Get a load of this — you may be obese after all!
About 40% of US 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 commission of 56 medical experts is proposing a major overhaul of how obesity is defined and diagnosed, which means the days of relying solely on body mass index to reveal if you’re overweight or obese may be numbered.
The new guidance considers how excess fat is distributed around 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 commission chair Dr. Francesco Rubino of King’s College London.
Here’s a look at the commission’s recommendations, published Tuesday in the 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 above is considered severely obese.
A Belgian mathematician devised 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. As of late, critics have called BMI an unreliable measure of health.
“BMI-based measures of obesity can both underestimate and overestimate [the amount of fat stored in the body] and provide inadequate information about health at the individual level, which undermines medically sound approaches to health care and policy,” the commission wrote.
How should obesity be diagnosed?
The commission suggests confirming obesity with one of these methods:
- One measurement of body size (waist circumference, waist-to-hip ratio or waist-to-height ratio), as well as BMI
- Two measurements of body size regardless of BMI
- Direct body fat measurement with a bone density scan no matter the BMI
- Assumption of excess body fat if BMI is over 40
“Relying on BMI alone to diagnose obesity is problematic,” said commissioner Dr. Robert Eckel, “as some people tend to store excess fat at the waist or in and around their organs, such as the liver, the heart or the muscles, and this is associated with a higher health risk compared to when excess fat is stored just beneath the skin in the arms, legs or in other body areas.
“People with excess body fat do not always have a BMI that indicates they are living with obesity, meaning their health problems can go unnoticed,” added Eckel, a professor of physiology and biophysics at the University of Colorado Anschutz Medical Campus.
“Additionally, some people have a high BMI and high body fat but maintain normal organ and body functions, with no signs or symptoms of ongoing illness.”
What are the two new obesity categories?
The commission advises two new categories of obesity: clinical and preclinical obesity.
Clinical obesity is a chronic disease affecting organ function or daily routine. Patients may struggle to eat, bathe or dress themselves because of excess body fat.
The commission devised 18 diagnostic criteria for clinical obesity in adults and 13 criteria for children and adolescents that include:
- Breathlessness, shallow breathing or wheezing from the effects of obesity on the lungs
- Obesity-induced heart failure
- Knee or hip pain with stiffness and reduced range of motion due to excess pressure on joints from extra weight
- Alterations of bones and joints in children that limit movement
- Other symptoms caused by dysfunction of kidneys, upper airways, metabolic organs, the nervous, urinary and reproductive systems and the lymph 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’s unclear if the number of Americans classified as obese would go up or down if these changes were adopted.
Dr. David E. Cummings, a commissioner and professor of medicine at the University of Washington, told The Post that’s being studied.
What’s next?
The commission is embarking on a worldwide publicity campaign, hoping it leads to better obesity prevention and treatment strategies.
“The commission’s report is a major step forward in recognizing obesity as a disease and not merely a risk factor. It also helps clinicians identify individuals who are in need of 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 insurer policies. The commission pointed out that providers often require evidence of other conditions associated with obesity, like diabetes, to cover obesity therapies such as Ozempic-like drugs.
The commission is urging insurers to cover clinical obesity without the presence of another disease. Care for those with preclinical obesity, meanwhile, should be focused on risk reduction.
