Is Obesity Always A Disease? Scientists Offer A More Nuanced View

More than 50 health experts have called for a rethinking of the definition of obesity, highlighting that some overweight people may be metabolically healthy.

A crucial debate about how to define and treat obesity has gained momentum following the publication of a report in The Lancet Diabetes and Endocrinology.

More than 50 physicians and scientists participated in the development of this document, which proposes a paradigm shift: obesity should not always be automatically considered a disease, as some people can be obese and still maintain a healthy metabolism.

The proposal breaks with the traditional view, in which the body mass index (BMI) was the predominant measure for classifying patients.

According to experts, this 19th-century formula is limited and does not accurately reflect the complexity of metabolic health.

“What really defines the disease?” asks Francesco Rubino, one of the main proponents of the report, emphasizing the need to rethink the clinical approach.

A more nuanced view of obesity

The document suggests distinguishing between “clinical obesity” and “preclinical obesity .” The former would include people who, in addition to being overweight, have metabolic complications and require treatment such as drugs or bariatric surgery.

The second, on the other hand, would encompass those whose health parameters are stable and whose management should focus on prevention and future risk reduction.

For Katherine Saunders, an obesity specialist, this perspective is more realistic. However, she acknowledges that implementing more comprehensive assessments, such as body composition analysis or fat distribution studies, could be difficult in resource-limited healthcare systems.

The support of the international medical community

The proposal has received support from more than 75 professional organizations, including the American Heart Association and the World Obesity Federation.

However, it remains to be seen how these recommendations will be implemented in everyday clinical practice, especially in countries where access to treatment remains unequal.

One of the most relevant points of the report is the need to analyze abdominal fat, which is associated with higher cardiovascular risks, compared to other, less dangerous types of fat accumulation.

The importance of adapting the criteria to different populations is also emphasized: people of Asian descent, for example, may develop health problems with a lower BMI than white Europeans.

Technology and customization, keys to the future

Experts believe that the development of more affordable technologies for measuring body composition will be essential to bringing these recommendations into everyday medical practice.

Although this means more work for professionals, it would allow for more accurate diagnoses and personalized treatments.

Ultimately, the report seeks to change the narrative about obesity, promoting a less stigmatizing and more equitable approach.

Recognizing that not all people with obesity need the same treatment could mark a turning point in medical care, promoting prevention, personalization, and equitable access to health care.