Experts Call for Major Changes in How We Measure Obesity

Traditional perceptions of obesity may be in for a big change. In a new report published this week, a group of crowd-funded scientists is calling for a radical change in the way obesity is diagnosed and categorized.

More than 50 obesity experts from around the world presented the report, as part of a committee supported by The Lancet. Among other things, the group wants the body mass index (BMI) to be removed as the sole measure of obesity. They also say that obesity should be divided into two different types, depending on how a person deals with the problem.

The aim of the organization was to develop methods for the diagnosis of obesity. Currently, obesity is measured by a person’s BMI, which is calculated using a person’s weight and height. People with a BMI over 30 are considered overweight, obesity is considered a BMI over 40 (some parts of the world use lower BMI criteria due to differences in population growth).

Although BMI is the most readily available and accurate, however, it often fails to tell the whole story, the association’s experts say – a criticism shared by many health professionals. showed in the past. Obesity-related injuries are caused by excess body fat, and BMI can sometimes fail to accurately correlate with this. A very healthy person may have a high BMI but low body fat, for example, while someone with a “good BMI” may have dangerous levels of body fat. The distribution of excess body fat can vary from person to person, too, as can the health effects of that fat. Excess fat around a person’s waist or in vital internal organs such as the liver and heart is more dangerous than excess fat on the skin under our arms or legs.

The experts are not calling on doctors to abandon BMI as a tool to diagnose obesity, but to use it in conjunction with other body measurements. This includes measuring people’s waist circumference, waist-to-hip ratio, or waist-to-height ratio. Health professionals should use two measures of body size when identifying people they suspect are obese, the researchers say, and one measure other than BMI. Alternatively, doctors may collect a direct measurement of a person’s body fat, such as a bone density test, known as a DEXA scan. People with a very high BMI (over 40) may be considered to have excess body fat, he added.

“If established – people with obesity (BMI close to obesity) should have at least one additional measurement of body size (such as waist circumference in most cases or DEXA if available) to ensure accurate identification of excess body fat – this can confirm that a person is obese, and not just an obese person with a high BMI,” said Francesco Rubino, an obesity researcher at Kings College London and chairman of the committee. Gizmodo in an email.

Rubino and his work also recommend that doctors divide obesity into two main categories: clinical obesity and obesity. Having too much body fat alone won’t harm your health, experts say, so they’ve compiled a list of ways (18 for adults, 13 for children) to find out when a person’s obesity can lead to other health problems. Someone with insomnia, knee pain, or heart disease that is thought to be associated with excess body fat may be classified as clinically obese, for example, while someone who is obese but has no symptoms of an abnormal body mass may be classified as having obesity. preclinical.

“The medical reform of obesity is necessary, explaining how obesity can be a risk factor for certain diseases and the causes of disease. The definition of obesity in medicine explains the difference between obesity as a cause of illness, and it can be a good way to overcome the misconceptions and prejudices that interfere with the creation wrong decisions among patients, medical professionals, and policy makers,” the authors wrote in their report, printed Tuesday in Lancet Diabetes & Endocrinology.

People with long-term obesity may be at higher risk in the future, but the difference allows for individualized obesity care, Rubino says. While people with obesity should be treated quickly with effective medications to reduce their weight, which may include new drugs such as semaglutide (used in Ozempic and Wegovy) or bariatric surgery, doctors can use a slimming method with a person with obesity, depending on the risk.

“These methods can be as simple as introducing periodic monitoring and lifestyle changes that only target weight loss in people at low risk (even a small amount of weight loss can prevent obesity-related diseases), or combining active types of intervention should be evaluated if “The risk is very high (because of factors other than obesity itself, such as family history, obesity, other cultures, obesity, especially obesity),” Rubino said.

Such is the opinion of the group. But their views are widely accepted by health organizations around the world-76 together, including the American Heart Association in the US, the Royal College of Physicians in the UK, and the World Obesity Federation. There are still important questions that remain to be answered about obesity, such as the true prevalence of preclinical obesity (under the latest BMI-only definition, more than 1 billion people worldwide are considered obese). But according to a report co-authored by Robert Eckel, an endocrinologist at the University of Colorado School of Medicine, the new guidelines should greatly help doctors and people with obesity.

“The goal of our work was to optimize and select individual patients, and risk versus care,” he told Gizmodo. “We think this will benefit patients, health care providers, and the next level of health care.”