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World experts urge overhaul of obesity definition


Chelsea Heaney


15/01/2025 4:26:57 PM

The Global Commission on Clinical Obesity says diagnosis must change, setting out new criteria, categories, and calling on doctors to go ‘beyond BMI’.

Man being measured by GP
The Commission has proposed a design to address limitations in the traditional definition and diagnosis of obesity that it says hinders clinical practice.

Could a new definition of obesity be on the way?
 
Healthcare experts from across the globe have banded together to call for an overhaul of obesity diagnosis, saying the current approach is too broad, over-reliant on Body Mass Index (BMI), and leaving patients without the care they need.
 
In a landmark research paper published in The Lancet on Wednesday, the Global Commission on Clinical Obesity made a long list of recommendations, saying the traditional definition and diagnosis hinders clinical practice.
 
It calls on doctors to go ‘beyond BMI’ and add extra diagnostic methods, such as waist circumference, waist-to-hip ratio or waist-to-height ratio, or a bone densitometry scan regardless of BMI.
 
Two new categories of obesity – ‘clinical obesity’ and ‘pre-clinical obesity’ – are also proposed.
 
It set out 18 criteria for ‘clinical obesity’ in adults and 13 for children and adolescents, including breathlessness, obesity-induced heart failure, or knee or hip pain.
 
‘Pre-clinical obesity’ is defined as patients who ‘do not have ongoing illness, although they have a variable but generally increased risk of developing clinical obesity and several other non-communicable diseases in the future’.
 
RACGP Specific Interests Obesity Management Chair Dr Terri-Lynne South said the research findings are not surprising.
 
‘There’s been a groundswell of dissatisfaction with the overuse of BMI as a diagnostic tool, so I think that’s one of the biggest things that we’ll be taking away with the recommendations,’ she told newsGP.
 
‘BMI is a risk factor, and it may be one of the measures that we use in regard to screening from a clinical obesity point of view, but it’s not the be all and end all.’
 
The Commission has also aimed at settling what it says is one of the most polarising debates in modern medicine – whether obesity is considered a disease.
 
Commission Chair Professor Francesco Rubino said the questions around this are ‘flawed’.
 
‘It presumes an implausible all-or-nothing scenario where obesity is either always a disease or never a disease,’ he said.
 
‘Evidence, however, shows a more nuanced reality.’
 
Dr South says this ongoing dispute of ‘disease versus risk factor’ shows again that obesity is not well defined.
 
‘Certainly, clinical obesity would fit the definitions of pathophysiology, and therefore a disease or chronic complex condition,’ she said.
 
Ultimately, Dr South said, although these extra criteria may add to consult times, they fit within the management of chronic and complex conditions.
 
‘This can’t be done in a short appointment, just like we can’t do comprehensive care of newly diagnosed type 2 diabetes,’ she said.
 
‘This will help with some of the stigma that’s surrounding weight – as well as allow for appropriate evidence-based care.’
 
The Commission’s recommendations have been endorsed by 75 medical organisations around the world, including experts from Australia.
 
Dr South said its conclusions will ‘open up a lot more appropriate discussion’.
 
‘It’s going to be going against generations that were very focused on weight range and BMI as diagnostic measures, so I think it will take some time and effort to have more nuanced conversations about the individual in front of us,’ she said.
 
‘We’re going to need to have more time to have these conversations but that’s probably a good thing, not a bad thing, for people living with clinical obesity.’
 
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BMI body mass index metabolic medicine obesity overweight and obesity preventive health weight loss


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Dr Paul Po-Wah Hui   16/01/2025 8:20:09 AM

On question of extension of consultation time, much of these parameters can be done by clinic staffs rather than the GP, as part of preventative health screening. That’s a rather poor excuse to start with.


Dr Farid Zaer   16/01/2025 9:01:44 AM

I see some of the "physicians" (internists) now using the term "obesity-associated illness", they would just "fat shame" them, and it never made it easy for us as "first contact physicians" to alleviate the patients' agony for "fat shaming"!. Obesity is a disease of the Western world and modern SAD food. I hope that more of the younger doctors learn about this. In the USA there is a "fellowship for internists" on obesity management. Australia can learn from the world economic and technological leaders.


A.Prof Christopher David Hogan   16/01/2025 9:01:23 PM

Oh dear, history is being redressed as news again.
When we started to use BMR as a measurement in the 1990s its limitations were well known & much discussed as were the limitations of waist circumference, hip/ waist ratio, etc etc.
A measurement is a measurement & must be interested as such