Commission report on “Fat in the Belly” and recommendations for a new category of obesity based on improved objective measures of illness,” Dr. A. Kushner, MD, MPH, Phys. Lett.
“Fat in the belly causes systemic inflammation, which then goes on and causes other metabolic problems like elevated blood sugar, elevated blood pressure and increased fats in the blood,” Kushner explains. This can set the stage for metabolic diseases including diabetes as well as heart disease.
The commission recommends a new category of obesity based on objective measures of illness. The first category is called ‘clinical obesity’, for people who already have a chronic disease associated with obesity. The second category is pre-clinical Obesity, and it means that a person has an increased risk of developing a health condition due to their level of body fat.
The chair of the commission says the reframing acknowledges the nuanced reality of Obesity and allows for personalized care.
The Commission included 56 experts with expertise in nutrition, endocrinology, internal medicine and public health. Their report is in a journal.
More than 1 billion people worldwide live with obesity, and the condition is linked to about 5 million deaths every year2 from disorders such as diabetes and cardiovascular disease.
Because it is easy to measure and compare, BMI has long been used as a tool to diagnose obesity. It does not account for differences in body composition, such as fat versus muscle, so it does not offer a full picture of health.
A group of 58 researchers are challenging the way obese people are defined and diagnosed, arguing that current methods do not capture the complexity of the condition.
Some people are stocky and muscular. When they step on the scale, their body weight may place them in the category of obesity, due to the weight of the muscle mass. But these folks may be healthy.
Although there isn’t a fixed threshold for obesity, body fat is typically considered to be in excess when it is above 25% in men and 30–38% in women. Because measuring adiposity directly might be impractical or costly, alternative health markers such as waist size, waist-to-hip ratio or waist-to-height ratio are important, the researchers say. They say it is safe to assume that a person with a body mass index of 40 or higher has high body fat.
“We’re not throwing out BMI, we are now recommending that individuals have another measurement obtained that more directly gets an estimate of body fat,” Kushner says.
The new definition published in The Lancet Diabetes & Endocrinology focuses on how excess body fat, which is a measure known as adiposity, affects the body rather than just relying on the body mass index to determine weight.
In order to determine if a person has excess body fat, the results of laboratory tests, medical history, and information on daily activities should be looked at, according to a study by Robert Eckel. He says that the diagnostic criteria are standardized across global health systems.
Louise Baur is a co-author of the study and says that the assessment of age, gender and ethnicity is equally important because certain groups may face health risks at lower thresholds than others.
“Now the idea is, eat less, move more, and you’ll lose weight,” says van Rossum, who wasn’t involved in the work. She says, “although a healthy lifestyle is important, we wouldn’t have an epidemic if it were so simple.”
The shift could improve clinical care, public- health policies and societal attitudes toward Obesity, says Elisabeth van Rossum, a endocrinologist at the Erasmus University Medical Center.