A panel of global health experts has recommended a shift in how obesity is diagnosed, proposing that the condition be categorized into two distinct types to help refine treatment approaches and avoid misdiagnoses.
In a groundbreaking report published on Wednesday, the expert commission—comprising 56 health specialists—suggested that obesity should no longer be viewed through the singular lens of body mass index (BMI). The move aims to provide a more accurate diagnosis of obesity and move away from the stigma often associated with the condition, which affects more than a billion people worldwide.
Obesity, widely recognized for its role in increasing the risk of chronic health conditions such as Type 2 diabetes, heart disease, and certain cancers, has sparked considerable debate over whether it should be classified as a disease. The World Health Organization (WHO) and other global health bodies have long considered it a “chronic complex disease.” However, some individuals who are classified as obese experience few health problems and live active, healthy lives, fueling further debate.
Dividing Obesity into Two Categories
The expert panel, chaired by Francesco Rubino, a bariatric surgeon and professor at King’s College London, proposed two new categories for diagnosing obesity. The first, clinical obesity, would apply to those whose obesity has led to serious health complications such as heart, liver, or breathing issues, high cholesterol, sleep apnea, and musculoskeletal problems like hip, knee, or foot pain. This category would be recognized as a distinct illness requiring medical attention.
The second category, pre-clinical obesity, would encompass individuals who are classified as obese but have not yet developed significant health issues. These individuals would still require monitoring but not immediate medical intervention, thereby reducing the risk of overdiagnosis.
Rubino, speaking at a press conference, emphasized the complexity of the obesity debate, noting that there are valid concerns on both sides. “Not everybody is entirely right and not everybody is entirely wrong,” he said, seeking a middle ground between medical and activist perspectives.
Moving Beyond BMI for Diagnosis
The commission also recommended moving beyond the traditional use of BMI— which simply calculates the ratio of weight to height—to more nuanced diagnostic tools. Experts advocated for including measurements such as waist circumference, waist-to-hip ratio, and even bone density scans to improve accuracy and ensure that obesity is diagnosed appropriately.
While the new recommendations are a step forward, the panel acknowledged the need for further research to determine how many individuals fall into each of the proposed categories. Notably, the commission did not make any recommendations regarding the use of popular weight-loss drugs, such as Wegovy, which have become increasingly common since the formation of the panel.
Mixed Reactions to the Recommendations
The proposal has garnered both support and criticism from various quarters.
Tom Sanders, professor emeritus of nutrition and dietetics at King’s College London, praised the recommendations, suggesting that an official recognition of clinical obesity could help shift the legislative and social landscape. “This could help reduce discrimination, particularly in employment, and address the social stigma associated with obesity,” he said.
However, some patient advocacy groups expressed dissatisfaction with the findings. Anne-Sophie Joly, founder of the National Collective of Obese Associations in France, criticized the recommendations as “counterproductive,” claiming that the panel’s suggestions fail to reflect the real-world struggles of people living with obesity, many of whom do not receive adequate care.
On the other hand, those skeptical of obesity being classified as a disease were also unimpressed. Sylvie Benkemoun, a psychologist and leader of France’s Reflection Group on Obesity, acknowledged the merit of the discussion but argued that the recommendations fall short in addressing the broader issue of patient care. “The recommendations are unlikely to change the attitudes of caregivers or improve the quality of care for individuals with obesity,” she stated.
Conclusion
The expert commission’s recommendations represent an important step in the ongoing debate about obesity and its impact on public health. While the call for more precise diagnostic criteria aims to reduce stigma and improve care, the mixed reactions highlight the complex and deeply personal nature of the conversation surrounding obesity. Further research and ongoing dialogue will be essential to address the concerns of both healthcare providers and those affected by the condition.
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