January 2025

ENDOCRINOLOGY
Featuring Robert Kushner, MD 

A BETTER DEFINITION OF OBESITY

New recommendations use more than just body mass index to diagnose obesity

One billion people are now estimated to be living with obesity. But the clinical definition for “obesity” is not one-size-fits-all. Relying on body mass index (BMI) alone can lead to under-diagnosis of people who are ill and, conversely, over-diagnosis of people who currently do not have negative health consequences of obesity.

What’s new​

​A newly released set of global clinical guidelines aims to create a better definition of obesity.

The Lancet Diabetes & Endocrinology Commission — which is endorsed by 75 medical organizations around the world — has set out a new way to diagnose obesity to use objective measures of illness based on an individual’s risk factors.
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The commission also has introduced two novel diagnostic categories of obesity: clinical obesity and pre-clinical obesity, which delineate if and how an individual’s excess body fat affects their organ health and daily functioning.

​Why it matters

This is a significant shift from the current standard of care, which primarily relies on BMI to diagnose obesity.

Northwestern Medicine obesity expert Dr. Robert Kushner is a member of the commission that devised the new definition and diagnostic criteria of clinical obesity.

“The commission’s report is a major step forward in recognizing obesity as a disease and not merely a risk factor. It also helps clinicians identify individuals who are in need of treatment,” said Kushner, a professor of medicine (endocrinology and medical education) at Northwestern University Feinberg School of Medicine.

Other key details from the new guidelines

  • Clinical obesity is defined in the new guidelines as a chronic disease with specific signs and symptoms of ongoing organ dysfunction due to obesity alone. Treatment for clinical obesity — lifestyle, medication, surgery, etc. — should be aimed to fully regain or improve the body functions reduced by excess body fat.
  • Pre-clinical obesity is defined in the new guidelines as being associated with variable level of health risk, but no ongoing health complications due to excess body fat. The approach to care should aim at risk reduction.
  • All people living with obesity should receive health advice and evidence-based care when needed — free of stigma and blame — with different strategies for clinical obesity and pre-clinical obesity.
  • As a distinct chronic illness, clinical obesity should not necessitate the presence of another disease (e.g. Type 2 diabetes) to justify health insurance coverage.

 
This article was originally published in Northwestern Now on January 14, 2025. 

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