On January 14, a Commission made up of 56 international multidisciplinary experts in the field of obesity, including people living with obesity, published in the English medical journal The Lancet Diabetes & Endocrinology the fruit of their deliberations which aimed to settle once and for all one of the greatest controversies in medicine: is obesity a disease, yes or not?
Since initially, the members of the committee were very far from being in agreement as to the answer to be given to this question, their work carried out over a period of more than two years led them to propose a new concept: distinguishing the clinical obesity, a disease, preclinical obesity, which is not a disease, at least, not at the time of its diagnosis.
From the outset of their deliberations, the commissioners recognized the great limitations of the traditional definition of obesity based on body mass index (BMI), a criticism we have voiced repeatedly for decades here at Quebec. The committee therefore recommends going beyond BMI and underlines the importance of adding the measurement of waist circumference, an approach also widely studied by our Quebec research teams. That said, the commissioners mention that even a precise measurement of adiposity is not enough to diagnose clinical obesity. Much more than the simple measurement of risk factors, the Commission defines clinical obesity by the presence of symptoms and by the damage or dysfunction of organs and systems (18 in total for adults and 13 for children and adolescents). ) which can be linked to excess adiposity.
Diagnostic
With such criteria, clinical obesity can now be clearly diagnosed as a disease and it must be treated in order to provide relief to those affected as quickly as possible.
Conversely, even in the presence of one or more cardiovascular or metabolic risk factors, the person who has no symptoms and no signs of damage to their target organs will receive a diagnosis of preclinical obesity. must, however, benefit from preventive measures or more or less intensive care depending on their condition, in order to reduce their risk of developing clinical obesity.
The commission’s recommendations are not without consequences when we consider the high and growing prevalence of obesity in Quebec, Canada and elsewhere in the world. Since it is now proposed that clinical obesity be considered as a disease, it is urgent that, in addition to public health measures aimed at configuring environments and living conditions that are less obesogenic and more compatible with health, resources be given priority in our health system in order to relieve the symptoms of people suffering from clinical obesity.
Heterogeneity of obesity
Furthermore, this new distinction between preclinical and clinical obesity takes into account the complexity and heterogeneity of obesity, an issue that we have been highlighting for decades in Quebec and which is now the subject of countless scientific demonstrations. To this end, we hope that this concept of clinical obesity can contribute to reducing the stigmatization of people who suffer from it, because they need resources and support rather than moralizing discourse.
Finally, we would like to emphasize that Quebec benefits from an important network of clinicians and researchers of international reputation in this field. This remarkable expertise should be put to greater use in order to serve the Quebec population of all ages, both in terms of care and in the preventive approaches to be implemented in local health services and public health.
Photo Jean-Pierre Després
Jean-Pierre Després, PhD
Professor, Laval University and University Institute of Cardiology and Pneumology of Quebec
Scientific Director of VITAM – Sustainable Health Research Center
CIUSSS de la Capitale-Nationale
-
Photo André Tchernof
André Tchernof, PhD
Professor, Laval University and University Institute of Cardiology and Pneumology of Quebec
Director of the Cardiometabolic Health, Diabetes and Obesity Research Network
Fannie Lajeunesse-Trempe, MD. FRCPC. General internist and specialist in bariatric medicine Professor, Laval University and
University Institute of Cardiology and Pneumology of Quebec
Marie-Philippe Morin, MD. FRCPC.ABOM
Specialist in general internal medicine and bariatric
Head of general internal medicine department
University Institute of Cardiology and Pneumology of Quebec
