A group of experts from around the world wants to change how obesity is defined and diagnosed. They want to do away with the controversial body mass index and find better ways to treat people who need it.
According to suggestions made public on Tuesday night, obesity would no longer be defined only by BMI, which is a calculation of height and weight. It would also be defined by other measures, like waist circumference, and health problems linked to extra weight.
More than a billion people around the world are thought to be obese. The U.S. Centers for Disease Control and Prevention say that about 40% of people in the country are overweight or obese.
“The whole point is to get a more precise definition so that we can help the people who really need it the most,” said Dr. David Cummings, an expert on obesity at the University of Washington and one of the 58 authors of the report that was published in The Lancet Diabetes & Endocrinology.
The study adds two new types of diagnoses: pre-clinical obesity and clinical obesity.
People who are clinically obese have organ, tissue, or other problems that are linked to their weight that are clear from their body mass index (BMI) and other tests. That could mean having heart disease, high blood pressure, liver or kidney disease, or knee or hip pain that lasts for a long time. These people would be able to get help, such as diet and exercise plans and medicines for obesity.
The study says that people who are pre-clinically obese are at risk for these health problems but do not have them right now.
The body mass index (BMI) has been thought to be flawed for a long time because it can either over- or under-diagnose obesity, which is now described as a BMI of 30 or more. The study does say that people with too much body fat don’t always have a BMI above 30. Also, people with a lot of muscle, like football players or other sports, may have a high BMI even though their fat mass is normal.
A first look at the new rules shows that about 20% of people who used to be considered obese would no longer fit the standards. They also said that about 20% of people who have major health problems but a lower BMI would now be considered clinically obese.
“It wouldn’t make a big difference in the number of people who are considered obese, but it would help doctors figure out who really has clinically significant extra fat,” Cummings said.
More than 75 medical groups from around the world agree with the new standards, but it’s not clear how quickly or widely they could be used in real life. The report says that following through with the suggestions “will have significant costs and workforce implications.”
A spokesman for AHIP, which used to be called America’s Health Insurance Plans, said, “At this point, it’s too early to tell how plans will address these issues in their coverage or other policies.”
Dr. Katherine Saunders, an expert on obesity at Weill Cornell Medicine and co-founder of the company FlyteHealth treats obesity, said that there are practical things to think about. It might sound easy to measure someone’s waist circumference, but there are different ways to do it, many doctors aren’t trained properly, and normal medical tape measures aren’t big enough for many obese people.
She also said that a full health exam and lab tests would be needed to tell the difference between clinical and pre-clinical obesity.
She also said, “For a new classification system to be widely used, it would need to be very quick, cheap, and accurate.”
Kate Bauer, a nutritionist at the University of Michigan School of Public Health, said that the new definitions are going to be hard to understand.
“People want and need simple messages.” “This difference doesn’t seem to be going to change anything,” she said.
It will take time to change the definition of obesity, said Dr. Robert Kushner, an expert on obesity at the Feinberg School of Medicine at Northwestern and one of the authors of the study.
He said, “This is the first step in the process.” “I believe it will start a conversation.”
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