The body mass index (BMI) was developed in the 19th century by Belgian statistician Adolphe Quetelet to measure human body proportions at a population level. By the mid-20th century, it became a widespread tool for classifying individuals as having normal weight, being overweight, or being obese. However, this method does not accurately reflect health status nor does it provide information about the fat distribution of each individual. It can both underestimate and overestimate adiposity and disease. Considering these limitations, the Clinical Obesity Commission of The Lancet Diabetes & Endocrinology published a long-awaited new definition today, suggesting the inclusion of the term “pre-obesity” and recommending the use of BMI solely for epidemiological screening studies. The experts stated, “We recommend that BMI be used only as a surrogate measure of population risk for epidemiological screening purposes, rather than for individual health assessment.” With this comprehensive proposal, if implemented, the work could revolutionize the diagnosis and treatment of obesity, helping to dismantle stigmas associated with it.
Discrimination related to obesity affects between 19% and 42% of adults, particularly women, as reported by 56 experts who are part of the Commission. “Internalized stigma related to obesity negatively affects mental and physical health beyond obesity itself, through stress, social isolation, low self-esteem, anxiety, depression, and substance abuse,” the authors noted. Paradoxically, weight, they detailed, “can exacerbate eating disorders, emotional overeating, and avoidance of physical activity.” The problem is significant, as more than one billion people worldwide live with obesity, including 124 million children and adolescents. Among those aged 5 to 19 years, the prevalence increased from 4% in 1975 to 18% in 2016. Additionally, in 2019, 38.2 million children under five years of age were reported to be affected. The authors indicate that this increase is driven by social and environmental factors, urbanization, and access to ultra-processed foods. The report was prepared by international experts from various medical disciplines and is supported by 75 scientific organizations worldwide. It did not receive funding from companies and was logistically supported by King’s Health Partners, an academic health sciences center located in London, United Kingdom.
What does the diagnosis consist of? To overcome the deficiencies of the BMI-based model, the proposal includes the use of DEXA absorptiometry. What do they mean by pre-obesity? The consensus proposes that pre-obesity should be addressed as a state of excess that affects organ function but increases the risk of developing chronic diseases. According to the authors, “the condition is normal for organs. They have active disease, although variable, generally increased, clinically several other transmissible diseases.” There is evidence that pre-obesity can increase the risk of type 2 diabetes, prediabetes, hypertension, elevated triglycerides, and low levels of LDL cholesterol (HDL), as well as increased cardiovascular and atherosclerotic risks, among others. Professor Francesco Rubino, president of the Commission, explained: “Our rethinking recognizes a nuanced reality that allows for personalized care.” What are they seeking? He clarified that they aim to transform the general treatment approach. The main objectives include emphasizing that “public strategies to reduce population incidence must be based on current scientific evidence, rather than assumptions that blame individuals for the development of obesity.” Experts consulted in a dialogue with Infobae, such as Dr. Silvio Schraier, former president of the Argentine Society of Nutrition and vice director of the specialization career at the Barceló Foundation, positively valued the publication. “I agree that it implies that organ function is altered. It is also key to highlight that it increases the risk of, at least, 50% reducing life expectancy by 7 to 10 years,” he expressed. The expert considers the concept of pre-obesity necessary, viewing it not just as a stage but as a warning of elevated risks for future complications. He concurred that different methods should be considered for each individual in consultations, taking into account the diversity of ethnicities.
Similarly, María Virginia Busnelli, a medical specialist in nutrition at Nutrición Actual, stated: “We were waiting for this publication as it addresses a chronic systemic condition characterized by alterations in tissues and organs due to adiposity.” She emphasized that this “provides a precise and empathetic medical framework that has the potential to benefit early intervention.” The proposal includes specific criteria and additional measures with adjusted thresholds based on age, sex, and ethnicity, which will allow for the identification of cases in early stages to prevent complications, Dr. Busnelli asserted. She highlighted that the publication “recognizes the multifactorial nature of obesity, which is not simply a matter of willpower. In this way, it helps to eliminate prejudices and stigmas, promoting a respectful and effective approach.” The report calls for responsible systems and policies to ensure equitable treatment based on evidence. It addresses symptoms associated with obesity.
