Millions of people may be taking weight-loss jabs unnecessarily as people are being “over diagnosed” with obesity, a landmark report has found.
Leading medics said that a body mass index (BMI) score is not “nuanced” enough to measure obesity and more assessments are needed before someone is told they are obese.
Those making up the Lancet Commission of more than 50 experts from around the world said that a “radical overhaul” is needed in how obesity is diagnosed – and that a person’s BMI should not be the sole measure.
Solely using BMI can lead to both overestimates and underestimates of the number of obese people, they said.
The measurement has long faced criticism as some people who are very active and have no ill-effects of their weight are still classified as obese on the score chart. The UK currently defines obesity as anyone with a BMI of at least 30, or at least 27.5 for certain groups of ethnic minorities.
In a briefing to journalists, the team said that a “blanket definition does not reflect reality” and leads to over diagnosis, “leading to unwarranted use of surgical operations, devices and drugs”.
The NHS has initiated the rollout of weight-loss jabs for obese people meeting certain criteria after it was revealed in 2022 that obesity costs the health service £6bn every year, a figure which is expected to rise to more than £9.7bn each year by 2050.
But surgeon Francesco Rubino, chair of bariatric and metabolic surgery at King’s College London – who chairs the commission – said the obesity “landscape” had changed since it was formed five years ago due to the dawn of weight-loss jabs.
“If anything, the possibilities that we have now of more treatment for obesity make the commission’s reframing all the more relevant,” he said.
“If you have one million people, and sometimes 30-40 per cent of the population [classified as obese], it’s important to understand if that problem requires immediate active treatment – by pathological intervention or by simply monitoring and giving good advice on lifestyle intervention.
“You want to make sure you’re not using an invasive intervention for somebody who doesn’t need it. That makes everything both more medically meaningful but also more economically sustainable.”
The commission said that “BMI is useful but we need to go beyond BMI to determine excess body fat” and that the measurement tool should be used only as a “surrogate measure of health risk”.
The UK currently defines obesity as anyone with a BMI of at least 30, or at least 27.5 for certain groups of ethnic minorities (Photo: Getty)Obesity should only be diagnosed using BMI when clinicians also take other measurements such as waist to hip ratio or waist to height ratio into consideration.
Ideally, obesity would be measured using total body fat, but the medics conceded that this would involve clinics “going beyond” what they would usually do to identify obese people because it can include more expensive and time-consuming body scans – with the NHS suffering a shortage of scanners and staff trained to use them.
As well as calls to ditch BMI as a sole measure of obesity, the commission wants two new “diagnostic categories” of obesity.
Firstly clinical obesity – defined as a “chronic systematic illness” whereby excess fat can lead to organ damage and cause “life-altering and potentially life-threatening complications”; and secondly, pre-clinical obesity – a “state of excess adiposity” where the person has a variable level of health risk, but no ongoing illness.
Professor Rubino said that under the new classification, some people currently considered obese would not be. Equally, some people whose BMI was just under the obesity range, could be considered clinically obese.
“It’s difficult to give a figure [on the number of people who would no longer be considered obese] but we think it will improve accuracy, which is what we need in the clinic.”
The authors said there has been “polarised” debate about whether obesity should be classed as an illness and these new definitions should help provide some clarity.
“No system – the NHS or others – have had these methods yet – I think everybody has been using the old classification for four decades, at least,” Rubino said.
“But we are calling for a change, a radical change, because obviously, in the context of one billion people being classified as having obesity in the world today, and with a number that is projected to increase, no country is rich enough to be able to afford inaccuracy in the diagnosis of obesity.”
Tom Sanders, professor emeritus of nutrition and dietetics, King’s College London, said: “The recommendations are helpful because they will help target interventions to those that need them most. The recognition of clinical obesity as disease would hopefully persuade lawmakers to regard it as a disability.
“This would have implications in terms of discrimination particularly in employment as well as the social stigma associated with the condition.”
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Read MoreAccording to the latest Health Survey for England, some 29 per cent of adults are obese and 15 per cent of children aged two to 15 are obese.
The National Institute for health and Care Excellence (Nice) said it had updated its overweight and obesity management guideline on Tuesday which reflected some of the issues raised by the commission. An update earlier this year had also recommended the use of waist-to-height ratio.
Regarding the creation of new categories for clinical and pre-clinical obesity, a spokesman said this would need further consideration and debate by the obesity community, and was not something it would comment on at this stage.
Katharine Jenner, director of the Obesity Health Alliance, said: “Our priority should be supporting those living with excess weight, rather than focusing solely on how it is measured.
“Currently, obesity treatment is inaccessible to those who need it most, namely individuals with the highest levels of excess weight, while our prevention policies remain insufficient.”
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