The debate around the definition of obesity as a disease has taken a major turn with the publication of the conclusions of 56 international experts, brought together by the journal The Lancet Diabetes & Endocrinology.
Their definition of obesity highlights an important distinction between clinical obesity, now considered a disease, and preclinical obesity, which is not.
This new definition suggests not relying solely on body mass index (BMI) to diagnose obesity. Jean-Pierre Després, researcher at the University Institute of Cardiology and Pneumology of Quebec (IUCPQ)–Laval University, underlines the importance of this revolution in the medical world, explaining that the BMI is too limited to correctly assess the risks health problems linked to excess weight.
Criteria for clinical obesity
Traditionally, obesity has been viewed as a risk factor for serious illnesses, but not as a disease in itself. With this new definition, clinical obesity is now recognized as a chronic disease, and experts are recommending more precise criteria for diagnosing this condition. In addition to BMI, it is now advisable to measure waist circumference, particularly abdominal fat, which is associated with significant health risks. A waist circumference greater than 102 cm in men and 88 cm in women is now considered an indicator of risk.
However, the presence of excess body fat alone is not enough to classify obesity as clinical. For obesity to be diagnosed as a disease, the patient must also have a dysfunction related to their excess body fat. Among the 18 dysfunctions identified by the commission for adults, we find heart failure, sleep apnea, hypertension, and fatty liver disease. For children, problems include sleep apnea, hypertension and chronic pain.
Reactions from experts and practitioners
Dr. Marie-Philippe Morin, clinician-researcher at IUCPQ–Université Laval, welcomes this new definition, which should facilitate the identification of patients requiring specific treatment for clinical obesity. According to her, this will improve access to care for these patients, who are often neglected or poorly cared for.
Drugs recently introduced to the market, such as Ozempic and Wegovy, which are used to treat obesity, are currently not covered by the Quebec drug insurance plan. Pediatric endocrinologist Mélanie Henderson, who practices at CHU Sainte-Justine, hopes that this new definition will help expand access to these treatments for people who really need them.
Other specialists, such as Dr. Julie St-Pierre, emphasize the importance of obesity management by multidisciplinary teams, which remain rare in Quebec, but which are essential to treat this disease effectively.
Dysfunctions associated with clinical obesity
Experts from The Lancet have identified several dysfunctions in adults and children that are directly linked to clinical obesity. Here are some examples:
In adults:
-• Heart failure
• Sleep apnea
• Hypertension
• Fatty liver disease
• Chronic urinary incontinence
• Significant limitations of mobility in daily activities
In children:
• Sleep apnea
• Hypertension
• Renal damage
• Chronic pain linked to poor leg alignment
This revision of the definition of obesity could have significant repercussions on the way obesity is treated in the health system, by encouraging better treatment coverage and more adapted care. Specialists hope that these new guidelines will better protect patients and reduce the stigma associated with obesity.
Source : The Lancet Diabetes & Endocrinology / La Presse
Publication Health Index: 2025-01-16
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