Doctors worldwide should adopt a more comprehensive approach to diagnosing obesity, incorporating broader criteria and focusing on when the condition leads to ill health, according to a new framework proposed by experts and endorsed by 76 medical organizations internationally.
Currently, clinicians rely on body mass index (BMI) — a calculation based on a person’s weight and height — to diagnose obesity. However, this tool is not precise enough, according to the 56 experts involved in the global commission. They recommend incorporating additional measurements, such as waist circumference, to reduce the risk of misdiagnosis, according to a Reuters report.
The commission also advocates for redefining obesity into two distinct categories: clinical obesity and pre-clinical obesity. Their findings were published Tuesday in The Lancet Diabetes & Endocrinology.
- Clinical Obesity: This involves excess body fat accompanied by symptoms such as reduced organ function (e.g., breathlessness or heart failure) or difficulties in daily life. The commission suggests this should be classified as a chronic disease requiring appropriate treatment.
- Pre-Clinical Obesity: This refers to excess body fat without any signs of illness or impaired organ function. It should be considered a risk factor for both clinical obesity and other illnesses, such as diabetes. Patients in this category should receive support to reduce their risk, either through monitoring or proactive treatment.
“Obesity is a spectrum,” said Francesco Rubino, the commission’s chair and a professor at King’s College London, during a press conference earlier this week.
Currently, over one billion people globally are estimated to have obesity.
The experts aim to refine the diagnostic process, which they believe could improve healthcare resource allocation. While it remains uncertain whether this approach will result in more or fewer diagnoses, the commission hopes to clarify the ongoing debate within the medical community about whether obesity should be classified as a disease.
“We cannot afford to have a blurry picture of obesity,” Rubino emphasized.
The new guidelines have been supported by major organizations, including the American Heart Association, the Chinese Diabetes Society, and the World Obesity Federation. Experts from the World Health Organization (WHO) also contributed to the commission, which began its work in 2019.
Since then, the development of GLP-1 drugs to treat obesity, pioneered by Eli Lilly and Novo Nordisk, has transformed the landscape of obesity care. However, Rubino clarified that the commission’s focus was not on these drugs. He noted that a clearer diagnostic framework, if adopted globally, could guide doctors on when to prescribe such treatments based on individual risk.
The commission further suggested that insurers might start covering GLP-1 drugs for clinical obesity as a standalone illness. Currently, many insurers require the presence of another related condition, such as diabetes, to justify coverage.
“We hope this leads to a change in practice, and maybe even before that, a change in mindset,” Rubino said.
