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A global panel of health experts has introduced a groundbreaking proposal to redefine obesity, moving away from the longstanding reliance on Body Mass Index (BMI) as the sole diagnostic criterion. Instead, the new framework, unveiled in a report published Tuesday, combines BMI with additional measurements such as waist circumference and a deeper look into obesity-related health complications.

The aim of this shift is to better identify individuals who require medical intervention for obesity, which affects over 1 billion people globally, with an estimated 40% of U.S. adults facing obesity, according to the Centers for Disease Control and Prevention.

“This new approach is designed to offer a more precise definition of obesity, ensuring that treatment is directed toward those most in need,” explained Dr. David Cummings, an obesity expert at the University of Washington and one of the 58 authors of the report, which was published in The Lancet Diabetes & Endocrinology.

New Diagnostic Categories: Clinical and Pre-clinical Obesity

The report introduces two new categories of obesity:

  • Clinical Obesity: This category applies to individuals who meet the BMI threshold for obesity (a BMI of 30 or more) and exhibit additional health issues linked to excess body fat. Conditions such as heart disease, high blood pressure, liver or kidney disease, or severe joint pain would qualify individuals for treatment options like diet changes, exercise, and medication.
  • Pre-clinical Obesity: These individuals are at risk of developing health problems associated with obesity but do not yet show signs of disease.

The existing BMI-based definition of obesity has been widely criticized for failing to accurately diagnose the condition in certain individuals. Athletes or people with high muscle mass, for example, may have a BMI above 30 without necessarily having excess body fat. Conversely, those with excess fat but a lower BMI may not have been classified as obese under the traditional system.

The proposed shift in diagnosis aims to more accurately categorize people with clinically significant obesity, including those with health complications related to excess fat. Preliminary analysis suggests that under the new criteria, about 20% of people who would have previously been classified as obese might no longer be, while about 20% of individuals with lower BMI but serious health issues could now fall under the “clinical obesity” category.

“This change won’t drastically increase the number of people diagnosed with obesity but will help pinpoint those who truly have clinically significant excess fat,” said Cummings.

Challenges in Implementation

While the new framework has been endorsed by over 75 medical organizations globally, there are significant hurdles to its widespread adoption. Dr. Katherine Saunders, an obesity expert at Weill Cornell Medicine, pointed out the logistical challenges of measuring waist circumference accurately and the need for comprehensive health assessments to distinguish between clinical and pre-clinical obesity.

“To be widely adopted, this classification system must be quick, inexpensive, and reliable,” she noted. Additionally, while the criteria are set to improve diagnostic accuracy, there are concerns that they might add complexity to an already challenging health issue.

The changes also carry potential financial implications, especially in terms of healthcare coverage. A spokesperson for the health insurance trade group AHIP stated, “It’s too early to determine how these new criteria will affect insurance plans or policies.”

A Step Toward a Broader Conversation

The new classification is expected to spark ongoing discussions around the global obesity epidemic, but experts acknowledge that shifting societal views and medical practices will take time.

Dr. Robert Kushner, an obesity expert at Northwestern Feinberg School of Medicine, and a co-author of the report, called the new guidelines “the first step in the process.”

As public understanding of obesity continues to evolve, Kate Bauer, a nutrition expert at the University of Michigan, cautioned that complex medical definitions might not resonate with the general public. “The public prefers simple messages, and this differentiation may not significantly alter how obesity is perceived by most people,” she said.

The new criteria will likely evolve in the coming years, but they are already igniting a crucial conversation about the way obesity is defined and treated worldwide.

For further information on the new diagnostic criteria for obesity, refer to The Lancet Diabetes & Endocrinology (2025), DOI: 10.1016/S2213-8587(24)00316-4.

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