Is BMI KIA? The Lancet Diabetes & Endocrinology Commission’s Report on Obesity
A commission of 58 experts has redefined obesity, moving beyond BMI (body mass index) as the primary measure. They define:
Clinical obesity as a chronic, systemic illness resulting from excess adiposity that impairs organ and tissue.
Preclinical obesity as excess adiposity without current organ dysfunction but with an increased risk of developing clinical obesity and other diseases.
The commission recommends that BMI should primarily be used for population-level studies and screening, not as a sole individual measure of health. They advise:
- Confirming excess adiposity with direct body fat measurement or at least one anthropometric measure (like waist circumference) in addition to BMI, using appropriate cutoffs for age, gender, and ethnicity.
- For individuals with a BMI over 40 kg/m², excess adiposity can be assumed.
Diagnosis of clinical obesity requires evidence of reduced organ/tissue function due to obesity or substantial, age-adjusted limitations in daily activities caused by obesity.
- Individuals with clinical obesity should receive timely, evidence-based treatment to improve their condition and prevent further damage.
- Those with preclinical obesity should receive health counseling, monitoring, and interventions to reduce their risk.
The commission emphasizes the need for equitable access to obesity treatments and calls for public health strategies based on scientific evidence, rather than blaming individuals. They also highlight the importance of addressing weight-based bias and stigma in healthcare and policy.
These recommendations have a high level of consensus among the experts and are endorsed by numerous organizations.
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