Moving Beyond BMI: A Paradigm Shift in Diagnosing Obesity

The Global Lancet Commission on Clinical Obesity has proposed a groundbreaking framework to redefine how obesity is diagnosed and treated beyond Body Mass Index (BMI) limitations.

While BMI has been a helpful population-level tool, it often fails to reflect the complexity of obesity as a chronic disease, leading to overdiagnosis, underdiagnosis, and inadequate care.

Published in The Lancet Diabetes & Endocrinology and endorsed by over 75 medical organisations, the new framework integrates additional measures such as waist circumference and direct fat assessments alongside BMI. It introduces two categories: Clinical Obesity, where excess body fat causes organ dysfunction or health issues, and Pre-Clinical Obesity, characterised by excess fat with no current health impairments but increased risk of future diseases.

This approach emphasises personalised care. People living with clinical obesity require timely, evidence-based treatments aimed at restoring or improving body functions affected by excess fat. Depending on individual risk assessments and patient preferences, these treatments may include lifestyle changes, medication, surgery, or a combination. The best treatment for a patient may also change during their lifetime.

With over one billion people affected globally, adopting this nuanced diagnostic method could improve outcomes and reduce the burden of obesity worldwide. It’s a vital step toward compassionate, effective care.

• The Global Commission Report was published on January 14, 2025, in The Lancet Diabetes and Endocrinology.
• Comments from the European Coalition for People living with Obesity (ECPO)