Credit score: Unsplash/CC0 Public Area
A world Fee, printed in The Lancet Diabetes & Endocrinology and endorsed by greater than 75 medical organizations world wide, presents a novel, nuanced method to diagnose weight problems, based mostly on different measures of extra physique fats along with physique mass index (BMI), and goal indicators and signs of unwell well being on the particular person stage.
The proposal is designed to deal with limitations within the conventional definition and analysis of weight problems that hinder scientific observe and well being care insurance policies, leading to people with weight problems not receiving the care they want.
By offering a medically coherent framework for illness analysis, the Fee additionally goals to settle the continuing dispute across the concept of weight problems as a illness, which has been on the middle of one of the vital controversial and polarizing debates in trendy medication.
Fee chair, Professor Francesco Rubino, King’s Faculty London (UK) says, “The query of whether or not weight problems is a illness is flawed as a result of it presumes an implausible all-or-nothing situation the place weight problems is both at all times a illness or by no means a illness. Proof, nonetheless, exhibits a extra nuanced actuality.
“Some people with weight problems can keep regular organs’ perform and total well being, even long run, whereas others show indicators and signs of extreme sickness right here and now.
“Contemplating weight problems solely as a danger issue, and by no means a illness, can unfairly deny entry to time-sensitive care amongst people who find themselves experiencing unwell well being attributable to weight problems alone. However, a blanket definition of weight problems as a illness may end up in overdiagnosis and unwarranted use of medicines and surgical procedures, with potential hurt to the person and staggering prices for society.
“Our reframing acknowledges the nuanced actuality of weight problems and permits for personalised care. This consists of well timed entry to evidence-based therapies for people with scientific weight problems, as acceptable for folks affected by a persistent illness, in addition to risk-reduction administration methods for these with pre-clinical weight problems, who’ve an elevated well being danger, however no ongoing sickness.
“This will facilitate a rational allocation of health care resources and a fair and medically meaningful prioritization of available treatment options.”
With over one billion folks on the earth now estimated to be dwelling with weight problems, the Fee’s proposal offers a chance for well being techniques globally to undertake a common, clinically related definition of weight problems and a extra correct technique for its analysis.
Present approaches to diagnosing weight problems are ineffective
There may be an ongoing debate amongst clinicians and policymakers over the present diagnostic method to weight problems, which is susceptible to misclassification of extra physique fats and misdiagnosis of illness.
A part of the difficulty is because of weight problems being presently outlined by BMI, with a BMI of over 30 Kg/m2 thought-about as an indicator of weight problems for folks of European descent. Totally different, country-specific BMI cutoffs are additionally used to account for ethnic variability of obesity-related danger.
Though BMI is helpful for figuring out people at elevated danger of well being points, the Fee highlights that BMI just isn’t a direct measure of fats, doesn’t mirror its distribution across the physique and doesn’t present details about well being and sickness on the particular person stage.
“Relying on BMI alone to diagnose obesity is problematic as some people tend to store excess fat at the waist or in and around their organs, such as the liver, the heart or the muscles, and this is associated with a higher health risk compared to when excess fat is stored just beneath the skin in the arms, legs or in other body areas,” says Commissioner Professor Robert Eckel, College of Colorado Anschutz Medical Campus (U.S.).
“But people with excess body fat do not always have a BMI that indicates they are living with obesity, meaning their health problems can go unnoticed. Additionally, some people have a high BMI and high body fat but maintain normal organ and body functions, with no signs or symptoms of ongoing illness.”
Past physique mass index
Whereas recognizing BMI is helpful as a screening software to determine people who find themselves probably dwelling with weight problems, the authors suggest transferring away from detecting weight problems based mostly on BMI alone.
As an alternative, they suggest affirmation of extra fats mass (weight problems) and its distribution across the physique utilizing one of many following strategies:
At the least one measurement of physique measurement (waist circumference, waist-to-hip ratio or waist-to-height ratio) along with BMI
At the least two measurements of physique measurement (waist circumference, waist-to-hip ratio or waist-to-height ratio) no matter BMI
Direct physique fats measurement (similar to by a bone densitometry scan or DEXA) no matter BMI
In folks with very excessive BMI (e.g. >40 Kg/m2) extra physique fats could be pragmatically assumed.
Two new classes of weight problems: ‘scientific weight problems’ and ‘pre-clinical weight problems’
The Fee additionally offers a brand new mannequin for illness analysis in weight problems based mostly on goal measures of sickness on the particular person stage.
