Commission recommendations for new types of obesity based on objective measures of illness and how to reduce risk of developing diabetes and cardiovascular disease via adiposity

The inflammation in the belly can result in elevated blood sugar, elevated blood pressure and increased fats in the blood. This can lead to diseases like diabetes and heart disease.

In addition, the commission recommends two new categories of obesity, based on objective measures of illness. People with a chronic disease associated with Obesity are referred to asclinical obese. And the second category is called ‘pre-clinical obesity’ and would signify that a person has elevated risks for developing a health condition due to their level of body fat.

“Our reframing acknowledges the nuanced reality of obesity and allows for personalised care,” says Dr. Francesco Rubino, of King’s College London, who is chair of the commission.

The Commission included 56 experts with expertise in nutrition, endocrinology, internal medicine and public health. Their report was published in a journal.

More than 1 billion people worldwide live with obesity, and the condition is linked to about 5 million deaths every year2 from disorders such as diabetes and cardiovascular disease.

But BMI doesn’t provide adequate information about a person’s health, the commission concludes, and the reliance on BMI alone can result in a misdiagnosis.

“About 40% of the adult population in America has obesity, when it’s defined solely by BMI,” Kushner says. Do all of these millions of Americans have a disease? And do they all have to go through treatment? Kushner says the commission aims to give some clarity to the confusion.

Some people have low muscle mass, but carry a lot of weight around their organs. Their level of belly fat can put them at a higher risk of developing diseases such as heart disease and diabetes.

For a long time, physicians have used the body mass index to determine whether a person is obese. BMI is a quick and inexpensive estimate based on weight and height.

“We’re not throwing out BMI, we are now recommending that individuals have another measurement obtained that more directly gets an estimate of body fat,” Kushner says.

The revised definition, published in The Lancet Diabetes & Endocrinology1 on 14 January, focuses on how excess body fat, a measure called adiposity, affects the body, rather than relying only on body mass index (BMI), which links a person’s weight to their height.

Conventional methods can lead to unnecessary treatment for some people. Rubino and his colleagues propose a method for diagnosis of obese people that also includes measuring waist circumference, using low-level X-rays to measure fat mass, and measuring a person’s level of adiposity.

Personalized assessments that consider age, gender and ethnicity are equally important, because certain groups might face health risks at lower BMI thresholds than others, says study co-author Louise Baur, a paediatrician at the University of Sydney, Australia.

“Now the idea is, eat less, move more, and you’ll lose weight,” says van Rossum, who wasn’t involved in the work. Although a healthy lifestyle is important, she adds, “if it would be so simple, we wouldn’t have an epidemic, and this paper is an excellent contribution to the discussion about the complexity of obesity”.

This shift could improve clinical care, public-health policies and societal attitudes toward obesity, says Elisabeth van Rossum, an endocrinologist at the Erasmus University Medical Center Rotterdam in the Netherlands.