"BMI misses a lot of information," Dr. Francesco Rubino, a professor of bariatric and metabolic surgery at King's College London, told Live Science.
Now, a new study published Wednesday (Nov. 11) in the journal Nature confirms that these new criteria could detect obesity with greater precision than BMI alone. In other words, with the new approach, more people would be accurately diagnosed with obesity and fewer people would be misdiagnosed than are with BMI alone.
At the simplest level, obesity is excess body fat. There are special scans and exams that send weak electrical signals through the body to measure a person's body fat percentage directly, but criteria based on body measurements are more accessible across clinical settings.
BMI doesn't capture nuances and variation between patients, experts argue, and it limits what doctors can say about a given person's health risk. (Image credit: Marco Ortiz via Getty Images)
Additionally, the different BMI categories — such as "overweight" and "obese" — don't carry the same risks for all patients. Certain racial and ethnic groups tend to experience health consequences, such as higher mortality rates, at different BMI levels than others do.
What metrics does the new obesity definition use?
The proposed body measurements are less influenced by a person's muscle mass or bone structure than BMI is. They include waist circumference, waist-to-hip ratio and waist-to-height ratio. Notably, because different ethnicities are associated with different fat distribution patterns in the body, the latest Nature study incorporated different waist circumference cutoffs based that varied by ethnicity.
Rubino and his colleagues — which together made up what's known as a Lancet Commission — defined "clinical obesity" as a disease state involving at least one of 18 forms of bodily dysfunction caused by excess fat tissue. Preclinical obesity, by contrast, is when a person is at risk of this disease state and may need interventions to avoid obesity-related dysfunction.
This distinction can be complicated, though, as the diagnostic metrics for each form of dysfunction contain their own ambiguities.
The Lancet Commission argues that the categories of preclinical and clinical obesity could help doctors identify the people with the greatest need for treatment. The researchers tracked health outcomes using electronic health records from China, the United Kingdom, the United States and Spain, and they determined that their clinical obesity classification was better at flagging people's risk of death than BMI alone.
Changing the diagnostic criteria for obesity could, in turn, change who is recommended to receive weight-control medications. (Image credit: Galina Zhigalova via Getty Images)Would the new criteria affect the overall prevalence of obesity?
The Lancet Commission's approach could drive a small net uptick in individuals diagnosed with obesity, according to the new study.
With the BMI-only approach, people with BMIs of 30 or higher are categorized as obese. With the new definition, some people with BMIs under 30 would be newly categorized as clinically obese, while a smaller group of people with high BMIs would suddenly not count as clinically obese, the Nature study predicted.
Overall, the new criteria would increase obesity prevalence by about 3.3% to 7.4%, the team predicted. The percentage varied depending on the group analyzed.
What would it take to implement this new definition?
Exclusive to Live Science ProMore research is needed to prove that the Lancet Commission's criteria would improve patient care and be practical to use in a clinical setting, Hwang said. She noted potential challenges in implementing both new aspects of the new framework. While the body measurements sound simple enough to use, clinicians would need training to perform them accurately.
Rubino and the rest of the Lancet Commission plan to continue validating their framework to see how it could best support personalized obesity treatment. For instance, they want to determine which forms of organ dysfunction are of greatest concern and develop a way of scoring each patient's level of risk.
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