Medical experts have urged a shift away from the Body Mass Index (BMI) as the main yardstick to determine obesity as it does not factor in body fat levels. The prevalent method is so flawed that it may have likely led to fit athletes being told they are overweight, experts from the Lancet Diabetes & Endocrinology Commission have noted in a report.
The Lancet Diabetes & Endocrinology Commission, made up of more than 50 experts, has called for a “radical overhaul” in how obesity is defined. The Lancet is an independent, international medical journal that publishes scientific papers, editorial content, and letters.
The report states that a new method to diagnose obesity should be made the norm wherein the patients’ waist diameter, as well as his/her medical history and other tests, should be taken into account.
BMI has been used as the standard method of diagnosing obesity for decades the world over, but the Lancet commission urges doctors to “move away from BMI alone”.
What Is Wrong With The Current Method?
- The current method relies purely on BMI as a measure of fitness
- It slots people into three categories depending upon their BMI, the calculation of which depends on weight alone
- BMI is calculated by dividing a person’s weight in kilograms by the square of their height in metres
- A BMI over 30 indicates obesity, while over 25 indicates being overweight, and between 18.5 and 25, healthy
- The BMI-based method does not factor in body fat levels or the healthy muscle mass
- The old BMI-based formula may have likely led to over-diagnosis
- That means millions of people with big bones or strong muscles have likely wrongly been told that they have unhealthy weight gain
What Is The Recommended Method?
- Doctors are being told to diagnose patients as clinically obese only if they also have illness — especially those triggered by obesity
- No reliance on assumed parameters in absentia but examination of patient’s health in person is recommended
- The patient should be investigated for likelihood of acquiring diseases such as type 2 diabetes that are directly caused by excess body fat
- Before diagnosing obesity or otherwise, doctors should not just weigh and measure patients, but also look at their medical history
- Doctors must also perform physical examinations to determine body-fat levels of the patient — such as measuring their waist diameter
Professor Francesco Rubino of King’s College London, who chaired the commission, said: “Some people who are classified as having obesity by BMI might play sports, they’re very active, they might have very strong bones. Saying that those people have obesity and then classifying them as having a disease would obviously be an over-diagnosis.
“BMI doesn’t tell us if somebody has excess body fat. BMI contains no information about the functioning of organs. In the context of a billion people being classified as having obesity — no country is rich enough to be able to afford inaccuracy in the diagnosis of obesity.”
Categories Of Obesity
The Lancet commission has not just called for a revision of the definition and diagnostic criteria of clinical obesity, but also introduced a new model with two categories for the same: clinical obesity (an illness) & pre-clinical obesity. This reframing, it says, “identifies medically meaningful targets for prevention and treatment”.
Preclinical obesity: When people have excess body fat but no ongoing illnesses. People in this category should be offered weight-loss advice, counselling and monitoring, to reduce the chances of health problems developing.
Clinical obesity: When a patient shows “chronic systematic illness” whereby excess fat can lead to organ damage and cause life-threatening complications such as heart disease, breathlessness, type 2 diabetes or joint pain — and a person’s day-to-day activities stand affected. Treatment with drugs or surgery is likely in such cases.
The report says that the “commission sought to define clinical obesity as a condition of illness that, akin to the notion of chronic disease in other medical specialties, directly results from the effect of excess adiposity on the function of organs and tissues”.
What Is Adiposity?
Adiposity is the amount of fat stored in the body, and is often used to describe excess body fat. It’s a chronic condition that can lead to health complications.
The commission’s recommendations have been endorsed by 76 organisations worldwide, reports the UK daily The Times.
The writer is a senior independent journalist.
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