A team of international experts is suggesting a new approach to define and diagnose obesity, shifting the focus away from the controversial body mass index (BMI) in hopes of better pinpointing individuals in need of treatment for health issues related to excess body fat.
According to the recommendations unveiled on Tuesday, the definition of obesity would no longer rely solely on BMI calculations but would integrate other measurements like waist circumference, along with indications of health problems linked to being overweight.
It is estimated that obesity affects over 1 billion individuals globally, with about 40% of adults in the U.S. being classified as obese, as per the U.S. Centers for Disease Control and Prevention.
Dr. David Cummings, an obesity specialist at the University of Washington and a co-author of the report published in The Lancet Diabetes & Endocrinology journal, emphasized the aim of achieving a more precise definition to target those most in need of assistance.
The report introduces two new diagnostic categories: clinical obesity and pre-clinical obesity.
Clinical obesity encompasses individuals meeting criteria for obesity based on BMI and other factors, with evidence of health issues stemming from excess weight. These individuals would qualify for treatments such as dietary interventions, exercise programs, and obesity medications.
Those falling under pre-clinical obesity are at risk of developing related conditions but do not currently have any associated illnesses, according to the report.
The report highlights the limitations of using BMI alone to assess obesity, as it may not accurately represent all cases of excess body fat. The new criteria suggest that around 20% of previously classified obese individuals may no longer meet the definition, while about 20% of those with significant health concerns but lower BMIs could now be considered clinically obese.
Dr. Cummings emphasized the importance of better diagnosing individuals with clinically significant excess fat without significantly altering the overall percentage of people categorized as obese.
While the new definitions have garnered support from over 75 medical organizations globally, the practical implementation of these recommendations poses challenges, including cost implications and workforce considerations.
The adoption of the revised criteria by health insurance plans remains uncertain, with potential issues related to measuring waist circumference accurately and distinguishing between clinical and pre-clinical obesity requiring careful health assessments and laboratory tests.
For widespread acceptance of a new classification system, it would need to be efficient and straightforward to implement.
“Inexpensive, and reliable,” she said. The new definitions are likely to be confusing, said Kate Bauer, a nutrition expert at the University of Michigan School of Public Health. “The public likes and needs simple messages. I don’t think this differentiation is going to change anything,” she said. Overhauling the definition of obesity will take time, acknowledged Dr. Robert Kushner, an obesity expert at the Northwestern Feinberg School of Medicine and a co-author of the report. “This is the first step in the process,” he said. “I think it’s going to begin the conversation.”
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