New obesity benchmark adds body fat, organ health to BMI

(Bloomberg) — Medical experts proposed an overhaul of how obesity is diagnosed, moving away from relying solely on body mass to include broader measurements such as heart health.

This recommendation signals a long-awaited shift away from a single imperfect metric toward a more personalized diagnosis that takes into account a person’s ability to complete everyday tasks and the condition of their organs. It may also limit prescriptions of blockbuster weight loss drugs.

The Lancet Diabetes and Endocrinology Commission, consisting of experts from around the world, on Tuesday put forward a new definition of obesity. It was endorsed by 76 organizations including the World Obesity Federation, the American Heart Association and Britain’s Royal College of Physicians.

“The commission is reframing obesity and acknowledging the nuanced reality of obesity,” said Robert Eckel, professor emeritus of medicine at the University of Colorado Anschutz Medical Campus and one of the group’s members.

Body mass index, the weight-to-height ratio, has long been criticized as too simplistic, as it cannot differentiate between fat and muscle mass. Currently, anyone with a BMI of 30 or higher is considered obese, regardless of their body composition or general fitness.

A new generation of obesity drugs such as Novo Nordisk A/S’s Vegovy and Eli Lilly & Company’s Zepbound are changing the perception of obesity as a multifaceted disease that requires medical intervention rather than more willpower, which Ushering in a revolution with wide-ranging implications from food production to food manufacturing. medical insurance.

According to Francesco Rubino, chairman of the commission and head of metabolic and bariatric surgery at King’s College London, BMI is more useful at a population level rather than an individual level.

“BMI does not contain any information about organ function,” he said. For example, how well is the heart working? Are the lungs functioning normally?”

Under the new guidelines, patients whose BMI previously classified them as obese should get checked for excess fat with tools such as waist circumference or waist-to-hip ratio. If they have excess fat, the doctor should look for signs of organ dysfunction or limitations in day-to-day activities.

A person will be considered clinically obese only if the last measurement is also positive. Otherwise they would be classified as pre-clinical obese.

According to the Lancet Commission, the new benchmarks should be incorporated into clinical-practice guidelines and training of health-care workers. This applies to adults regardless of age, gender or ethnicity, said Eckel, of the University of Colorado.

The new framework could help physicians determine whether a patient needs medications or just monitoring and general health advice. As a result, the way obesity medications are prescribed may also be affected.

Wegovi and Zepbound are approved in the US for anyone with a BMI of 30 or higher. The limit for individuals with weight-related conditions such as high blood pressure or sleep apnea is 27. But under a new set of rules, some patients previously considered obese may no longer be eligible for treatment.

Drug manufacturers are also increasingly paying attention to the importance of body composition, with companies trying to create therapies that help people lose fat as well as maintain muscle.

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