A groundbreaking report from global medical experts is challenging the traditional definition of obesity, arguing that the current terminology is “medically flawed.” The report suggests the need for a more nuanced approach, proposing that the term “clinical obesity” be reserved for patients whose health is directly impacted by excess weight, while a new term, “pre-clinically obese,” should be used for individuals who are overweight but still fit, and at risk of future health issues. Redefining obesity is essential to ensure better health outcomes and more accurate diagnoses.
Should Obesity Be Viewed as a Spectrum?
Obesity is often seen as a simple binary—overweight or not—but the new report asserts that redefining obesity should involve viewing it as a spectrum. This change in perspective is supported by more than 50 medical professionals from around the world, who argue that current practices do not accurately capture the complexity of obesity and its effects on individual health.
One of the report’s authors emphasized the importance of this shift in understanding. “Some individuals with obesity can maintain normal organ function and overall health, even long term, whereas others display signs and symptoms of severe illness here and now,” they explained. “Obesity is a spectrum.”
The experts argue that the traditional BMI (Body Mass Index) definition—where a BMI of over 30 is considered obese—fails to account for the wide variety of physical conditions and health risks within this category. As a result, many patients are misdiagnosed and not given the most effective care. Redefining obesity allows for a more accurate understanding of these varied health risks.
Why Is BMI No Longer an Accurate Measure of Obesity?
BMI has long been the standard measurement to determine whether a person is overweight or obese. However, the report critiques BMI for its lack of specificity, particularly its inability to distinguish between muscle mass and fat. This can result in athletes and people with high muscle mass being misclassified as obese, even though they may have very low body fat.
“The problem with BMI is that it measures whether someone is carrying too much weight, but not too much fat,” one of the report’s authors explained. “Very muscular people, such as athletes, tend to have a high BMI but not much fat.”
BMI is a useful tool for measuring population-level obesity trends, but it reveals little about an individual’s overall health. It fails to account for factors like heart problems, organ function, and even the distribution of body fat. Dangerous fat around the abdomen, for instance, is often a much more significant health risk than fat stored elsewhere.
The experts suggest that doctors take a more holistic approach, using additional measurements like waist size and body fat percentage, along with a thorough medical history, to assess a patient’s health risks more accurately. Redefining obesity means considering more than just BMI when diagnosing and treating patients.
What Are the Two Categories of Obesity?
The experts propose two distinct categories to better define obesity and tailor treatment to individual needs:
1. Clinically Obese
“Clinical obesity” refers to those whose weight directly affects their health. This can include conditions like heart disease, type 2 diabetes, joint pain, and breathlessness. Individuals in this category may experience significant impairment in day-to-day activities, and treatments like medication or surgery may be necessary.
“Obesity is a health risk—the difference is it’s also an illness for some,” one expert noted.
2. Pre-Clinically Obese
The term “pre-clinically obese” is intended for people who carry excess weight but are not yet experiencing significant health problems. These individuals may still be fit and lead an active lifestyle. Despite being classified as obese due to their BMI, they feel healthy and maintain a healthy routine.
Individuals in the “pre-clinically obese” group should receive weight-loss advice, counseling, and monitoring to prevent the onset of obesity-related diseases. Doctors should also consider family history and other risk factors when assessing these patients.
How Are Weight-Loss Treatments Changing?
The new definition of obesity is timely, as the demand for prescription weight-loss drugs has surged. Medications like Wegovy and Mounjaro, which can reduce body weight by up to 20%, are now commonly prescribed. However, access to these drugs is often limited to patients who have a BMI over 30 and a weight-related health condition.
An expert contributing to the report stated that the new approach would allow both adults and children to receive more appropriate care. “This new classification will help ensure people get the right treatment based on their individual health needs,” they said, while also reducing the number of people who are over-diagnosed and unnecessarily treated.
Will Healthcare Budgets Be Affected by the New Obesity Classification?
The Royal College of Physicians has praised the report for providing a foundation for treating obesity with the same medical rigor and compassion as other chronic conditions. However, some experts worry that the redefinition could create additional pressure on healthcare budgets, leading to reduced funding for those in the “pre-obesity” category.
As obesity continues to be a growing health concern worldwide, redefining obesity may be crucial for ensuring that patients receive the most effective care tailored to their individual needs. The shift in perspective aims not only to improve the diagnosis and treatment of obesity but also to address the underlying health risks that come with carrying excess weight. By distinguishing between those who are clinically obese and those who are pre-clinically obese, doctors can provide more personalized care and prevent the onset of serious health conditions before they develop.