Lancet report urges overhaul of obesity diagnosis, says BMI alone not reliable measure of disease

New Delhi: Urging an overhaul of how obesity is diagnosed, a Lancet Global Commission report has recommended a new, nuanced approach that looks at measures of body fat such as waist circumference or waist-to-hip ratio in addition to body mass index or BMI to detect obesity.

The authors said that current medical approaches rely on BMI, which is not an honest measure of health or disease in an individual, and can result in a wrong diagnosis, potentially causing negative consequences for people living with obesity.

Part of the issue is the current definition of BMI, with a value of over 30 indicating obesity among people of European descent. Country-specific cutoffs help account for how obesity risk changes with ethnicity, said the international team, including experts from India.

Published in The Lancet Diabetes and Endocrinology journal and endorsed by over 75 medical organisations, including the All Indian Association for Advancing Research in Obesity (AIAARO), the report presents a "novel, nuanced approach to diagnose obesity" and could reduce risk of misclassification.

The authors also introduced two new categories for diagnosing obesity, which are "objective measures" of illness in an individual -- 'clinical obesity' and 'pre-clinical obesity'.

While clinical obesity refers to a chronic or persistent condition because of an obesity-related organ dysfunction, pre-clinical obesity is related to an increased health risk without illness.

"The question of whether obesity is a disease is flawed because it presumes an implausible all-or-nothing scenario where obesity is either always a disease or never a disease. Evidence, however, shows a more nuanced reality. Some individuals with obesity can maintain normal organs' function and overall health, even long term, whereas others display signs and symptoms of severe illness here and now," said Francesco Rubino, Commission chair, King's College London.

The reframing of diagnosing obesity allows for personalised care, including a timely access to evidence-based treatments for individuals with clinical obesity, as well as risk-reduction management strategies for those with pre-clinical obesity, Rubino added.

"This will facilitate a rational allocation of healthcare resources and a fair and medically meaningful prioritisation of available treatment options," Rubino said.

In 2022, over a billion around the world were estimated to be living with obesity, according to the World Health Organization.

Obesity has wide-ranging effects, including increasing risk of metabolic and heart diseases. The condition is also known to impact one's bone health and fertility along with increasing risk of cancers. Quality of life, including how one sleeps and moves, is also affected.