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Redefining Obesity With New Global Guidelines

Robert Kushner, MD, professor of Medicine in the Division of Endocrinology, is a member of the commission that devised the new definition and diagnostic criteria of clinical obesity.

An international team of scientists has developed a new set of global clinical guidelines for obesity aimed at better diagnosing and categorizing the condition, according to a report published in The Lancet Diabetes and Endocrinology.

Previously, diagnosing obesity relied on body mass index (BMI), an imprecise measurement which can lead to under-diagnosis of people who are ill and, conversely, over-diagnosis of people who currently do not have the negative health consequences associated with obesity.

With one billion people in the world now estimated to be living with obesity, scientists with The Lancet Diabetes & Endocrinology Commission have defined a new way to diagnose obesity by using objective measures of illness based on an individual’s risk factors. 

The study authors also introduced two novel diagnostic categories of obesity: clinical obesity and pre-clinical obesity, which delineate if and how an individual’s excess body fat affects their organ health and daily functioning.

Robert Kushner, MD, professor of Medicine in the Division of Endocrinology, is a member of the commission that devised the new definition and diagnostic criteria of clinical obesity.

Clinical obesity is defined in the new guidelines as a chronic disease with specific signs and symptoms of ongoing organ dysfunction due to obesity alone. Treatment for clinical obesity — lifestyle, medication, surgery, etc. — should be aimed to fully regain or improve the body functions reduced by excess body fat, according to the report.

Pre-clinical obesity is defined in the new guidelines as being associated with variable level of health risk, but no ongoing health complications due to excess body fat. The approach to care should aim at risk reduction.

All people living with obesity should receive health advice and evidence-based care when needed — free of stigma and blame — with different strategies for clinical obesity and pre-clinical obesity, according to the new guidelines.

The guidelines also call on insurance companies to cover treatment for clinical obesity without requiring the presence of another disease.

“The commission’s report is a major step forward in recognizing obesity as a disease and not merely a risk factor. It also helps clinicians identify individuals who are in need of treatment,” Kushner said.

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