According to a new definition of the condition released by the International Commission on Obesity, obesity must be assessed in a way that goes beyond the standard measurement of body mass index, or BMI.
His ReportPublished Tuesday in The Lancet Diabetes and Endocrinology journal, it makes the case for focusing on how much body fat a person has and what medical complications a person has, not just their weight.
If the guidelines are widely adopted, they could change doctors’ perception of who needs to be treated for obesity. They can also affect the use of prescription drugs that treat obesity, such as Vigovi and Zipbound. The new obesity definition was endorsed by 76 organizations worldwide.
The commission recommended that instead of continuing the current use of BMI—as a way to define obesity—it should be a screening tool to determine who should be tested for excess body fat. should
People who have a BMI over 25 and are very obese, but who are otherwise healthy, should be left well enough alone, the commission said. They should be monitored and advised not to gain more weight and possibly lose some.
Their condition will be called preclinical obesity.
Others with any of the 18 medical conditions caused by obesity — 13 for children and adolescents — need medical treatment to improve their health and prevent serious organ injuries. These conditions include shortness of breath, heart problems, hip or knee pain, metabolic abnormalities and malfunctioning organs.
Their condition will be called clinical obesity.
Those with a BMI of 40 or higher are clinically obese based on BMI alone — there is no need to assess their body fat, the group said.
The commission said it did not know the prevalence of the two types of obesity.
The easiest way for doctors to see if someone has excess body fat is to wrap a tape measure around a person’s waist, the group said. If a woman’s waist is greater than 34.6 inches, she likely has a lot of fat. For a man, the waist measurement should be at least 40 inches.
Other tools for health professionals include waist-to-hip ratio, waist-to-height ratio or a DEXA scan, which is a type of X-ray.
The commission’s 58 experts spent years on the report, meeting regularly online. The head of the commission, bariatric surgeon Dr Francesco Rubino of King’s College London, said that instead of treating obesity as a disease, they wanted to look at it differently. (Dr. Rubino consults with manufacturers of obesity drugs and medical devices.)
The commission’s approach fits with the American Heart Association, which endorsed the report.
“We struggled in the wrong ways to define wrong weight,” said Dr. Meryl Jessup, the association’s chief scientific and medical officer. “How do you define ideal weight and how do you define unhealthy weight?”
“We were asked many times, do you think obesity is a chronic disease? We were reluctant to say ‘yes’ or ‘no,'” he said. “We think it’s more important.”
Rebecca Puhl, deputy director of the University of Connecticut’s Rudd Center for Food Policy and Health, said she saw the commission’s approach as “an attempt to reduce some of the misconceptions about obesity that may have fueled stigma.” can reduce.”
Obesity is seen as a character flaw rather than a complex health condition, he said.
But new definitions can be difficult to get into common use.
For years, experts have complained about the reliance on BMI to define overweight and obesity.
Measuring the index is easy – only a person’s height and weight are needed. It soon became the standard for defining whether people were underweight, overweight or obese.
And BMI is established as a major risk factor for diabetes, heart disease, cancer and other conditions, said Dr. David M. Nathan, professor of medicine at Harvard and founder of the Diabetes Center at Massachusetts General Hospital.
A large waist is also a risk factor, he added. But unlike BMI, waist measurement is often inaccurately measured in clinical settings.
It’s unrealistic, Dr. Nathan said, “to say the whole world is going to turn into this.”
Totally unrealistic, he continued, saying that obesity should not be treated unless complications develop. “As they would have it, you wouldn’t treat high blood pressure until the person had a stroke,” Dr. Nathan said.
Dr. Nathan added that while not everyone with obesity develops serious health problems, “the number who do not develop any weight-related complications is very small.”
The use of new standards may also have implications for new obesity drugs and other drugs headed to the market. They’re so expensive that some health systems that initially covered them for people with obesity — defined by their BMIs. was done by the source – decided they couldn’t afford to do it anymore.
But Dr. David Cummings, a member of the commission and an obesity expert at the University of Washington, suggested they could be limited to patients diagnosed with medical obesity.
The needs of this group, he said, are “more compelling.”