HEALTHCARE systems around the world should rethink the way they diagnose obesity, according to a group of international and Australian experts who say current approaches are too reliant on body mass index (BMI).
Published in the Lancet Diabetes & Endocrinology, the Global Commission on Clinical Obesity recommends a new approach focusing on other measures of body fat to avoid misclassification and itsconsequences.
The proposal is designed to address limitations in the traditional definition and diagnosis of obesity that hinder clinical practice and healthcare policies, resulting in individuals with obesity not receiving the care they need.
Rather than using BMI alone, the Commission recommends confirmation of excess fat mass (obesity) and its distribution around the body using a combination of body measurements, such as waist circumference, waist-to-hip ratio or waist-to-height ratio, with or without BMI; or direct body fat measurement (such as by a bone densitometry scan or DEXA).
In people with a BMI over 40, they say excess body fat can be pragmatically assumed.
The Commission also provides a new model for disease diagnosis in obesity based on objective measures of illness at the individual level.
It outlines 18 diagnostic criteria for clinical obesity in adults, including metabolic, respiratory and musculoskeletal symptoms, while pre-clinical obesity is defined as a condition of obesity with normal organ function but future risk.
"This nuanced approach to obesity will enable evidence-based and personalised approaches to prevention, management and treatment in adults and children living with obesity, allowing them to receive more appropriate care, proportional to their needs.
"This will also save healthcare resources by reducing the rate of overdiagnosis and unnecessary treatment," said Commissioner Professor Louise Baur, of the University of Sydney.
The proposal has been endorsed by 75 medical organisations around the world.
Read the full paper HERE.
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