Experts agree | New definition of obesity

Is obesity a disease or not? The debate has raged in the medical community for decades. Here are 56 international experts, brought together by the journal The Lancet Diabetes & Endocrinologyagree on a definition of the disease and establish the criteria for diagnosing it.

“We expect this to be a revolution in the medical world,” says Jean-Pierre Després, researcher at the University Institute of Cardiology and Pneumology of Quebec (IUCPQ) – Université Laval and member of the group of selected experts by the British magazine.

Obesity is traditionally defined as excess body fat increasing the risk of developing health problems, therefore, a risk factor. “About half of the experts wanted this condition to be considered an illness,” says Jean-Pierre Després.

After two years of discussions, the committee on obesity The Lancet Diabetes & Endocrinology rule on the matter. Its conclusions, published Tuesday evening, are supported by 75 medical organizations.

The expert panel distinguishes between clinical obesity, a chronic disease, and preclinical obesity, which is not. He lists various criteria for there to be pathology. According to the commission, obesity should no longer be defined solely by a body mass index (BMI) of 30 or more. In Quebec, approximately 30% of adults fall into this category, according to Statistics Canada.

“The BMI is rubbish because it does not distinguish between a high weight which is determined by a large muscle mass and a high weight linked to excess body fat,” says Jean- Pierre Despres. He cites the example of Laurent Duvernay-Tardif who “would have been diagnosed with obesity at the time he played football” and that he was “in great shape”.

Disease criteria

In order to confirm excess adipose tissue, the group of experts recommends measuring the BMI, but also the waist circumference where the abdominal fat is located – “dangerous for health”, insists Jean-Pierre Després. The commission sets the threshold for a problematic waist circumference at 102 cm for men and 88 cm for women.

But this is not enough to diagnose clinical obesity. The patient must also have a dysfunction directly related to their obesity. The commission counts 18 for adults and 13 for children and adolescents (see capsule “Dysfunctions associated with clinical obesity”). Among them, heart failure and fatty liver disease.

Patients who have none of these problems have preclinical obesity. “These people must be monitored,” says Jean-Pierre Després. These may be people whose BMI is slightly below 30, but whose waist circumference exceeds the threshold established by experts. “Think of the 60-year-old man, sedentary all his life, who has lost muscle mass, who has small legs and a hard belly,” says Jean-Pierre Després.

Reactions

The D^re Marie-Philippe Morin, clinician-researcher at IUCPQ-Université Laval, is delighted with this new definition which will make it possible to target sick patients and prioritize them. “They must be treated and have access to care and services like [pour] any other illness, she emphasizes. Currently this is not the case. » Medicines treating obesity (Ozempic and Wegovy) are not covered by the Quebec drug insurance plan.

Pediatric endocrinologist Mélanie Henderson, who practices at the Sainte-Justine University Hospital Center (CHU), believes that this “clearer definition” will help “guideline the coverage”, by the Régie de l’assurance santé du Québec, of medications treating ‘obesity. “We hope that this would be accessible, not to everyone, but to the subgroup of people who will really benefit from it and for whom it will make a big difference for their health. »

For the D^re Julie St-Pierre, pediatrician and obesity specialist, this publication is one more “argument” in favor of the management of patients with clinical obesity and preclinical obesity by multidisciplinary teams, which are too few in number at present. Quebec, according to her.

“If your parents don’t have insurance, it’s practically impossible to have access to a nutritionist and a kinesiologist,” laments the founder of Approach 180, an interdisciplinary approach to the prevention and management of obesity.

The D^re Morin believes that this publication also has positive repercussions for people with a high BMI and who do not have an associated health problem. “For their insurability, for example, or even the stigma linked to weight, this has a benefit,” she thinks.