Obesity diagnosis needs to change, research says fat distribution is more vital than BMI

Obesity diagnosis should not be restricted to checking the body mass index (BMI). A recent study has shown that assessing the distribution of body fat is more vital than relying on BMI alone.

Researchers in a novel study have proposed a novel framework for diagnosing, staging, and treating obesity in adults. They argue that limiting diagnosis to a BMI cutoff of 30 could exclude many people who could benefit from obesity treatment.

Accumulating abdominal fat, known as visceral fat, is a significant risk factor for impoverished health, even in people with a low BMI and no clinical signs of obesity, according to a novel framework developed by the European Association for the Study of Obesity (EASO) and published in the journal Nature Medicine.

The researchers noted that including people with a lower BMI but higher visceral fat in the definition of obesity reduced the risk of undertreatment compared with the current BMI-based definition.

“An vital novelty in our framework is the anthropometric component of the diagnosis. The basis for this change is the recognition that BMI alone is not sufficient as a diagnostic criterion, and that body fat distribution has a significant impact on health. More specifically, abdominal fat accumulation is associated with an increased risk of cardiometabolic complications and is a stronger determinant of disease development than BMI, even in people with a BMI below the standard cut-off for obesity (BMI 30),” say the EASO Steering Group members who developed the framework. he wrote.

The researchers recommend that people affected by the novel definition of obesity follow currently available obesity treatment guidelines, which include behavioral modifications such as nutritional therapy, physical activity, stress reduction and improved sleep, as well as psychological therapy, obesity medications and metabolic or bariatric procedures.

Research recommendations suggest that antiobesity medications should be considered for patients with a BMI of 25 kg/m² or higher, a waist-to-height ratio of more than 0.5, and medical, functional, or psychological problems, regardless of BMI cutoffs.

“This statement can also be seen as a call to pharmaceutical companies and regulators to design future clinical trials of obesity drugs using inclusion criteria that are more aligned with the clinical severity of obesity and less aligned with customary BMI cutoffs. This statement will bring obesity treatment closer to the treatment of other noncommunicable chronic diseases, where the goal is not short-term intermediate outcomes but long-term health benefits,” the researchers noted.