Is obesity. The discussion of this new definition by a doctor.

Chiu, F. (n.d.). CNN.

https://www.cnn.com/2025/01/24 & 1:38PM.

Health professional’s, in general, have depended upon the calculation of BMI; an investigation that measures body fat content based on an individual’s height and weight since it conveys much more about the accumulated fat reserves to access potential health risks.

Renowned health agencies, such as the World Health Organization, and the United States’ Centers for Disease Control and Prevention have classified adult obesity as having a BMI of 30 and above and overweight when it ranges from 25 to 29.9.

Recently an international commission proposed a novel definition of obesity taking into consideration waist circumference in addition to BMI calculations as a measure of the effect of excess body fat on health, rather than being dependent solely on BMI calculations. This newly defined concept was published online in The Lancet Diabetes & Endocrinology on January 14 and may affect the clinical approach to the 890 million adults currently suffering from obesity across the world.

What exactly is BMI, and what criticisms have been directed at its application? How does the new definition vary from the previous one, and in what ways might this shift impact clinical care? Are these adjustments likely to happen? What questions should individuals think about posing to their health care providers as discussions around revisions take place?

I sought answers to these questions from Dr. Leana Wen, a CNN health expert. Dr. Wen is an attending physician in the emergency department and an adjunct associate professor at George Washington University. She has also served as health commissioner in Baltimore.

Dr. Leana Wen explains that body mass index is the weight in kilograms divided by the square of the height in meters. For people who are more used to measuring weight in pounds and height in feet and inches, there are online calculators one can use. You put in your weight and your height and it calculates what your BMI is.

Undoubtedly, the primary advantage associated with BMI is its simplicity of calculation. All you need to do is take a reading of the scale and measuring height with a ruler. Also, it is considered one of the fundamental health indicators in the clinical condition, since it has been existing for years and has been incorporated in several research works. From all these works, it has been established that higher BMI relates to many chronic diseases, including type 2 diabetes, high blood pressure, high cholesterol levels, heart disease, and even cancer. On the contrary, lowering one’s BMI would lead to a minimized risk of suffering from such conditions.

It's commonly recommended by health professionals but isn't a highly recommended measurement. To begin, it only gives consideration to general weight rather than specially measuring weight from fatty tissue. Hence, people with a lot of muscle mass (for example, athletes) may have a high BMI and be classified as obese on paper, although they do not actually have excessive body fat, or adiposity.

Thus, a person may be of normal body weight, but still have an undesirable amount of body fat. Another common criticism is that the B.M.I. calculations do not relate to the accurate measurement of different racial and ethnic groups. This has been brought out in the open by certain medical bodies like the American Medical Association through a paper released in June 2023 claiming that B.M.I. does not serve as a good weapon to measure body fat especially across varied demographics. Another argument among some critics is that we need to differentiate between those classified as obese using certain criteria and those with issues due to obesity.

From CNN: How does this new definition recommended by this International Commission of differ from previous ones?

Reference: Micic D, Balint LJ, Kruljac I, et al. Definition and pathogenesis of obesity. In: Feingold KR, Anawalt B, Boyce A, et al., editors. Endotext. South Dartmouth (MA): MDText.com, Inc.; 2000.
This commission, consisting of 58 selected global experts, proposes an alternative view of obesity to that of traditional definitions in two key ways. They propose that obesity should not be measured only through the BMI but that this index should serve only as a screening tool to evaluate who should further be tested for body fat. Additional ways of determining fatty adequacy include measuring waist circumference, calculating waist-to-hip ratio, or special apparatus that could measure bone density in terms of what percentage of the whole body is composed of fat.

The first official distinction is that of the "clinically obese," wherein an individual is deemed obese and shows bodily systems under impact. This group, thus, will include all obese people who are diabetic and/or have heart complications or other medical condition indicating obesity and related to joint or back pain. Medical professionals should consider evaluating these people for treatment aimed at directly addressing conditions related to obesity.

Conversely, it labels some as “pre-clinically obese.” According to the commission, this includes people who have obesity, though it has not been associated with other disease processes. As such, for them, the obesity is a risk factor, and it should be controlled to reduce the likelihood of emerging chronic conditions; however, they present no medical complications with their obesity.

What are the benefits and drawbacks of this classification method? How might it impact clinical care?

Wen: I believe it is important to have a clearer definition of obesity. The use of BMI may be good for the measurement of research studies on a population scale; however, it should very strictly be an initial screening tool at the individual patient level, not the end-all criterion for determining whether someone is categorized as being obese.

Supporters of the revision stress the necessity of distinguishing between those obese individuals who need drug therapy to control their weight, such as GLP-1 agonist medications, from those who can adequately control their weight through diet and exercise alone. This new procedure could allow those afflicted with secondary obesity an easier and quicker way to obtain proper medical treatment. Moreover, redefining may help in reducing the social stigma related to obesity by presenting it as a chronic medical condition.

At the same time, it is widely accepted that BMI is a major risk factor for the development of serious chronic disease. Furthermore, there may be disagreement among clinicians on the term ‘pre-clinical obesity’ since they may want to be able to treat a serious chronic condition before any complications develop. If this redefinition gains an audience it is possible that insurance companies might not pay for particular treatments until such time as complications are apparent in a move that would harm efforts in preventive health care.

CNN: Do you think that this report by the commission will bring about any real changes?
Wen: It may happen but I believe that they are not going to be immediate. BMI is deeply entrenched in both clinical practice and research and is unlikely to be removed that easily.

Maybe with that in mind, many healthcare providers, and medical organizations have moved away from using BMI as the sole measure of gauging obesity. This report may serve to further dissuade clinicians from relying on BMI as their only measure.
CNN: What questions should patients be asking their health-care providers if they want the conversation to move beyond just the number that shows up on the BMI scale?

Wen: And it’s not unreasonable to ask your doctor to assess your body fatness, as recommended by this panel’s report. Waist measurement is easy to take. Studies show that the level of belly fat is strongly correlated with health risks; it reflects the level of visceral fat surrounding the organs.

Awareness regarding the health impacts associated with obesity needs to be known by all. This disorder should be appropriately addressed with compassion and focused treatment rather than the associated stigma and can involve nutritional and exercising therapy and, when necessary, the application of medicine as would be in any other chronic health disorder. People should talk about these options with their physician.

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