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Image source, Getty Images photo caption, Experts say that people with excess body fat can still be active and healthy. Item information Author, Philippa Roxby Author’s title, BBC News, Health Correspondent January 16, 2025 A report prepared by experts from around the world warns that there is a risk of diagnosing too many people with obesity, and that a “more precise” and “nuanced” definition of this term is needed. Doctors should take into account the overall health of patients with excess fat, rather than simply measuring their body mass index (BMI), the report says. Those who suffer from chronic diseases caused by their weight should be diagnosed with “clinical obesity,” but those without health problems should be diagnosed with “preclinical obesity.” It is estimated that more than one billion people suffer from obesity worldwide, so there is a great demand for weight loss medications. The report, published in the magazine The Lancet Diabetes & Endocrinologyis supported by more than 50 medical experts from around the world. New look “Obesity is a spectrum,” says Francesco Rubino, a professor at King’s College London and president of the group that carried out the research. “Some suffer from it and manage to lead a normal life, function normally.” “Others cannot walk or breathe well, or are in a wheelchair and have serious health problems.” Image source, Getty Images photo caption, There is a difference between overweight people who can be physically active and lead healthy lives and those who cannot, the report says. The report calls for “reframing” the concept of obesity to distinguish between patients with a disease and those who remain healthy but are at risk of disease in the future. Currently, in many countries, obesity is defined as having a BMI greater than 30, a measure that estimates body fat based on height and weight. Access to weight loss medications such as Wegovy and Mounjaro is usually restricted to patients in this category. However, according to the report, BMI reveals nothing about a patient’s overall health, and does not distinguish between muscle and body fat or take into account the more dangerous fat around the waist and organs. Experts advocate a new model that takes into account the signs of obesity that affect the body’s organs – such as heart disease, dyspnea, type 2 diabetes or joint pain – and its detrimental impact on daily life. This indicates that obesity has become a clinical disease and needs pharmacological treatment. Image source, Getty Images photo caption, Access to weight loss medications such as Wegovy and Mounjaro is often restricted to patients with a high BMI. However, people with “preclinical obesity”, instead of drugs and surgery, should be offered weight loss advice, counseling and follow-up to reduce the chances of health problems developing. Treatment may also be necessary. “Unnecessary treatment” “Obesity is a health risk; the difference is that for some it is also a disease,” Professor Rubino said. The expert added that it was sensible to redefine it to know the level of risk in a broad population, instead of the current “blurred image of obesity.” According to the report, waist-to-height ratio or direct measurement of fat, along with a detailed medical history, can provide a much clearer picture than BMI. Image source, Getty Images photo caption, BMI is not an index that gives us information about a person’s health status, the report says. Louise Baur, a childhood obesity expert at the University of Sydney who helped produce the report, says the new approach will allow obese adults and children to “receive more appropriate care”, while reducing the number of overdiagnoses and unnecessary treatments. At a time when drugs that reduce body weight by up to 20% are being prescribed on a large scale, the report states that this “rethinking” of obesity “is all the more relevant” as it “improves the accuracy of diagnosis.” “Limited funding” The Royal College of Physicians of London says the report lays a solid foundation “for treating obesity with the same medical rigor and compassion as other chronic diseases.” Distinguishing between preclinical and clinical obesity would be “a vital step” and would “highlight the need to identify and intervene early,” while providing appropriate care to patients whose health was already severely affected, the college said. Many fear that pressure on healthcare budgets will mean less money for “pre-obese” patients. Jim Mann, co-director of the Edgar Center for Diabetes and Obesity Research in Otago, New Zealand, said there was likely to be an emphasis “on the needs of those defined as clinically obese” and that limited funding was “very likely” to be intended for them. Subscribe here to our new newsletter to receive a selection of our best content of the week every Friday. And remember that you can receive notifications in our app. Download the latest version and activate them.