News & Trends - Pharmaceuticals
Commission proposes major overhaul of obesity diagnosis

A global Commission, endorsed by 76 organisations – including Australian scientific societies and patient advocacy groups – has introduced a novel, nuanced approach to diagnosing obesity. This approach expands the traditional reliance on body mass index (BMI) to include other measures of excess body fat and objective signs and symptoms of ill health.
Associate Professor Priya Sumithran, a Commission member and Head of Monash University’s Obesity and Metabolic Medicine Group at Alfred Health, emphasised the urgency of addressing obesity in Australia.
“The proposed definition and diagnostic criteria will help clinicians to provide personalised, timely, and appropriate care,” she said.
The proposal addresses significant limitations in the current obesity diagnosis framework, which often results in individuals with obesity failing to receive the care they need. By providing a medically coherent framework, the Commission also aims to resolve the ongoing debate over whether obesity should be classified as a disease, a matter that has sparked considerable controversy within modern medicine.
Professor Wendy Brown, Chair of the Department of Surgery at Monash University’s School of Translational Medicine, said “With the new criteria proposed by the Commission, we finally have a medically meaningful way of diagnosing obesity, meaning we can tailor the treatment plan according to the patient’s needs.”
At the heart of the Commission’s work is the idea that considering obesity solely as a risk factor, and never a disease, can deny timely care to individuals suffering from obesity-related illness. On the other hand, broadly categorising obesity as a disease could lead to overdiagnosis and unnecessary treatments.
Professor Francesco Rubino, Chair of the Commission and a leading expert at King’s College London, clarified the issue, saying “The question of whether obesity is a disease is flawed because it presumes an implausible all-or-nothing scenario where obesity is either always a disease or never a disease. Evidence, however, shows a more nuanced reality.”
Professor Rubino continued, “Some individuals with obesity can maintain normal organ function and overall health, even long term, whereas others display signs and symptoms of severe illness here and now. Considering obesity only as a risk factor, and never a disease, can unfairly deny access to time-sensitive care among people who are experiencing ill health due to obesity alone.
“On the other hand, a blanket definition of obesity as a disease can result in overdiagnosis and unwarranted use of medications and surgical procedures, with potential harm to the individual and staggering costs for society.”
The Commission’s reframing, Professor Rubino said, “acknowledges the nuanced reality of obesity and allows for personalised care. This includes timely access to evidence-based treatments for individuals with clinical obesity, as appropriate for people suffering from a chronic disease, as well as risk-reduction management strategies for those with pre-clinical obesity, who have an increased health risk, but no ongoing illness.”
With over one billion people worldwide now living with obesity, the Commission’s proposal provides a unique opportunity for global health systems to adopt a universally applicable, clinically relevant definition of obesity.
Currently, debates persist regarding the effectiveness of the existing diagnostic approaches to obesity, which often lead to misclassification and misdiagnosis. Part of the issue lies in defining obesity by BMI alone, with a BMI over 30 kg/m² considered an indicator of obesity in people of European descent. Other countries have adapted different BMI cut-offs to account for ethnic variations in obesity-related risks.
However, BMI is not a direct measure of body fat, nor does it account for its distribution or provide insight into an individual’s health status. The Commission stressed that relying solely on BMI for obesity diagnosis is problematic.
“Some people tend to store excess fat at the waist or around organs like the liver, heart, or muscles, which is associated with higher health risks. But people with excess body fat don’t always have a BMI indicating obesity, which means their health issues can go unnoticed. On the other hand, some people with a high BMI and body fat maintain normal organ and body functions, with no signs of illness,” said Professor Robert Eckel, a Commission member from the University of Colorado Anschutz Medical Campus.
To address these limitations, the Commission is introducing a new model for diagnosing obesity, based on objective measures of illness at the individual level. It sets out 18 diagnostic criteria for clinical obesity in adults and 13 specific criteria for children and adolescents.
“This nuanced approach to obesity will enable evidence-based and personalised approaches to prevention, management and treatment in adults and children living with obesity, allowing them to receive more appropriate care, proportional to their needs. This will also save healthcare resources by reducing the rate of overdiagnosis and unnecessary treatment,” commented Commissioner Professor Louise Baur, a paediatrician and Head of Child and Adolescent Health at the University of Sydney.
According to the Commission, people with clinical obesity should receive timely, evidence-based treatments – including medicines (Eli Lilly’s Mounjaro or Novo Nordisk’s Wegovy) and surgery – with the aim to fully regain or improve the body functions reduced by excess body fat, rather than solely to lose weight.
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