Redefining obesity

[Cocoaone]

Saw this on BBC today re: calls for a redefining of obesity to 'clinical obesity' if the patient has excess body fat AND clinical signs and symptoms related to that excess body fat - e.g joint pain, diabetes/endocrine problems, breathlessness etc
Anyone without these but with excess fat would be 'pre-clinical obesity' or even 'no obesity'

www.bbc.co.uk/news/articles/c79dz14d30ro

I wonder if this is in part due to WLI being so popular? I imagine a chunk of people who are currently BMI 30+ don't have any associated medical issues, and it would take out people with high muscle mass from the obese category too.

By redefining it to people with medical issues, they will be more free to (hopefully!) prescribe WLI to those who will medically gain the most from weight loss, quicker than then previously given 12 year timeframe.

I wonder if we'll see pharmacies having to apply this new criteria at some point?

I wonder if we'll see pharmacies having to apply this new criteria at some point

I think you’ve misunderstood the article. There is no new criteria, it is a group of experts saying there should be, which doesn’t mean there will be,

and pharmacies won’t need to apply it because having a bmi of 30 means your risk of events are much higher, not hai ng it today doesn’t mean you won’t have it tomorrow. And that’s why it is 27 with health conditions, as they already basically do this.

By redefining it to people with medical issues, they will be more free to (hopefully!) prescribe WLI to those who will medically gain the most

They are doing this anyway by prioritising to those who are severely obese + have weight related conditions.

I also disagree with this from the article "Some have it and manage to live a normal life, function normally. Living a normal life when severely obese is short term, it catches up with us all, and while obese preventable damage is being done to hearts, knees, metabolisms etc and costing the NHS a fortune.

I'm sure these experts could spend their time doing something more valuable to society than trying to redefine language that doesn't need redefined. The cynic in me wonders what their motivation is.

Opportunity to be a talking head , get their name in the media.

I also disagree with this from the article "Some have it and manage to live a normal life, function normally. Living a normal life when severely obese is short term, it catches up with us all, and while obese preventable damage is being done to hearts, knees, metabolisms etc and costing the NHS a fortune.

They didn't say anything about those who are severely obese. I'm severely obese and I cannot imagine that any doctor would say that it's ok for me to stay at this weight. But BMI on its own is too crude a measurement to give a reliable estimate of a given person's overall health. Crossing the line from a BMI of 29.999 to a BMI of 30 makes you officially obese but does that small a change make an actual difference to your overall health?

I'm waiting for many MNers to pop up who say they have the physique of Mike Tyson which is why they can have BMI of 32 & not be at all overweight. They'll trash BMI again & say this redefinition if long overdue... and ignore how much it talks about TOFIs.

I’m never quite sure why people focus on the line, like it’s some sort of gotcha moment, surely everyone knows it is a sliding scale up wards if issues, the heavier you get, the more risk you’re at, and that no of course not that 29.999 to 30 doesn’t make a health difference, it is a line in the sand. A pound or two either way, A marker. Not you’re healthy one side and not at the other.

Exactly, it's a sliding scale. Which is why having so much about obesity care and treatment being focussed on which side of the 30 BMI line you currently sit at is not necessarily that helpful. Maybe something more nuanced is justified which is what these experts are calling for.

But you need to draw a line somewhere, it is impossible to manage otherwise. 30 is reasonable.

Presumably they want to remove that arbitrary cut off line to ensure the most at need receive quicker medical intervention - you either have excess fat or you don't (dexa scans being the best measure of that - which will never happen within current nhs resources!) AND you either have a weight related health issue or not. And if you don't meet both of those, you aren't at risk enough to be classified as clinically obese and potentially don't need the WLI/bariatric surgery/further medical interventions.

Ps - I didn't misunderstand the article. The commission outcome has been agreed by 76 worldwide organisations and experts - therefore it's not outside the realms of possibility that health organisations in this country, including NHSE or the WHO could take the recommendations and adjust policy to reflect it. Including prescribing guidelines.

@Cocoaone you are right, it is worth taking note of ,as far as from what I have read today ( I will try and attach the Lancet pdf) it does sound like they are thinking how they are going to boundary and approach future use of WLJ on the NHS ( and that may well filter through to the private sector, or not). I do agree with a lot of what they are saying in terms of BMI being such a broad measure, that waist and height ratios also need to be used etc . The category of “ pre obesity “ may well end up as how they approach “pre clinical hypothyroidism “ ie. nothing doing from the NHS so people go private instead! https://www.thelancet.com/pb-assets/Lancet/infographics/clinical-obesity/image-1736175271690.pdf

Image attached

The point is whether or not BMI on its own is a good enough scale to draw that line against. These experts are saying that they don't think it is. I don't know and I'm not qualified to judge but I'm glad that there are people out there who are qualified and that are asking these kinds of questions. Understanding and treatment for the obesity epidemic has been in the dark ages for years and it's about time it's being taken seriously.

Thanks for sharing @Leplep. I clicked through to the main paper and found the clinical 'signs and symptoms'

Although I'd hit the excess fat criteria on waist/height ratio, I don't think I'd fall under any of these clinical issues. I have/had some knee pain which was definitely worse at my heaviest (BMI 34.8, but much less now my BMI is 26.7) but I wouldn't call it severe, neither would I say it limits my daily function much - I just take it easy up stairs and don't do squats
I also have high cholesterol, but not grouped with high triglycerides and low HDL so it's not a metabolic disease. My blood pressure is ok and I don't have apneoa. I was apparently a fairly healthy obese person 😁

Interesting thought about the preclinical subset potentially still being able to go privately though. Hopefully if the NHS does adopt this, it will mean quicker help for those at high risk, and the rest of us who want to minimise the risk of getting to that point can continue to self fund. I can't see the pharmaceutical companies wanting to limit their drugs to the clinical obesity group only...

The odds of that are non existent due to the money the drugs will save the nhs, and the health benefits being brought in. Couple with the overwhelming safety of the drugs.

Your comments throughout this thread OP seem to not align with your posts heading,

The post’s heading was because the Lancet’s piece was called ‘redefining obesity: advancing care for better lives’