Experts urge overhaul of obesity measurements, introduce two new diagnostic categories of obesity

Experts urge overhaul of obesity measurements, introduce two new diagnostic categories of obesity

Seeking recalibration on how obesity is measured worldwide a global commission on this issue, in its recent report published in The Lancet Diabetes and Endocrinology, has said that Body Mass Index (BMI) is not an adequate indicator of obesity, as distribution of body fat is also crucial to assess overall health and disease patterns.

Simultaneously in step with this report, experts in India, including a group of doctors, nutritionists and others, from the National Diabetes Obesity and Cholesterol Foundation (N-DOC), Fortis C-DOC Hospital, and the All India Institute of Medical Sciences (AIIMS), have updated the guidelines for obesity treatment and diagnosis after 15 years.

Speaking to The Hindu, Anoop Misra, co-author of the paper said that these recommendations are vital for Asian Indians, typically because we have higher body fat percentages compared to Western populations and develop diabetes at lower BMI levels.

“This framework places special emphasis on abdominal fat distribution, which has particularly adverse effects in Asian Indian populations,” he said adding that abdominal obesity, which is now very common in Indians, is a harbinger of diabetes, heart disease and fatty liver.

What is also worrying the doctors is the fact that in India, they are seeing an early and widespread onset of abdominal obesity. The trend is hitting women and alarmingly, children too. They warn that Asian Indians experience more severe metabolic consequences from excess fat accumulation and studies show that excess fat in Indian populations generates higher levels of inflammation and metabolic disturbances at lower BMI thresholds compared to Western populations. “Starting with exercise and diet early on in life is the only preventive measure,’’ said Dr. Misra.

Giving a glimpse of obesity trends in India, the scientific paper, ‘Overweight and obesity, the clock ticking in India? A secondary analysis of trends of prevalence, patterns, and predictors from 2005 to 2020 using the National Family Health Survey (NFHS)’ — showed that over a 15-year period, the NFHS recorded that the combined prevalence of overweight or obese (BMI ≥25 kg/m2) among women in the age group 15 to 49 years and men in the age group 15 to 49 years increased from 12.6% to 24% and from 9.3% to 22.9% respectively.

This also shows that almost one-fourth of our population (both men and women) are currently either overweight or obese in India. The prevalence of obesity (BMI ≥30 kg/m2) has also more than doubled in both men and women in the last 15 years.

The current report states that medical approaches to diagnosing obesity rely on BMI, which is not a reliable measure of health or illness at the individual level. This can result in misdiagnosis with negative consequences for people living with obesity, and the wider society.

Speaking about the India report Naval Vikram, Department of Medicine, AIIMS, said that a distinct definition of obesity for Indians is crucial for the early detection of related diseases and the development of targeted management strategies. This study fills critical gaps in our understanding and offers a clear, rational approach to tackling obesity in the Indian population.

The Commission on clinical obesity recommends a new, nuanced approach where measures of body fat— for example, waist circumference or direct fat measurement— in addition to BMI are used to detect obesity, therefore reducing the risk of misclassification.

Additionally, the authors introduce two new diagnostic categories of obesity based on objective measures of illness at the individual level: ‘clinical obesity’ (a chronic disease associated with ongoing organs’ dysfunction due to obesity alone) and ‘pre-clinical obesity’ (associated with a variable level of health risk, but no ongoing illness).

The authors call for all people living with obesity to receive personalised health advice and evidence-based care when needed— free of stigma and blame— with different strategies for clinical obesity and pre-clinical obesity.

The proposed recommendations, endorsed by more than 75 medical organisations around the world, are designed to address limitations in the traditional definition and diagnosis of obesity that hinder clinical practice and healthcare policies, resulting in individuals with obesity not receiving the care they need.

“By providing a medically coherent framework for disease diagnosis, the commission also aims to settle the ongoing dispute around the idea of obesity as a disease, which has been at the centre of one of most controversial and polarising debates in modern medicine,’’ said Commission chair, Francesco Rubino, King’s College London (UK). He added that the question of whether obesity is a disease is flawed because it presumes an implausible all-or-nothing scenario where obesity is either always a disease or never a disease. Evidence, however, shows a more nuanced reality. Some individuals with obesity can maintain normal organ function and overall health, even long term, whereas others display signs and symptoms of severe illness here and now, he noted.

“Considering obesity only as a risk factor, and never a disease, can unfairly deny access to time-sensitive care among people who are experiencing ill health due to obesity alone. On the other hand, a blanket definition of obesity as a disease can result in over-diagnosis and unwarranted use of medications and surgical procedures, with potential harm to the individual and staggering costs for society,’’ he added.