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New Report Aims to Further Define Diagnostic Criteria for Clinical Obesity
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Key Takeaways
- Clinical obesity is redefined as a chronic disease caused by excess adiposity, distinct from preclinical obesity, which poses future health risks.
- The report suggests using waist circumference, waist-to-hip ratio, and waist-to-height ratio with BMI for a comprehensive obesity assessment.
The Commission aims to provide information for clinical decision making, therapeutic interventions, and public health strategies.
The Lancet Diabetes and Endocrinology published a report aiming to further define and refine diagnostic criteria of clinical obesity. The authors state that obesity as a chronic disease is highly controversial, and the current body mass index (BMI) measurements provide inadequate information about health for individuals. Therefore, the Commission’s aim is to define clinical obesity as an illness by establishing criteria for diagnosis and providing information for clinical decision making, therapeutic interventions, and public health strategies.1
Obesity, Clinical Obesity, Preclinical Obesity | Image Credit: taniasv | stock.adobe.com
The Commission provided a new framework for diagnosis of clinical obesity, defined as a standalone illness. When obesity is a risk factor, the authors proposed that it be called preclinical obesity. The authors noted that the classification and definition of obesity has not been agreed upon, specifically because individuals with obesity have different health profiles and needs. They noted that obesity is often defined and discussed in terms of BMI, which is imperfect.2
The Commission included 58 professionals with a broad range of expertise from a variety of high-, middle-, and low-income countries. The Commission included regular meetings and was endorsed by more than 75 international medical organizations. The authors defined clinical obesity as a "chronic, systemic disease state directly caused by excess adiposity” and preclinical obesity "[as] a condition of excess adiposity without current organ dysfunction or limitations in daily activities but with increased future health risk.” Clinical obesity can lead to end-organ damage, potentially life-threatening complications, including heart attack, stroke, renal failure, and more. For preclinical obesity, the Commission further defined it as risk of developing other non-communicable diseases, such as type 2 diabetes, cardiovascular disease, certain types of cancer, and mental disorders.2,3
The Commission also used other measurements for body size, such as waist circumference, waist-to-hip ratio, and waist-to-height ratio in combination with BMI to define obesity status. They recommend that BMI is used as a surrogate measure of health risk or for screening purposes instead of a measure of health. When using the other measurements in combination with BMI, the authors suggest using validated methods and cutoff points that are relevant to age, gender, and ethnicity. One of the goals of the authors was to make the proposed changes accessible since BMI is often used due to the ease of use without expensive resources. The diagnosis of clinical obesity includes 1 or both of the criteria defined as: “evidence of reduced organ or tissue function due to obesity (ie, signs, symptoms, or diagnostic tests showing abnormalities in the function of one or more tissue or organ system); or substantial, age-adjusted limitations of daily activities reflecting the specific effect of obesity on mobility, other basic activities of daily living (eg, bathing, dressing, toileting, continence, and eating).”2,3
The proposed new body measurements should be equivalent in easy when implemented into practice. They also acknowledge that the existing policies for access to care are inadequate and should be updated to prioritize cost-effectiveness and patients that need those interventions the most, and those with preclinical obesity should focus on risk mitigation, with lower risk individuals engaging in lifestyle interventions.2
The authors stated that preliminary audits of available data are underway, which currently suggest that a substantial number of patients currently with obesity do not meet the clinical obesity criteria. The database also needs to include the full picture of an individual’s health care status, and subtypes for clinical obesity had the potential to be implemented.2
The Commission also addressed policy makers and health authorities to ensure there is adequate access to evidenced-based treatment. Public health strategies should be used to reduce the incidence and prevalence of obesity—focusing on scientific evidence instead of blaming the individual for the development of obesity. They noted that stigma and bias based on weight are major barriers to treatment, so health care providers and policy makers should receive training to properly address the issue of obesity.3
