Reframing obesity: new definition and diagnostic criteria for clinical and preclinical obesity

An international multidisciplinary commission published a consensus document on obesity, proposing two distinct definitions for obesity, clinical obesity and preclinical obesity.

An international, multidisciplinary commission comprising of 58 experts developed a new, updated definition of obesity. Although obesity affects a large number of people worldwide, global consensus on the definition and diagnostic criteria has not been reached. There is a lot of controversy, both within and outside the medical community, about the idea that obesity should be considered as a standalone disease entity. Moreover, current BMI-based measures of obesity have several limitations, as BMI provides no information about health at the individual level. The aim of the Lancet Diabetes & Endocrinology Commission was to develop consensus about obesity using available evidence.

The commission's report, published in Lancet Diabetes & Endocrinology, introduces a distinction between clinical obesity and preclinical obesity. Clinical obesity is defined as a chronic, systemic illness characterized by functional alterations in tissues, organs, the entire individual or a combination thereof, due to excess adiposity. In contrast, preclinical obesity is defined as the presence of excess adiposity with preserved function of other tissues and organs and a varying, but generally increased, risk of developing clinical obesity and other noncommunicable diseases such as T2D and CVD.

Excess adiposity should be confirmed with body fat measurements, where available, or at least one anthropometric criterion (such as waist circumference, waist-to-hip-ratio, or waist-to-height ratio) in addition to BMI. The commission recommends that BMI should be exclusively used as a surrogate marker for health risk at a population level, rather than assessing health risk at the individual level.

For patients with clinical obesity, the commission emphasizes the need for timely, evidence-based treatment strategies. For those with preclinical obesity, the focus should be on health counseling, regular monitoring, and, when applicable, preventive interventions aimed at reducing the risk of progression to clinical obesity and associated comorbidities.

Find the recommendations from commission online at Lancet Diabetes Endocrinol.

Reference

1.  Rubino F, Cummings DE, Eckel RH, et al. Definition and diagnostic criteria of clinical obesity. Lancet Diabetes Endocrinol. 2025:S2213-8587(24)00316-4. doi: 10.1016/S2213-8587(24)00316-4.