A new definition excludes the size of one’s body to focus on health
Commission on Obesity Based on Objective Measurements of Disease, with a Special Report by P. A. Rubino, M. H. Kushner
Fat in the belly causes inflammation and leads to other problems such as high blood sugar, elevated blood pressure, and increased fats in the blood. This can start a chain of diseases, including diabetes and heart disease.
In addition, the commission recommends two new categories of obesity, based on objective measures of illness. The first category is called ‘clinical obesity’, for people who already have a chronic disease associated with obesity. The second category is known as ‘pre-clinical obesity’, and means a person with a high level of fat has a higher risk of developing a health condition.
“Our reframing acknowledges the nuanced reality of overweight and gives for individualised care” said Dr. Rubino, who is chair of the commission.
The experts on the commission have expertise in nutrition, endocrinology, internal medicine and public health. Their report is published in the Journal Lancet Diabetes & Endocrinology.
The condition is linked to about 5 million deaths per year from diseases such as diabetes and cardiovascular disease, thanks to the 1 billion people living with it.
It is easy to measure and compare the difference between overweight and normal weight. A full picture of a person’s health doesn’t include differences in body composition like muscle or fat.
40% of the adult population in the US is obese when it’s not defined by a body mass index. But do all of these millions of Americans have a disease? And do they all need treatment? Kushner says the commission aims to give some clarity to the confusion.
Some people are stocky and muscular. When they step on the scale, their body weight may place them in the category of obesity, due to the weight of the muscle mass. But these folks may be healthy.
The commission recommends that excess body fat should be confirmed by measuring a person’s waist circumference, waist-to-hip ratio, or waist-to-height ratio. Another option is a direct measurement of body fat from a screening, such as a DEXA scan, when this option is available and affordable.
“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.
Excess body fat, also called adiposity, is a measure of fat that affects the body rather than just the body mass index.
Conventional methods lead to unnecessary treatment for some people while missing others who need help, he says. To address this, Rubino and his colleagues propose a system for diagnosing obesity that goes beyond BMI, combining it with other methods such as measuring waist circumference, which is a proxy for adiposity, or body scans using low-level X-rays, which can directly measure fat mass.
The study co-author says that it’s equally important for the different groups to be assessed because there may be risks at lower levels than others.
“Now the idea is, eat less, move more, and you’ll lose weight,” says van Rossum, who wasn’t involved in the work. The paper is an excellent example of how simple a healthy lifestyle could be if it were that easy.
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.
The Commission on Obesity based on objective measurements of illness recommends two new categories of obesity, called ‘clinical obesity’, for people who already have a chronic disease associated with obesity. The second category is known as ‘pre-clinical obesity’ and means a person with a high level of fat has a higher risk of developing a health condition.