A new approach to diagnosis and treatment

A groundbreaking framework for diagnosing and managing obesity in adults, launched by the European Association for the Study of Obesity (EASO) and published in Nature Medicine, challenges the traditional reliance on the Body Mass Index (BMI) alone. The framework aims to modernise obesity care by integrating the latest scientific insights, including advancements in medications targeting obesity.

Obesity is widely recognised as a complex, chronic condition characterised by abnormal or excessive accumulation of body fat, linked to various health risks. Despite this understanding, many current diagnostic practices primarily use BMI cut-off values, which may overlook individuals who would benefit from treatment due to factors like adipose tissue distribution and function.

The EASO Steering Group, composed of leading experts in the field, emphasises the need for a more nuanced approach. They highlight that BMI alone is inadequate as a diagnostic tool, advocating instead for considering body fat distribution, particularly abdominal fat, which significantly impacts health outcomes. Even individuals with a BMI below the conventional obesity threshold (BMI of 30) may experience health complications due to abdominal fat accumulation.

The new framework broadens the definition of obesity to include individuals with lower BMIs (≥25–30 kg/m2) but elevated abdominal fat and associated medical, functional, or psychological impairments. This shift aims to prevent undertreatment of individuals who may not meet traditional BMI criteria but still face significant health risks.

Treatment recommendations outlined in the framework align with current guidelines, focusing on behavioural modifications such as nutrition therapy, physical activity, stress management, and improved sleep patterns as foundational strategies. Additionally, psychological therapy, obesity medications, and metabolic or bariatric procedures are recommended options, tailored to individual needs and preferences.

However, the committee notes a gap in current clinical guidelines, which often exclude individuals with lower BMIs from accessing medications or procedures intended for obesity management. They propose revising inclusion criteria for clinical trials to better reflect the diverse clinical presentations of obesity, advocating for the consideration of waist-to-height ratio and the presence of associated health complications, regardless of BMI.

In particular, the framework suggests that obesity medications should be considered for individuals with a BMI of 25 kg/m2 or higher, coupled with an elevated waist-to-height ratio and associated impairments. This recommendation serves as a call to pharmaceutical companies and regulatory bodies to adopt more inclusive criteria in future research on obesity medications.

Ultimately, the goal of this new approach is to align obesity management with practices for other chronic diseases, focusing on long-term health outcomes rather than short-term weight reduction. It underscores the importance of personalised treatment plans that consider disease severity, therapeutic options, potential risks, patient preferences, and barriers to treatment.

In conclusion, the framework represents a significant step towards a comprehensive, lifelong approach to managing obesity, aiming to improve overall health and quality of life for individuals affected by this complex condition.