Leading medical experts have warned that current obesity diagnostic methods may be leading to overdiagnosis, calling for a more nuanced approach that considers overall health rather than just body mass index (BMI).
The report, published in The Lancet Diabetes & Endocrinology journal and backed by more than 50 global medical experts, proposes distinguishing between “clinical obesity” for those with chronic weight-related illnesses and “pre-clinical obesity” for those with excess weight but no health problems.
Prof Francesco Rubino from King’s College London, who chaired the expert group, said: “Obesity is a spectrum. Some have it and manage to live a normal life, function normally. Others can’t walk well or breathe well, or are wheelchair bound with significant health issues”.
The experts argue that the current BMI-based definition, which classifies obesity as a BMI over 30, fails to account for differences between muscle and body fat or consider more dangerous fat around internal organs.
They propose a new model focusing on obesity’s impact on organs and daily life, including conditions such as heart disease, breathlessness, type 2 diabetes and joint pain, to determine whether drug treatment is necessary.
Under the proposed framework, those with pre-clinical obesity would receive weight-loss advice, counselling and monitoring rather than immediate drug interventions, though treatment might still be required.
The Royal College of Physicians has endorsed the report, saying it provides a foundation for treating obesity with “medical rigour and compassion”.
However, concerns have been raised about healthcare funding, with Prof Sir Jim Mann from the Edgar Diabetes and Obesity Research Centre warning that limited resources might be directed primarily towards those classified as clinically obese.
The recommendations come as more than a billion people worldwide are estimated to be living with obesity, amid high demand for prescription weight-loss drugs such as Wegovy and Mounjaro.
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