Experts call for obesity to be redefined

The definition and classification of obesity is medically flawed, according to a report that provides a new definition and diagnostic framework.

Supported by over 50 global experts, the report states that ‘clinical obesity’ should be used to refer to a chronic disease state directly caused by excess body fat. ‘Preclinical obesity’ should refer to a condition of excess body fat without organ dysfunction or daily activity limitations, but with an increased risk of future health.

This new definition identifies when obesity is a risk factor (preclinical obesity) and when it represents a stand-alone illness (clinical obesity).

The experts also urge that the reliance on body mass index (BMI) could be causing millions to be misdiagnosed as it fails to capture the complexity of the condition. This is because it cannot accurately measure how much body fat someone has as weight is connected to bone density, natural muscle and built-up muscle through fitness.

Instead, the experts propose that other body size measurements should be used in addition to BMI, such as waist circumference, waist-to-hip ratio or waist-to-height ratio. This new diagnostic approach could ‘open the doors to a more accessible and effective management of obesity’, according to the report.

Published in The Lancet Diabetes & Endocrinology, the report sought to acknowledge the obstacles and knowledge gaps in the obesity field and change how we think about the disease. At the heart of the report’s proposals is ‘the aim to improve the lives of people living with obesity’, the experts said.

‘Obesity is a spectrum’

Professor Francesco Rubino of King’s College London chaired the expert group. He said: ‘The question of whether obesity is a disease is flawed because it presumes an implausible all-or-nothing scenario where obesity is either always a disease or never a disease. Evidence, however, shows a more nuanced reality.

‘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.

‘Considering obesity only as a risk factor, and never a disease, can unfairly deny access to time-sensitive care among people who are experiencing ill health due to obesity alone. On the other hand, a blanket definition of obesity as a disease can result in over-diagnosis and unwarranted use of medications and surgical procedures, with potential harm to the individual and staggering costs for society.’

He added: ‘Obesity is a spectrum: it’s not always a disease, it can be something that people can live with in relatively good health. At the same time, others can have full-blown illness due to obesity alone.’

Laura Gray of the University of Sheffield welcomes the report’s proposed changes. She said: ‘It’s much needed. These guidelines set out for clinical practice what current research is saying. Not everyone with obesity according to BMI is unwell, and not everyone with a lower BMI is healthy.

‘The hope is that defining obesity in a more nuanced way shows it is a disease in its own right. It isn’t just a consequence of behavioural things, there’s lots of risk factors, environmental, psychological and genetic.

Impact of calorie labels

This comes as new research found that calorie labels have a small effect on eating habits.

Analysing the impact of calorie labels in supermarkets, restaurants and other food outlets, the researchers found that calorie information led to people selecting and purchasing food with an average of 1.8% fewer calories.

In a 600-calorie meal, this amounts to a reduction of around 11 calories – about two almonds or one Pringle crisp.

Dr Gareth Hollands from University College London is the senior author of the study. He said these findings show that calorie labels have ‘a small but potentially meaningful effect on people’s food choices’.

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