Obesity is one of the world’s biggest health challenges, causing a mass of shorter, unhappier lives and a mounting burden on already overstretched healthcare systems.
There is no doubt that more people than ever before are living with excess body fat, and there is no doubt about the dangers of doing so. Obesity has the ability to harm every single organ in the body, and increases the risk of type 2 diabetes, heart disease, cancer and mental illness.
But at the same time, the idea of obesity as a disease itself has been at the centre of one of the most controversial and polarising debates in modern medicine. The row is rooted in the fact that while some people may tick the box of being obese, currently determined as having a body mass index (BMI) over 30, they show no signs or symptoms of ill health, and their organs are in perfect working order.
Other people currently not classified as obese – because their BMI is below 30 – may in fact have serious undiagnosed health problems as a direct result of excess body fat around their body.
A new report, authored by dozens of the world’s leading experts and published in The Lancet Diabetes & Endocrinology journal, aims to finally settle the dispute. They argue that there needs to be a “reframing” around obesity to avoid millions of people being misdiagnosed, and ensure only those who need treatment are offered it.
First, they are proposing a more accurate way to diagnose obesity. Instead of relying only on BMI, they say other measures must also be used, such as waist circumference, waist-to-hip ratio or waist-to-height rati – an important change, because people can store excess body fat in different areas of the body.
Some may store it around their waist or their organs, such as the liver or the heart. This is associated with a higher health risk compared with when excess fat is stored just beneath the skin in the arms, legs or in other body areas.
Health professionals should also now look for signs and symptoms of ill health in the patient caused by excess body fat, the experts said.
Second, a shake-up of how the condition is classified is being proposed, with two new categories: clinical obesity and pre-clinical obesity.
The changes aim to help reduce stigma and improve patient management. Those diagnosed with clinical obesity could be offered weight-loss drugs, while those with pre-clinical obesity could be offered advice to become healthier and avoid getting heavier.
However, while the proposals may help end the debate over diagnosis, the larger challenge – curbing obesity – remains. Measures such as eating more healthily and slowly, becoming more active, getting better sleep, managing stress and limiting screen time, can help people reduce their risk of developing obesity.
But it would be unwise to think people can rely on education and willpower alone. Governments, companies and communities must also do much more to help people overcome or avoid obesity.
That includes promoting active travel so people can rely less on cars, cracking down on junk food advertising, and tackling destructive food environments saturated with unhealthy food choices.
