EASO Advances the Long Goodbye for BMI in Obesity

We’ve been hearing quite a lot about this on many levels. For years now, obesity thought leaders and even the public have had an increasingly sour relationship with BMI. It’s been misused, abused, detested, and even accused of racism. Yes, the love is gone. On Friday, the European Association for the Study of Obesity (EASO) advanced the long goodbye for BMI in obesity by yet another step.

It was a messy process – as consensus building always is. But in Nature Medicine, Luca Busetto and colleagues published a new framework for the diagnosis, staging and management of obesity in adults. It emerged from a modified Delphi study, incorporated perspectives from 21 global obesity experts, and brought together a lot of thinking that represents the mainstream of clinical perspectives on obesity.

No More Exclusive Relationship

Obesity experts are not exactly breaking up with BMI. But the relationship between BMI and the diagnosis of obesity is clearly no longer an exclusive one. The authors of the framework say it quite plainly: “BMI alone is insufficient as a diagnostic criterion.”

Obesity treatment can be entirely appropriate in patients with lower BMI, they say, even with obesity medicines. Treatment decisions should depend instead upon other signs and symptoms of obesity. They also emphasize the importance of shifting the focus of clinical care away from a preoccupation with body weight:

“Full agreement among the experts was reached for the statement that the management of obesity should move beyond weight loss alone, and should include the prevention, resolution or improvement of obesity-related complications, a better quality of life and mental wellbeing, and improvement of physical and social functioning and fitness.

“This statement will move obesity management closer to the management of other non-communicable chronic diseases, in which the goal is not represented by short-term intermediate outcomes, but by long-term health benefits.”

Not Exactly Radical

Because this is the product of a consensus process, this framework is hardly radical. It is most notably a very clear articulation of the long goodbye to BMI as the diagnostic criterion for obesity. Some might view this framework as somehow competitive with the more ambitious work of the Lancet Commission on Clinical Obesity. We do not.

Rather, we see the EASO framework as an excellent articulation of a current consensus. The Lancet Commission may well serve to push toward a new and more refined consensus. We look forward to its emergence.

Click here for the publication in Nature Medicine, here and here for further perspective.

Untitled Figure Construction with Waving Man, painting by Bill Traylor / WikiArt

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July 6, 2024