The traditional method of diagnosing and managing obesity using body mass index (BMI) is being reconsidered.
The European Association for the Study of Obesity (EASO) has introduced a new framework, published in Nature Medicine, that modernizes the approach to obesity diagnosis and treatment. This new method takes into account recent advancements in obesity research and medication.
Obesity is widely recognized as a complex, chronic disease characterized by excessive body fat accumulation. However, many healthcare settings still rely solely on BMI cut-off values to diagnose obesity. This method overlooks the significance of fat distribution and its impact on health.
The EASO Steering Group, which includes current and former presidents of the Association, has developed new guidelines to bring obesity management in line with the latest scientific understanding.
A key change in this new framework is the inclusion of body fat distribution, especially abdominal fat, as a critical factor in diagnosing obesity. Abdominal fat is strongly linked to an increased risk of cardiometabolic complications, often more so than BMI alone.
The new guidelines recognize that individuals with a BMI between 25 and 30, who have high levels of abdominal fat and related health issues, should be included in the definition of obesity.
This approach aims to reduce the risk of undertreatment for those who fall below the traditional BMI cut-off but still have significant health risks due to fat distribution.
The treatment recommendations for obesity remain largely the same, emphasizing lifestyle changes such as improved diet, increased physical activity, stress reduction, and better sleep.
Psychological therapy, obesity medications, and surgical options like bariatric procedures are also part of the treatment plan.
However, the committee highlighted that current guidelines often exclude patients with low BMI from receiving obesity medications or surgeries, despite their significant health burdens.
To address this, the committee suggested that obesity medications should be considered for patients with a BMI of 25 or higher, especially if they have a waist-to-height ratio above 0.5 and other health impairments.
This recommendation aims to shift clinical trials and treatment guidelines away from strict BMI cut-offs and towards a more comprehensive clinical evaluation.
The authors call on pharmaceutical companies and regulatory bodies to design clinical trials with inclusion criteria that reflect the broader clinical picture of obesity, rather than relying solely on BMI.
They advocate for long-term health benefits as the primary goal of obesity management, similar to other chronic diseases.
This means focusing on personalized, long-term treatment plans that consider the severity and stage of the disease, available therapies, potential side effects, patient preferences, and individual challenges.
In summary, the new EASO framework aims to provide a more accurate and inclusive approach to diagnosing and managing obesity.
By moving beyond BMI and considering factors like fat distribution and overall health, this approach seeks to improve long-term outcomes for individuals with obesity.
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The research findings can be found in Nature Medicine.
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