Some doctors involved in treating obesity believe that body mass index (BMI) isn’t good enough to treat obesity and improve quality of life. That is, some people who have normal BMI values might also benefit from obesity treatment if they meet specific criteria.
Body measurements are still important. But the researchers believe the belly fat area is especially risky and that’s what they should be focusing on. An obesity diagnosis would only follow after other aspects are taken into consideration, including the presence of symptoms and impairments, whether medical, functional, or mental.
The European Association for the Study of Obesity (EASO) scientists believe the new diagnosis method might improve the quality of life of people who would otherwise not be diagnosed with obesity, as their BMIs would fall within normal values.
“An important novelty of our framework regards the anthropometric component of the diagnosis,” the authors said in a statement. “The basis for this change is the recognition that BMI alone is insufficient as a diagnostic criterion, and that body fat distribution has a substantial effect on health.”
“More specifically, the accumulation of abdominal fat is associated with an increased risk of developing cardiometabolic complications and is a stronger determinant of disease development than BMI, even in individuals with a BMI level below the standard cut-off values for obesity diagnosis (BMI of 30).”
The researchers propose new frameworks to diagnose obesity. They start by measuring abdominal fat in people with a normal BMI between 25 and 30kg/m2. Following the measurement, they would determine a new waist-to-height ratio. A value over 0.5 would be a risk factor for obesity even without symptoms, but it would not be enough for a diagnosis.
The doctors will also look at the presence of medical, functional, or psychological impairments to assess whether a person could benefit from obesity treatment options. The same therapies used to treat people with high BMI values would apply to people with normal BMIs who could be diagnosed as obese under the proposed framework.
That’s therapies aiming to correct one’s behavior, such as nutritional therapy, physical activity, stress reduction, and sleep improvement. Psychological therapy, obesity medications, and metabolic and bariatric procedures could also be offered to patients with high abdominal fat who might be in the early stages of developing obesity.
The EASO group also acknowledged that in the current guidelines of obesity treatment, obesity drugs, and metabolic and bariatric procedures aren’t part of therapies in patients “with a substantial burden of obesity disease but low BMI values.”
The researchers propose that the use of obesity medications should be considered in these patients regardless of BMI cut-off values.
The proposed frameworks “will move obesity management closer to the management of other non-communicable chronic diseases, in which the goal is not represented by short-term intermediate outcomes, but by long-term health benefits,” the authors said in a statement.
“Defining long-term personalised therapeutic goals should inform the discussion with the patients from the beginning of the treatment, considering the stage and severity of the disease, the available therapeutic options and possible concomitant side effects and risks, patient preferences, individual drivers of obesity and possible barriers to treatment. Emphasis on the need for a long-term or life-long comprehensive treatment plan rather than short-term body weight reduction is warranted.”
While the initiative is commendable, as it could indeed catch obesity cases much earlier, we’re still in the early days. It’s unclear how long it’ll take for the new obesity diagnosis framework to be adopted.
Meanwhile, you can read the full EASO article in Nature Magazine.