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A global commission of health experts has proposed a revolutionary change in how obesity is diagnosed, suggesting a move away from the traditional reliance on Body Mass Index (BMI) and introducing new methods to assess obesity based on excess body fat and individual health status. The proposal, published in The Lancet Diabetes & Endocrinology and supported by over 75 medical organizations worldwide, seeks to address the limitations of current obesity diagnostic practices, ultimately ensuring more accurate identification and treatment of the condition.
The Commission, led by Professor Francesco Rubino of King’s College London, argues that the current BMI-based definition of obesity is flawed, as it does not account for variations in fat distribution or provide a comprehensive understanding of an individual’s overall health. BMI, which categorizes obesity as a measurement of weight relative to height, has long been used as a screening tool. However, it fails to indicate where fat is stored in the body—an important factor that can significantly affect health outcomes. For example, fat stored around organs such as the liver and heart poses higher health risks than fat stored subcutaneously in limbs.
“Considering obesity solely as a risk factor and never as a disease can unfairly deny timely care to those experiencing ill health due to obesity,” Professor Rubino states. “At the same time, labeling obesity as a disease for everyone can lead to overdiagnosis and unnecessary treatments.”
The new framework introduces two distinct categories of obesity: clinical obesity and pre-clinical obesity. Clinical obesity refers to cases where excess fat causes clear signs of illness, such as breathlessness, joint pain, heart failure, or other organ dysfunctions. Those with clinical obesity would receive appropriate medical management, including lifestyle interventions, medications, or surgery. On the other hand, pre-clinical obesity applies to individuals who have excess fat but do not yet exhibit symptoms of illness. These individuals are considered at high risk for future health problems, including type 2 diabetes, cardiovascular diseases, and mental health issues. They would be supported with strategies focused on risk reduction.
The Commission recommends replacing BMI as the sole diagnostic tool with more specific measurements such as waist circumference, waist-to-hip ratio, or direct body fat measurements through techniques like DEXA scans. This approach allows clinicians to better understand the individual distribution of fat and make more accurate diagnoses.
The proposed changes to obesity diagnosis have the potential to significantly impact healthcare systems worldwide, particularly given that over one billion people are estimated to be living with obesity globally. By moving away from a one-size-fits-all approach, the new framework offers a more personalized and effective way to address obesity, ensuring that those with clinical obesity receive necessary medical interventions, while those with pre-clinical obesity receive the support needed to prevent the onset of further health complications.
In addition to improving individual care, the Commission’s proposal aims to reduce the stigma associated with obesity. The authors stress that societal stigma often exacerbates the difficulties individuals face when managing their condition and seeking treatment. By reframing obesity as a disease based on objective health outcomes rather than a one-dimensional view of weight, the hope is to reduce the shame and discrimination faced by many living with the condition.
The proposed changes have already garnered support from leading experts in endocrinology, internal medicine, surgery, and nutrition, as well as patient advocates. However, the Commission emphasizes the need for a global shift in healthcare policies, including better training for healthcare workers and policymakers to understand the new framework and its implications.
“This nuanced approach will allow for more appropriate care, reduce overdiagnosis, and ultimately save healthcare resources,” says Professor Louise Baur of the University of Sydney, one of the key commissioners involved in the project.
The Lancet’s publication of this new framework marks a critical moment in the ongoing conversation around obesity, its classification, and the best approaches for prevention and treatment. With widespread endorsement from the medical community, the hope is that this new definition of obesity will soon become a universally adopted standard in health systems worldwide.
For more information, refer to the article Definition and Diagnostic Criteria of Clinical Obesity in The Lancet Diabetes & Endocrinology (2025).
