it’s not always accurate,” he noted.
Contrastingly, Mike argued that diet is crucial for maintaining a healthy weight and dismissed new weight-loss drugs as unnecessary. “If you want to lose weight, stop eating. It’s simple,” he said.
BMI, calculated by dividing an individual’s weight in kilograms by the square of their height in meters, serves as a quick screening tool but fails to provide a comprehensive health assessment. The report suggests using additional measurements like waist circumference and body fat percentage alongside a detailed medical history for a more accurate health evaluation.
Professor Rubino underscored that while obesity poses health risks, it’s a disease only for some individuals. Differentiating between clinical and pre-clinical obesity would enable more precise diagnosis and treatment, especially as demand for weight-loss drugs like Wegovy and Mounjaro surges.
Currently, access to these medications is often limited to individuals with a BMI over 30 and a related health condition. The report advocates for redefining obesity to ensure only those who need medical intervention receive it, reducing unnecessary treatments for others.
Professor Louise Baur from the University of Sydney, who contributed to the report, highlighted that this nuanced approach could lead to more appropriate care for both adults and children with obesity while preventing over-diagnosis. The Royal College of Physicians praised the report for setting a foundation to treat obesity with the same rigor and compassion as other chronic illnesses.
However, some express concern that reclassifying obesity could strain health budgets, potentially limiting resources for individuals in the pre-obesity category. The report suggests that redefining obesity will allow for a more targeted approach, potentially reducing overall healthcare costs by focusing resources on those most in need.