Medical weight problems is outlined as a situation of weight problems related to goal indicators and/or signs of lowered organ perform, or considerably lowered capacity to conduct customary day-to-day actions, similar to bathing, dressing, consuming and continence, instantly attributable to extra physique fats. Individuals with scientific weight problems ought to be thought-about as having an ongoing persistent illness and obtain acceptable administration and coverings.
The Fee units out 18 diagnostic standards for scientific weight problems in adults and 13 particular standards for kids & adolescents together with:
Breathlessness brought on by results of weight problems on the lungs
Weight problems-induced coronary heart failure
Knee or hip ache, with joint stiffness and lowered vary of movement as a direct impact of extra physique fats on the joints
Sure alterations of bones and joints in youngsters and adolescents limiting motion
Different indicators and signs brought on by dysfunction of different organs together with kidneys, higher airways, metabolic organs, nervous, urinary and reproductive techniques and the lymph system within the decrease limbs
Pre-clinical weight problems is a situation of weight problems with regular organ perform. Individuals dwelling with pre-clinical weight problems due to this fact would not have ongoing sickness, though they’ve a variable however usually elevated danger of creating scientific weight problems and several other different non-communicable illnesses (NCDs) sooner or later, together with sort 2 diabetes, heart problems, sure forms of most cancers and psychological sickness, amongst others. As such, they need to be supported to scale back the danger of potential illness.
“The Commission’s new diagnostic criteria fill a gap in the notion of obesity diagnoses as they enable clinicians to differentiate between health and illness at the individual level,” says Commissioner Dr. Gauden Galea, WHO Regional Workplace for Europe (Europe).
“We hope that the broad endorsement of the new framework and diagnosis of obesity by many important scientific societies from around the world will ensure that a systematic clinical assessment of obesity becomes a requirement in health systems globally.”
Individuals dwelling with weight problems want personalised care
The Fee’s reframing of weight problems is designed to make sure that all folks dwelling with weight problems obtain acceptable well being recommendation and evidence-based care when wanted, with completely different methods for scientific weight problems and pre-clinical weight problems.
Individuals with scientific weight problems ought to obtain well timed, evidence-based therapy, with the goal of absolutely regaining or enhance the physique capabilities lowered by extra physique fats, slightly than solely to drop some pounds. The kind of therapy and administration for scientific weight problems—life-style, treatment, surgical procedure, and so forth –ought to be knowledgeable by particular person danger: profit assessments and decided by an energetic dialogue with the affected person.
Well being insurers worldwide usually require proof of different circumstances related to weight problems (e.g. sort 2 diabetes) to offer protection of weight problems therapies. As a definite persistent sickness itself, scientific weight problems mustn’t necessitate the presence of one other illness to justify protection.
Individuals dwelling with pre-clinical weight problems are in danger for future illnesses however would not have ongoing well being issues attributable to extra physique fats. Accordingly, the method to their care ought to goal at risk-reduction. Relying on the person stage of danger, this may increasingly require simply well being counseling and monitoring over time, or energetic therapy if needed to scale back considerably excessive ranges of danger.
“This nuanced approach to obesity will enable evidence-based and personalized approaches to prevention, management and treatment in adults and children living with obesity, allowing them to receive more appropriate care, proportional to their needs. This will also save health care resources by reducing the rate of overdiagnosis and unnecessary treatment,” says Commissioner Professor Louise Baur, College of Sydney (Australia).
The Fee concerned 56 world main consultants throughout a broad vary of medical specialties, together with endocrinology, inner medication, surgical procedure, biology, vitamin and public well being, representing many nations and numerous well being care techniques. The Fee additionally included folks dwelling with weight problems and particularly thought-about the potential influence of the brand new definitions of weight problems on widespread societal stigma.
“Studies show that the way obesity is usually talked about adds to weight stigma, making it harder to prevent, manage and treat. The approach proposed by this Commission can help clear up misconceptions and reduce stigma. We also urge better training for health care workers and policymakers to tackle this issue,” says Joe Nadglowski, affected person advocate and Commissioner, Weight problems Motion Coalition (U.S.).
Extra info:
Definition and diagnostic standards of scientific weight problems, The Lancet Diabetes & Endocrinology (2025). DOI: 10.1016/S2213-8587(24)00316-4
Quotation:
International consultants suggest main overhaul of weight problems analysis, going past BMI to outline when weight problems is a illness (2025, January 14)
retrieved 14 January 2025
from https://medicalxpress.com/information/2025-01-global-experts-major-overhaul-obesity.html
This doc is topic to copyright. Aside from any truthful dealing for the aim of personal research or analysis, no
half could also be reproduced with out the written permission. The content material is offered for info functions solely.
