Diagnosing obesity is no longer just about BMI

Written By Mark

On 5 July, the European Association for the Study of Obesity launched a new framework for the diagnosis, classification and management of obesity in adults. The new framework, published in Nature Medicine, proposes to update the diagnosis and treatment of obesity to take into account all recent developments in the field, including new generations of obesity drugs.

Belly fat and poor health

The new framework clarifies that abdominal fat (visceral fat) is an important risk factor for poor health, even in people with a low BMI who do not have clinical manifestations of the disease; the new framework includes people with a lower BMI (25–30 kg/m2) but abdominal fat accumulation with any medical or psychological dysfunction within the definition of obesity, reducing the risk of undertreatment in this patient group compared to the current BMI-based definition of obesity.


Body mass index (BMI) is a number calculated using a person’s height and weight to assess whether most people are overweight or underweight. BMI is calculated by dividing a person’s weight in kilograms by the square of their height in meters. BMI does not measure the amount or percentage of body fat.

Despite the widespread recognition of obesity as a chronic, recurrent, non-communicable, multifactorial disease characterized by abnormal and/or excessive accumulation of body fat, in many settings the diagnosis of obesity is still based solely on BMI values, which does not reflect the role of adipose tissue distribution and function in the severity of the disease.

Pillars of obesity treatment

The researchers confirm that the pillars of treatment for people with obesity in their recommendations are largely in line with currently available guidelines, as they agreed that behavioral modifications – including dietary therapy, physical activity, stress reduction, and improved sleep – are key pillars for obesity management, with the possibility of adding psychotherapy, obesity medications, or surgical or endoscopic procedures.

The researchers added, according to the Eurek Alert website, that this framework will bring obesity management closer to the management of other chronic non-communicable diseases, where the goal of treatment is not short-term intermediate results, but rather long-term health benefits.

The patient should be informed of personal long-term treatment goals by discussing them from the beginning of treatment, taking into account the stage and severity of the disease, available treatment options, potential side effects and risks, discussing the patient’s preferences, individual drivers of obesity and potential barriers that may hinder treatment.