Take such a load – after all, you can be fat!
About 40% of American adults – more than 100 million Americans – are considered obese. It’s a growing public health crisis that makes patients vulnerable to heart disease, type 2 diabetes, stroke and certain cancers.
Now, a global panel of 56 medical experts is proposing a major overhaul of how obesity is defined and diagnosed, meaning the days of relying solely on body mass index to find out whether you’re overweight or obese may be numbered.
The new guidance considers how excess fat is distributed in the body and how it affects organ function and daily life, paving the way for two new obesity categories.
“Our reframing acknowledges the nuanced reality of obesity and allows for personalized care,” said committee chair Dr. Francesco Rubino of King’s College London.
Here’s a look at the committee’s recommendations, published Tuesday in Lancet Diabetes & Endocrinology.
What is BMI?
BMI is a person’s weight in kilograms divided by the square of their height in meters.
A BMI of 30 or higher is considered obese, while a BMI of 40 or higher is considered severely obese.
A Belgian mathematician invented the formula in the 1830s, but it took about 150 years, until the 1980s, for the calculation to become the international standard for measuring obesity. Recently, critics have called BMI an unreliable measure of health.
“Obesity measures based on BMI can underestimate and overestimate [the amount of fat stored in the body] and provide insufficient health information at the individual level, which undermines sound medical approaches to health care and policy,” the commission wrote.
How should obesity be diagnosed?
The Commission suggests confirming obesity by one of the following methods:
- A measurement of body size (waist circumference, waist-to-hip ratio or waist-to-height ratio), as well as BMI
- Two measures of body size independent of BMI
- Direct measurement of body fat with a bone density scan regardless of BMI
- Presumption of excess body fat if BMI is above 40
“Relying only on BMI to diagnose obesity is problematic,” said commissioner Dr. Robert Eckel, “as some people tend to store excess fat around the waist or in and around their organs, such as the liver, heart or muscles, and this is associated with a higher health risk than when excess fat stored only under the skin on the arms, legs or other areas of the body.
“People with excess body fat do not always have a BMI that indicates they are living with obesity, which means their health problems may go unnoticed,” added Eckel, a professor of physiology and biophysics at the University of Colorado Anschutz Medical Campus.
“Furthermore, some people have a high BMI and high body fat but maintain normal organ and body function, with no signs or symptoms of ongoing disease.”
What are the two new categories of obesity?
The commission recommends two new categories of obesity: clinical and preclinical obesity.
Clinical obesity is a chronic disease that affects organ function or daily routine. Patients may have difficulty eating, bathing or dressing themselves due to excess body fat.
The commission developed 18 diagnostic criteria for clinical obesity in adults and 13 criteria for children and adolescents that include:
- Shortness of breath, shallow breathing, or shortness of breath from the effects of obesity on the lungs
- Heart failure caused by obesity
- Knee or hip pain with stiffness and reduced range of motion due to excess pressure on the joint from excess weight
- Bone and joint changes in children that limit movement
- Other symptoms caused by dysfunction of the kidneys, upper respiratory tract, metabolic organs, nervous, urinary and reproductive systems and the lymphatic system in the lower limbs
Preclinical obesity is characterized by normal organ function, but an increased risk of clinical obesity, type 2 diabetes, heart disease, certain types of cancer, and mental illness.
It is unclear whether the number of Americans classified as obese would increase or decrease if these changes were enacted.
Dr. David E. Cummings, a commissioner and professor of medicine at the University of Washington, told The Post that it is being studied.
What’s next?
The Commission is launching a worldwide publicity campaign, hoping that this will lead to better strategies to prevent and treat obesity.
“The commission’s report is a big step forward in recognizing obesity as a disease and not just a risk factor. It also helps clinicians identify individuals who need treatment,” said Commissioner Dr. Robert Kushner, a professor of medicine at Northwestern University Feinberg School of Medicine and a Northwestern Medicine physician.
One way to change the system is to influence health insurance policies. The commission noted that providers often require evidence of other obesity-related conditions, such as diabetes, to cover obesity therapies such as Ozempic-like drugs.
The Commission requires insurers to cover clinical obesity without the presence of any other disease. Meanwhile, care for those with preclinical obesity should focus on risk reduction.
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