New innovation revolutionizes obesity diagnosis and treatment

The current system for diagnosing and managing obesity is flawed. Relying solely on body mass index (BMI) excludes many people who could benefit from obesity treatment. A new framework, launched by the European Association for the Study of Obesity (EASO) and published in Nature Medicine, aims to modernize obesity diagnosis and treatment. This new approach incorporates the latest developments in the field, including new obesity medications.

Although obesity is widely recognized as a multifactorial, chronic, relapsing, non-communicable disease marked by abnormal or excessive accumulation of body fat, many still diagnose it based only on BMI. This method doesn't consider the role of adipose tissue distribution and function in the severity of the disease.

The EASO Steering Group, including current and former Association Presidents, has developed a series of statements on obesity diagnosis, staging, and treatment. These statements align obesity management with the latest scientific knowledge and developments.

The authors highlight a significant change in the anthropometric component of the diagnosis. They state, “An important novelty of our framework regards the anthropometric component of the diagnosis. 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 new framework emphasizes that abdominal (visceral) fat accumulation is a critical risk factor for health deterioration, even in those with low BMI who show no overt clinical symptoms. It includes individuals with a BMI between 25 and 30 kg/m2 who have increased abdominal fat and any medical, functional, or psychological impairments in the definition of obesity.

This approach reduces the risk of undertreatment in patients who would otherwise be overlooked by the current BMI-based definition.

The authors clarify that their recommendations adhere to current guidelines, emphasizing behavioral modifications as the main pillars of obesity management. These include nutritional therapy, physical activity, stress reduction, and sleep improvement. Psychological therapy, obesity medications, and metabolic or bariatric procedures may also be considered.

However, the steering committee noted that current guidelines are based on clinical trial evidence, where inclusion criteria were mostly based on anthropometric cut-off values rather than a comprehensive clinical evaluation. Strictly applying these criteria in practice prevents the use of obesity medications or metabolic/bariatric procedures in patients with a significant burden of obesity disease but low BMI values.

Therefore, the committee proposed that obesity medications should be considered for patients with a BMI of 25 kg/m2 or higher, a waist-to-height ratio above 0.5, and the presence of medical, functional, or psychological impairments, regardless of current BMI cut-off values.

The authors assert, “This statement may also be seen as a call to pharmacological companies and regulatory authorities to use inclusion criteria that are more adherent to the clinical staging of obesity and less to traditional BMI cut-offs when designing future clinical trials with obesity medications.”

They conclude that this approach will align obesity management with the treatment of other non-communicable chronic diseases. The goal should be long-term health benefits, not short-term outcomes. Defining long-term personalized therapeutic goals should be part of the discussion with patients from the beginning of treatment.

This approach considers the stage and severity of the disease, available therapeutic options, possible side effects and risks, patient preferences, individual drivers of obesity, and potential barriers to treatment. The focus should be on a long-term or lifelong comprehensive treatment plan rather than short-term weight reduction.

This new framework recognizes that treating obesity requires more than a one-size-fits-all approach. By considering factors beyond BMI, it aims to provide a more inclusive and effective strategy for managing obesity. This shift in perspective could lead to better health outcomes for many people who have previously been overlooked or inadequately treated under the current system.

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