(© Feng Yu - stock.adobe.com)
When the issue is obesity, the questions are many, and the routes to answers anything but straight. What is abundantly clear is a need for consensus on two foundational matters:
- What is a useful definition for obesity?
- Is obesity a disease?
To answer these questions and standardize the concepts, a group of 58 experts, representing multiple medical specialties and countries, convened a commission and participated in a consensus development process. They were careful to include people who experienced obesity to ensure consideration of patients’ perspectives. The commission’s report was just published in The Lancet, Diabetes & Endocrinology.
The commission recognized that the current measure of obesity, which is body-mass index (BMI), can both overestimate and underestimate adiposity (how much of the body is fat). The global commission determined that to reduce misclassification, it is necessary to use other measures of body fat. Some of these included waist circumference, waist-to-hip ratio, waist-to-height ratio, direct fat measurement, and signs and symptoms of poor health that could be attributed to excess adiposity.
The experts proposed two distinct types of obesity:
- Clinical obesity: A systemic chronic illness directly and specifically caused by excess adiposity
- Preclinical obesity: Excess adiposity with preserved tissue and organ function, accompanied by an increased risk of progression to clinical or other noncommunicable disease
The commission’s leader, Dr. Francesco Rubino, of King’s College, London, explained the importance of distinction in these new definitions of disease. The group acknowledges the subtleties of obesity and support timely access to treatment for patients diagnosed with clinical obesity. That is appropriate for people with any chronic disease. For people with preclinical obesity, the definition points to risk-reduction strategies.
Clinical vs. preclinical obesity
Currently, clinical obesity is defined as a state of chronic illness. Some tissues or organs show reduced function which is attributed to excess fat and affects daily activities. Some of these conditions are breathlessness, joint pain or reduced mobility, often in the knees and hips, metabolic dysfunction and impaired function of organ systems.
Applying the proposed definition, the diagnosis of clinical obesity requires two main criteria: confirmation of excess adiposity plus chronic organ dysfunction and/or limitations on mobility or daily living.
To confirm the diagnosis of clinical obesity in those with excess body fat requires that a healthcare provider evaluate the individual’s medical history and conduct a physical exam, the usual laboratory tests, and additional diagnostic tests as indicated.
The commission authors stated that, “A diagnosis of clinical obesity should have the same implications as other chronic disease diagnoses. Patients diagnosed with clinical obesity should, therefore, have timely and equitable access to comprehensive care and evidence-based treatments.”
Preclinical obesity is more of a spectrum of risk. Excess fat is confirmed, but these individuals don’t have ongoing illness attributed to adiposity. They can perform daily activities and have no or mild organ dysfunction. These patients are at higher risk for diseases like clinical obesity, cardiovascular disease, some cancers, Type 2 diabetes, and other illnesses.
“Preclinical obesity is different from metabolically healthy obesity because it is defined by the preserved function of all organs potentially affected by obesity,” the authors write, “not only those involved in metabolic regulation.”
What these changes mean for you, if you have excess fat, is that your condition is treated like any other medical condition. It isn’t something you just “get over” with diet and exercise. The effects of your fat are clearly identified, including the consequences without intervention. Specific fat-mediated dysfunctions have specific protocols for intervention. You work side-by-side with your healthcare provider to manage risk and consequences, hopefully even reducing risks and possibly reversing some consequences.
These changes facilitate your care. Ultimately, though, you oversee your health. You decide what you are willing or not willing to do to stay healthy or get healthier. There are no promises that it will get easier.
Why why do we need new definitions of the problem when the solution is already obvious?
It’s also obvious that obesity is a COMMUNICABLE disease. We are in the middle of a worldwide epidemic.