Commission Calls for Objective Obesity Diagnosis & Stigma-Free Care

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A new consensus redefines obesity as a chronic illness and urges better diagnostics, equitable care, and stigma-free, evidence-based interventions.

The upcoming American Association of Clinical Endocrinology Annual Meeting features several updates in obesity management, including one session titled “Too Much or Too Little Weight Loss: Non-Responders, Weight Loss Plateaus, and Maintenance Options,” with speaker W. Timothy Garvey, MD.

Recently, Dr. Garvey was also involved in an expert panel that sought to establish objective criteria for diagnosing and treating obesity, aiming to support clinicians and guide public health strategies. The group comprised 58 experts across several specialties and countries, including people with lived experience of obesity.

“This Commission sought to define clinical obesity as a condition of illness that, akin to the notion of chronic disease in other medical specialties, directly results from the effect of excess adiposity on the function of organs and tissues,” the authors wrote. “The specific aim of the Commission was to establish objective criteria for disease diagnosis, aiding clinical decision making and prioritization of therapeutic interventions and public health strategies.”

Obesity Definitions

The experts defined obesity as “a condition characterized by excess adiposity, with or without abnormal distribution or function of adipose tissue, and with causes that are multifactorial and still incompletely understood.” From there, the group broke obesity down into two categories: clinical and preclinical.

The panel defined clinical obesity as a chronic, systemic illness wherein excess adiposity leads to tissue, organ, and/or whole-body dysfunction. The authors wrote that clinical obesity could damage organs severely enough to cause life-threatening complications such as heart attack or stroke.

Preclinical obesity was defined as excess adiposity with preserved organ function and a varying (but typically increased) risk for progression to clinical obesity or other conditions such as cardiovascular disease, cancer, and mental health disorders.

“Although the risk of mortality and obesity-associated diseases can rise as a continuum across increasing levels of fat mass, we differentiate between preclinical and clinical obesity (ie, health vs illness) for clinical and policy-related purposes,” the group said.

Evaluation & Diagnosis

The experts described the following recommendations:

• BMI should be used only for measuring health risk at the population level, conducting epidemiological studies, or screening. It should not be used as an individual measure of health.
• To confirm excess adiposity, clinicians should directly measure body fat or evaluate patients for at least one anthropometric criterion in addition to BMI. These criteria may include waist circumference, waist-to-hip ratio, or waist-to-height ratio.
• Excess adiposity can be assumed in patients with very high BMI (>40 kg/m²) without additional confirmation.
• People with confirmed obesity status should be assessed for clinical obesity.
• To meet diagnostic criteria for clinical obesity, patients must have one or both of the following:
  • Evidence of reduced organ or tissue function due to obesity (ie, signs, symptoms, or diagnostic tests showing abnormalities in the function of one or more tissue or organ systems)
  • Substantial, age-adjusted limitations of daily activities reflecting the specific effect of obesity on mobility, other basic activities of daily living (eg, bathing, dressing, toileting, continence, and eating)

Management Recommendations

The experts offered the following guidance for managing patients with obesity:

• Clinical Obesity: Patients should receive timely, evidence-based treatment to improve or resolve clinical manifestations of obesity and prevent severe organ damage.
• Preclinical Obesity: Patients should receive health counseling, and clinicians should monitor health status longitudinally. When appropriate, clinicians should intervene to reduce the risk for clinical obesity and related diseases.
• Healthcare professionals and policymakers should receive training to reduce weight-based bias and stigma, which can interfere with efforts to prevent and treat obesity.

The group also called for healthcare policymakers and health authorities to improve access to evidence-based obesity treatments, emphasizing that population-level efforts should be based on evidence rather than unproven assumptions that blame individuals for developing obesity.

“All recommendations presented in this Commission have been agreed with the highest level of consensus among the commissioners (grade of agreement 90–100%) and have been endorsed by more than 76 organizations worldwide, including scientific societies and patient advocacy groups,” the authors said.