Expert commission defines obesity, sets advice on treatment
An expert commission sought to define clinical obesity as an illness that directly results from the effect of excess adiposity on the function of organs and tissues.
A group of experts commissioned by The Lancet offered a new definition of obesity and clinical considerations for treating it and related comorbidities.
The 58 international experts were chosen based on geography and medical specialty, including internal medicine, and tasked with establishing objective criteria for disease diagnosis, aiding clinical decision making, and prioritizing interventions. All recommendations had the highest level of consensus among the experts (grade of agreement, 90% to 100%), and they were then endorsed by 76 organizations, including scientific societies and patient advocacy groups. The statement was published online Jan. 14 in The Lancet Diabetes & Endocrinology, along with an executive summary.
The report recommended that body mass index (BMI) be used only as a surrogate measure of health risk at a population level for epidemiological studies or screening, rather than as an individual measure of health. Excess adiposity should be confirmed by direct measurement of body fat or at least one anthropometric criterion such as waist circumference, waist-to-hip ratio, or waist-to-height ratio, the report said. In patients with very high BMI (>40 kg/m2), excess adiposity can be assumed without further confirmation.
A diagnosis of clinical obesity requires evidence of reduced organ or tissue function due to obesity and/or substantial, age-adjusted limitations of daily activities specifically related to obesity's effect on mobility or other basic activities of daily living, it said.
Those with clinical obesity should receive timely, evidence-based treatment, aimed at improving or providing remission of clinical effects and preventing end-organ damage. People with preclinical obesity (i.e., no substantial comorbidities) should receive evidence-based health counseling, monitoring of their health status over time, and, when applicable, appropriate intervention to reduce risk for clinical obesity and related diseases.
Public health strategies to reduce the incidence and prevalence of obesity at population levels must be based on current scientific evidence, rather than unproven assumptions that blame individual responsibility for obesity, the report said. Weight-based bias and stigma are major obstacles in efforts to effectively prevent and treat obesity, and health care professionals and policymakers should receive proper training to address this, the report said.
An accompanying editorial pointed out that even though obesity affects one-eighth of the global population, it has had no standard definition.
“Adopting a new and more precise approach to obesity identification and shifting societal perceptions will take time and effort, but at the heart of these proposals is the aim to improve the lives of people living with obesity,” it stated. “We now have the opportunity to transform obesity care, moving away from a system in which individuals are seen under one single label toward a system that recognises the unique health and needs of each person.”