It’s estimated more than one billion people in the world are living with obesity as defined by the current definition that relies solely on body mass index or BMI. Now health care experts say one-size-does-not-fit-all.
It’s been used for more than 100 years but doctors around the world say it’s time to move the field forward when it comes to body mass index.
Dr Robert Kushner is a Northwestern Medicine physician and obesity expert.
“It does not measure one’s health. It does not measure body fat. And it does not measure the composition of the body or where the fat is located,” he said. “So one can have an elevated BMI and yet be very muscular like a football player. Or someone cannot have a high BMI but have extra body fat because their muscle mass is so low.”
Kushner helped craft the new definition of obesity as part of the Lancet Diabetes and Endocrinology Special Commission. Instead of relying on a single number – BMI – doctors are calling for a more nuanced approach to classifying the condition.
“Are you someone who is gaining extra body weight but is healthy and you can go on a live your life with maybe attention to eating healthy and being active? Or is your weight starting to impair your health and you should seek medical advice?” Kushner said.
The new recommendations, backed by 75 medical organizations around the world, call for health care providers and patients to consider multiple key factors when it comes to determining health risk — including waist circumference and fat distribution around the body — in addition to BMI.
“I think the commission’s report is monumental in that it’s the first take from getting away from just BMI and looking more specifically at the individual,” Kushner said.
The new definition consists of two categories: pre-clinical obesity and clinical obesity. Patients with pre-clinical obesity may have a higher BMI and some extra body fat while maintaining normal organ function. They may also have an increased risk for diseases like Type 2 diabetes, heart problems and certain cancers.
“They just may need some counselling on how to live a healthy life, don’t gain any body weight, eat healthy become physically active and be monitored,” Kushner said.
Patients with clinical obesity may exhibit shortness of breath, aching knees and hips, swelling in the legs, urinary incontinence, headaches and obesity-induced heart failure.
“So we’re trying to differentiate a condition which is not impairing your health versus one that is impairing your health and that has never been done before,” Kushner said.
The commission hopes more health care providers will adopt the new definition to help identify patients who need special intervention as well as those who do not.
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