A global panel of health experts has issued a landmark recommendation in response to the ongoing debate over whether obesity should be classified as a disease. In their findings, published Wednesday in The Lancet Diabetes & Endocrinology, the experts propose a new approach that divides obesity into two categories: clinical obesity and pre-clinical obesity. The goal is to improve diagnosis and move beyond the stigma and discrimination often associated with the condition, which affects over a billion people worldwide.
The debate over whether obesity should be classified as a disease has been one of the most divisive issues in modern medicine. On one hand, obesity is linked to several serious health conditions, including Type 2 diabetes, heart disease, and certain cancers. The World Health Organization (WHO) has classified it as a “chronic complex disease” due to its widespread impact on public health.
However, many individuals who are classified as obese lead active, healthy lives and experience no significant health problems. Advocacy groups focused on combating fat-shaming argue that obesity should not automatically be viewed as an illness, highlighting the fact that not everyone with obesity faces negative health outcomes.
Some health professionals and patients argue that recognizing obesity as a disease would help elevate its status in public health discussions and drive the development of policies to address its effects more effectively.
A Middle Ground: Clinical and Pre-Clinical Obesity
Francesco Rubino, a bariatric surgeon at King’s College London and chair of the expert commission, emphasized that the controversy stems from differing perspectives on the issue. “Not everybody is entirely right and not everybody is entirely wrong,” Rubino said during a press conference.
To address this, the commission has introduced two new categories for obesity. “Clinical obesity” is defined as obesity that impacts organ function or causes other serious health problems. Conditions such as heart disease, liver complications, high cholesterol, sleep apnea, and musculoskeletal pain fall under this classification.
Individuals who are obese but do not suffer from such health issues would be classified as having “pre-clinical obesity.” These individuals may require monitoring but do not need immediate medical intervention, helping to avoid “overdiagnosis” and unnecessary treatments.
Rethinking Diagnosis
In addition to these new categories, the commission called for a shift away from the traditional reliance on body mass index (BMI), which has been widely criticized for its limitations. BMI measures the ratio between weight and height but fails to account for factors like body composition, making it an inadequate tool for diagnosing obesity.
The experts recommend using additional measurements, including waist circumference, waist-to-hip ratio, and potentially bone density scans, to achieve a more accurate and comprehensive diagnosis.
While the recommendations provide a clearer framework for understanding obesity, the panel emphasized that further research is needed to determine how many individuals fall into each of the two newly defined categories.
No Consensus on Weight Loss Drugs
The commission did not address the rising popularity of new weight-loss drugs, such as Wegovy, which have become a significant part of the obesity treatment landscape since the commission was formed. These drugs, which are used to manage weight in patients with obesity, have sparked significant interest but remain a point of controversy within the medical community.
Mixed Reactions from Stakeholders
The proposal to officially recognize “clinical obesity” was welcomed by some researchers, including Tom Sanders, a professor emeritus of nutrition and dietetics at King’s College London. He suggested that recognizing clinical obesity as a disease could prompt lawmakers to treat it as a disability, which could reduce discrimination, especially in employment settings, and combat the social stigma associated with obesity.
However, the nuanced recommendations failed to satisfy all parties. Some patient advocacy groups voiced concerns that the distinction between clinical and pre-clinical obesity might downplay the severity of the condition for many individuals. Anne-Sophie Joly, founder of France’s National Collective of Obese Associations, criticized the recommendations as “counterproductive” and argued that the panel was out of touch with the realities faced by people with obesity, who often lack adequate care.
On the other hand, those who are skeptical of classifying obesity as a disease were also dissatisfied. Sylvie Benkemoun, a psychologist who leads France’s Reflection Group on Obesity and Being Overweight, acknowledged the importance of initiating a discussion but felt the recommendations did not go far enough in addressing the complexities of the issue.
As the debate over obesity’s classification continues, the expert commission’s recommendations represent a significant step in redefining the condition and its impact on individuals and public health. However, it is clear that the conversation is far from settled, with differing views still prevalent among healthcare professionals, patients, and advocacy groups alike.
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