The way we think about obesity is changing.
A new definition and diagnostic framework for obesity has been put forward in a commission published by The Lancet Diabetes & Endocrinology, recognizing both ‘clinical obesity’ and ‘preclinical obesity’.
Obesity affects nearly an eighth of the world’s population, but there is no global consensus on how it should be classified.
The commission, led by Professor Francesco Rubino (Kings College London), sought to bring clarity and precision to the diagnosis in order to better recognise the unique health needs of each individual.
What does ‘preclinical obesity’ mean and how will the new diagnostic framework impact people’s lives?
What is clinical obesity?
The new diagnostic framework shifts away from defining peoples’ bodies by body mass index (BMI), a measure that has been criticized for not considering other factors like health or body fat percentage.
Under the new definition, ‘clinical obesity’ is determined by the impact someone’s weight has on their health. The report defines it as “a chronic, systemic illness” in which bodily functions are impacted by excess fatty tissue, also known as adipose tissue.
What is preclinical obesity?
The commission defines “preclinical obesity” as having excess fatty tissue which doesn’t yet impact someone’s health. However, the individual will generally have an increased risk of developing clinical obesity and other diseases, such as type 2 diabetes, cardiovascular disease and certain types of cancer.
Experts believe that identifying “preclinical obesity” can positively impact people’s lives.
“By identifying individuals in a preclinical obesity phase, where they are not yet classified as obese but are showing signs of metabolic dysregulation, there is an opportunity for earlier intervention”, Dr Mohammed Enayat, GP and founder of longevity clinic HUM2N, told The Standard.
“This proactive approach shifts the focus from treatment to prevention, empowering people to take control of their health before serious consequences arise”, said Dr Suzanne Wylie, GP and medical adviser at IQdoctor.
However, experts caution that while “redefining obesity as a progressive health condition rather than an issue of willpower” is important, “early diagnosis should empower individuals” and should “avoid unnecessary medicalisation or reinforcing stigma”, said Emily Lenoir, registered associate nutritionist and behaviour change coach at Voy.
How do you know if you’re in the obesity danger zone?
The recognition of preclinical obesity may help people protect themselves from serious health risks, whether “it’s encouraging proactive lifestyle choices, assessing potential health issues, or addressing the root causes behind weight gain”, said Dr Martin Thornton, GP and Bluecrest's Chief Medical Officer.
Loud snoring can be an early sign of sleep apnoea, a condition that causes breathing to stop and start while you’re sleeping. Excess body fat can cause sleep apnoea by building up inside the throat and obstructing breathing.
According to the new guidelines, someone who suffers from sleep apnoea can be classified as clinically obese.
Painful knees
Under the new guidelines, for someone to be clinically obese, their weight must be causing them health problems or impacting their ability to perform day-to-day tasks. Regular joint pain that makes walking difficult would classify someone as clinically obese.
Excess stomach fat
The new guidelines list specific measurements such as waist circumference, waist-to-hip ratio and waist-to-height ratio as indicators of clinical obesity.
Getting out of breath easily
Clinical obesity is defined by its impact on your health and daily life. If you are finding yourself panting when walking up the stairs, it could be a sign that your weight is making things more difficult.
What should you do if you are in the obesity danger zone?
Visit your GP
Your GP can offer advice about how to lose and manage your weight safely. They can also point you in the direction of helpful services, like local weight loss groups.
Change your diet
Swapping fast food, processed food and sugary drinks for healthier choices can help you lose weight. The NHS advises obese people to avoid eating lots of very salty foods, because they can raise blood pressure.
Take up exercise
Adults are recommended that they should do a minimum of 150 minutes of moderate-intensity exercise a week, according to Chief Medical Officers. This is classified as activities that increase your heart and breathing rate, such as brisk walking, cycling, and dancing.
Alternatively, you could do 75 minutes of vigorous-intensity activity a week, such as running or circuit training.
It’s also beneficial to do strength exercises and balance training two days a week, such as working out at the gym or carrying heavy shopping bags.
