Researchers are calling for a shift in the way obesity is diagnosed, arguing that clinical decisions should be based not on body weight alone but on how excess body fat affects organ function and overall health.
In a review published in The Journal of Clinical Endocrinology & Metabolism, scientists from Pennington Biomedical Research Center examined the concept of metabolically healthy obesity and concluded that it is not a sufficiently reliable framework for making long-term clinical decisions.
Traditionally, people with obesity have been classified as either metabolically healthy or metabolically unhealthy based on the presence or absence of metabolic abnormalities, such as elevated blood glucose levels or cardiovascular disease risk factors. However, the researchers note that these categories are not stable, as individuals initially considered metabolically healthy may develop obesity-related complications over time.
"Metabolically healthy obesity helped demonstrate that obesity affects individuals differently. However, this classification is not well suited for long-term clinical management because definitions vary and health status can change over time," said Professor Eric Ravussin, one of the study's authors.
Instead, the researchers highlight a new framework proposed by the Lancet Diabetes & Endocrinology Commission, which classifies obesity as either preclinical or clinical.
Under this approach, preclinical obesity refers to excess body fat without evidence of organ dysfunction or limitations in daily activities. Individuals in this category may benefit from lifestyle modification, regular monitoring, and individualized decisions regarding drug therapy.
Clinical obesity, by contrast, is defined as a condition in which excess adipose tissue has already impaired organ function or interferes with normal daily activities. In such cases, pharmacological treatment and, when appropriate, bariatric surgery may be considered.
The authors also propose redefining treatment success. Rather than focusing solely on weight loss, they argue that the primary goal should be improving organ function and reducing obesity-related health complications.
The researchers emphasize that this proposed framework is still evolving and requires further studies to validate its diagnostic criteria before it can be widely implemented in clinical practice.
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