Experts Unveil Updated Obesity Definition: Will This Lead to Increased Access to Weight Loss Injections?

Experts Unveil Updated Obesity Definition: Will This Lead to Increased Access to Weight Loss Injections?

Francesco Rubino and over fifty global experts advocate for redefining obesity diagnosis, highlighting the limitations of BMI. They propose a more comprehensive approach that evaluates excess fat and organ function, emphasizing the need for accurate assessments to determine treatment eligibility. While the new guidelines aim to improve clarity around weight-loss medications, concerns persist about potential under-treatment and accessibility, especially for children and those in need. A broader conversation on obesity prevention and intervention is essential for effective solutions.

Rethinking Obesity Diagnosis: A Call for Change

Francesco Rubino, an obesity surgeon at King’s College Hospital in London, emphasizes the need for a fresh perspective on obesity. He argues that the current diagnostic methods are flawed, leading to many individuals missing out on necessary treatments or being incorrectly labeled as unhealthy. Rubino, along with a team of over fifty global experts, recently presented new guidelines aimed at redefining obesity in the medical journal “The Lancet Diabetes and Endocrinology.”

Stefan Bornstein, a diabetologist at the University Hospital Dresden and a member of the Lancet Commission, highlights the pressing issue: “Doctors are inundated with requests for quick and easy weight-loss solutions like the latest injections. Thus, a more accurate diagnosis of obesity is essential.” He points out the absence of clear guidelines for making informed, evidence-based decisions about who qualifies for costly but effective medications such as Ozempic or Wegovy.

The Limitations of BMI in Obesity Diagnosis

It is widely recognized that excess fat tissue can cause significant harm to various organs, including the lungs, heart, brain, kidneys, and liver. Moreover, this condition can lead to muscle and joint damage or chronic inflammation. However, the traditional method of diagnosing obesity—using the Body Mass Index (BMI)—has significant limitations. The BMI is calculated by dividing a person’s weight in kilograms by the square of their height in meters (BMI = weight : height²). A person who weighs 75 kilograms and is 1.75 meters tall would have a BMI of 24.5, categorizing them as within the normal weight range. Current guidelines label anyone with a BMI of 30 or higher as obese.

Yet, the BMI fails to account for the differentiation between “healthy” muscle and “harmful” fat, nor does it reflect an individual’s overall physical condition. The Lancet Commission argues for viewing BMI merely as a preliminary indicator of obesity while considering a more comprehensive approach.

The expert panel advocates for a multi-faceted strategy to diagnose obesity. This includes assessing excess fat through measurements such as waist circumference or waist-to-hip and waist-to-height ratios. Ideally, advanced imaging techniques like DEXA scans would be used to accurately measure fat, muscle mass, and bone density.

Additionally, it is crucial to evaluate whether any organ damage is present. This can be done through blood tests, lung function assessments, or ECGs. Healthcare professionals should also explore whether everyday activities, like climbing stairs or performing personal care tasks, pose challenges for the individual.

While this comprehensive diagnostic approach may be more time-consuming and costly than a simple BMI calculation, Rubino argues that these tests are typically performed when a patient with visible overweight seeks medical attention.

According to the proposed guidelines, an individual is classified as obese—and thus eligible for treatment—if they have excess fat tissue and exhibit functional impairments in at least one organ or experience limitations in daily activities. It is essential that all affected individuals receive appropriate treatment, whether through medication or surgical options.

However, not all individuals with excess fat tissue require immediate intervention. Some may have accumulated fat without experiencing organ dysfunction. For instance, they might have abdominal fat, but their liver functions normally, or they may possess thick limbs without joint pain and be able to exercise without difficulty.

The timeline for when organ damage occurs varies based on numerous factors, including genetics, pre-existing conditions, the distribution of fat, fitness levels, and lifestyle choices. The Lancet Commission emphasizes the importance of assessing the individual risks for those who are pre-clinically obese. Regular check-ups, lifestyle modifications, and medication therapy should be considered for those at high risk.

As it stands, these new diagnostic recommendations are merely expert proposals, and it remains uncertain whether they will be incorporated into national treatment guidelines. Bornstein notes that these guidelines provide better clarity on who should be considered for weight-loss injections and who should not.

However, some experts outside the commission express skepticism about the feasibility and precision of the new guidelines compared to the current methods. They argue that responsible physicians do not rely solely on BMI when prescribing weight-loss injections.

Concerns have also been raised that the new guidelines might lead to fewer treatments for overweight children lacking visible health issues. Nathalie Farpour-Lambert, a specialist in childhood and adolescent obesity at the University Hospital Geneva, asserts, “I have rarely encountered severely overweight children without health complications.”

Matthias Blüher, another obesity expert from the University Hospital Leipzig and a member of the commission, highlights the critical issue of under-treatment among obese individuals of all ages. He notes that in Germany, less than five percent of genuinely sick adults with obesity receive the necessary weight-loss injections, a trend seen in other countries as well.

The current shortage of medications is exacerbated by their popularity as lifestyle products and the sheer number of individuals needing assistance. Moreover, many who genuinely require these medications find them financially out of reach since health insurance covers them only under specific circumstances. It is hoped that the new guidelines will lead to broader insurance coverage for these treatments, which currently cost between 170 to 300 euros or francs monthly and must be maintained for life.

“I genuinely hope these new guidelines spark a broader conversation about obesity beyond just the medical community,” says Blüher. There is a pressing need for everyone, including healthcare professionals, policymakers, and society at large, to enhance preventive measures and explore innovative solutions. Additionally, it is crucial for individuals to recognize that being overweight can pose serious health risks and that seeking medical advice should not wait until health issues arise.