A groundbreaking report from the Commission on Clinical Obesity, a group of international health experts, suggests redefining obesity by incorporating body fat measurements and health status alongside the widely used body mass index (BMI).
Currently, obesity is defined by the World Health Organization (WHO) as a BMI of 30 or higher. However, the commission’s new guidance advocates for a more nuanced approach to diagnosing and managing obesity. It highlights the importance of measuring body fat and considering an individual’s overall health, urging medical professionals to move beyond using BMI alone as a health indicator.
The report proposes introducing two categories of obesity: “pre-clinical” and “clinical,” to better assess obesity and its associated health risks. Dr. Robert Kushner, a leading expert and commissioner, explains that “pre-clinical obesity” refers to individuals who have excess fat but no organ dysfunction, indicating an increased risk of developing serious health conditions such as cardiovascular disease or Type 2 diabetes. These individuals may have a normal quality of life and healthy organ function, but still carry a higher risk for future health issues.
In contrast, “clinical obesity” occurs when excess body fat directly impacts organ function or limits daily activities, potentially leading to life-threatening conditions like heart attack, stroke, or kidney failure.
The report also outlines new diagnostic criteria for obesity that combine elevated BMI with abnormal body fat measurements, such as waist circumference or direct body fat scans. This approach acknowledges that an individual with a high BMI but low body fat percentage, or one with normal BMI but high body fat, may still be at risk of obesity-related complications.
Dr. Louis Aronne, director of the Comprehensive Weight Control Center at Weill Cornell Medicine, emphasizes that BMI alone fails to account for body composition. “BMI doesn’t take into consideration how much of the body weight is fat or where the fat is located,” he explains. As a result, someone with a normal BMI but high body fat could still face significant health risks.
The commission stresses that obesity is a chronic disease with profound health implications, impacting a range of medical conditions. Treating obesity as a disease allows for more targeted and cost-effective care. Individuals with clinical obesity may benefit from intensive treatment, while those in the pre-clinical stage could begin with less invasive methods.
Although these recommendations are not yet widely adopted, the commission is pushing for a shift in how obesity is understood and managed. Dr. Kushner states, “We need to start identifying individuals who are harmed by their weight, not just those with an elevated BMI.”
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