Experts agree on defining obesity as a chronic disease. But, a report published in ‘The Lancet Diabetes & Endocrinology’ carried out by a commission of experts and supported by more than 75 medical organizations proposes a controversial redefinition of the diagnosis of obesity, by going beyond the Body Mass Index (BMI). ), with the aim of overcoming the limitations of this system as the only diagnostic tool, offering a more precise vision of when obesity should be considered a disease or not. The report introduces two new categories: clinical obesity, a chronic disease associated with ongoing organ dysfunction, and preclinical obesity or preobesity, a high-risk condition without persistent disease. With this distinction, the authors write, the aim is to personalize diagnoses and adapt treatment to the severity and impact that obesity has on the health of each patient. “Recognizing these differences is essential to ensure adequate treatments and avoid overdiagnosis,” explains Professor Francesco Rubino, President of the Commission. However, this new redefinition is not fully shared by many professionals and can leave many people undiagnosed and, therefore, untreated. Thus, Diego Bellido, president-elect of the Spanish Obesity Society (SEEDO), assures that the term pre-obesity could cause confusion. «Without being against it, SEEDO is concerned that with this proposed new diagnosis, obese patients classified as pre-obese will escape. I am a clinician, and if I diagnose pre-obesity, it is possible that I will not treat the patient.” Related News standard No Spanish researchers discover a new mechanism to ‘burn’ fat and combat obesity ABC The MCJ protein, key to activating brown fat and combat obesity. Andrea Ciudin, endocrinologist and coordinator of the Obesity Unit at the Vall d’Hebron Hospital, has a similar opinion. «If we consider this differentiation “pre-obesity” and “clinical obesity” it means that we assume that obesity has to be treated when it already has a clinical complication and that in the preclinical phase it is preventable or reversible in all cases. On many occasions, due to the nature of obesity as a chronic disease, it would only delay a diagnosis and an efficient intervention to prevent the appearance of complications,” he assures Science Media Center. Bellido points out that there are great examples to question the term pre-obesity. «We know – he says – that prediabetes, previously considered only for monitoring, can cause complications such as diabetic retinopathy, which highlights the need to treat it. And the earlier obesity is detected, the better results are obtained.” BMI is the common tool to detect obesity; However, it does not reflect fat distribution or its health risks. It is suggested to complement it with measurements such as waist circumference or advanced technologies. People with a high BMI may be healthy, while others with a normal BMI may have elevated risks from fat in key organs. BMI assesses whether a person’s weight is appropriate for their height. It is calculated by dividing the weight (kg) by the height squared (m²). It is useful but does not consider fat distribution or other health factors. Both Bellido and Ciudin recognize that the use of BMI as the only diagnostic measure does not reflect all the complexity of the disease. In fact, this concept is not new, and this article confirms the direction that has long been taken by scientific societies to change the narrative of obesity, erroneously defined for a long time by kilograms and BMI.The past September, the European Association for the Study of Obesity (EASO) updated the diagnosis of obesity, adding the diagnosis of obesity to a BMI greater than 30, the criterion of BMI greater than 25 plus a waist/height ratio >0.5. This helps to better identify cardiovascular and metabolic risks, showing that obesity can exist with BMI greater than 30. «Basing the diagnosis of obesity on the evaluation of body composition is correct, in this sense there is no doubt and discussion between societies. scientists and professionals,” says Ciudin. We do not disagree with the article, Bellido clarifies, but we believe that “the diagnosis of obesity is perfectly defined” and that the term pre-obesity “can generate confusion.” Fofisanos Bellido believes that this article refers indirectly to those falsely called healthy obese, who would be classified as pre-obese according to these guidelines. «When do you stop being healthy obese? -he wonders-. There are no criteria. I think that the editors of ‘The Lancet’ have thought about these patients to implement preventive measures, but… what do we do with these people? Preventing and treating are not the same. It is estimated that 25% of the population in Spain is obese. According to Bellido, if we also consider fat, this figure would be higher, because 30% of people diagnosed with overweight have excess fat and would meet the criteria for obesity. The increase in body fat in internal organs, such as the liver and pancreas, It is a significant risk factor that should be considered in the diagnosis. Obesity affects not only the aesthetics, but also the metabolic health of those who suffer from it, which justifies a more comprehensive and specific treatment. In Spain, it is not yet officially recognized as a chronic disease, which makes its adequate treatment difficult. Obesity is a disease. chronic metabolic disease that affects the quality of life of those who suffer from it and is linked to more than 200 conditions. Despite this, in Spain, it is not yet officially recognized as a chronic disease, which makes its adequate treatment difficult. The Spanish Society of Endocrinology and Nutrition (SEEN) has stressed the importance of its recognition in order to implement effective control measures, especially in a context in which obesity is increasing in the population. In this sense, Irene Bretón, from the SEEN , emphasizes that the treatment of obesity does not depend solely on the patient’s will. “A comprehensive approach is necessary that involves various health professionals, from endocrinologists to psychologists, and that makes use of digital tools to improve treatment coordination.” The implications of the new diagnosis proposed by the Commission could lead to a re-evaluation of global health systems, as treatments for obesity will require greater precision and personalization. And financing. The market for drugs that have revolutionized the treatment of obesity obesity, which contain liraglutide, semaglutide and dilaglutide, grew by 60.65% in 2024. They belong to a family of drugs called GLP-1, the best known name is Ozempic, they have The treatment of obesity has changed, but they have an important factor: their cost, between 200 and 300 euros per month. In Spain, they are also not funded. For the president of SEEDO, the first step is the recognition of obesity as a chronic disease, as has happened in Portugal. Financing for these medications may come later, although it recognizes that it will not be universal because the system will not be able to assume it. Bellido believes that, if things are done well, we will be able to ensure that certain groups of patients have access to financing for these medications that have achieved such good long-term results. The report maintains this constructive debate, Bellido concludes. “We know that we have to go beyond BMI to make an accurate diagnosis of obesity, but at SEEDO we do not go off script: obesity is a chronic disease and that is how it should be treated.”
#longer #overweight #preobese
