Lancet Commission on Clinical Obesity: It’s All About Health

Hygiea at the Centraal ApotheekWe’ve been waiting for this. And judging by the initial responses, the world is ready for it. The Lancet Commission on Clinical Obesity has made it official: The clinical disease of obesity is all about health. Not size, not appearance, not BMI. This global consensus report published at long last late yesterday in Lancet Diabetes and Endocrinology. A global launch event (register here) is planned for tomorrow.

We have nothing but praise for the accomplishment of the commission in building this global consensus. Major patient, professional, and scientific groups from all over the world have endorsed this report. Even with this remarkable degree of consensus, Robert Kushner, a member of the commission, tells us:

“This is the first step in a process. It’s going to begin the conversation.”

That conversation will be all about building a better understanding of obesity in all its forms.

Clinical & Preclinical Obesity

The core concept here is quite simple. Clinical obesity is defined by chronic, systemic illness due to excess adiposity. If a person has excess adiposity, but no signs or symptoms of systemic illness, then they have preclinical obesity. The Lancet report identifies signs and symptoms of clinical obesity for both adults and children.

Leaning Less on BMI

The report makes it clear that the historical overreliance on BMI to diagnose obesity has created confusion and problems:

“Current BMI-based measures of obesity can both underestimate and overestimate adiposity and provide inadequate information about health at the individual level, which undermines medically-sound approaches to health care and policy.”

Francesco Rubino, who chaired the commission, hopes this will be the beginning of a process to set aside distracting controversies about whether and when obesity may be regarded as a disease or merely a risk factor for other diseases:

“The question of whether obesity is a disease is flawed because it presumes an implausible all-or-nothing scenario where obesity is either always a disease or never a disease. Evidence, however, shows a more nuanced reality. Some individuals with obesity can maintain normal organs’ function and overall health, even long term, whereas others display signs and symptoms of severe illness here and now.

“Considering obesity only as a risk factor, and never a disease, can unfairly deny access to time-sensitive care among people who are experiencing ill health due to obesity alone. On the other hand, a blanket definition of obesity as a disease can result in overdiagnosis and unwarranted use of medications and surgical procedures, with potential harm to the individual and staggering costs for society.”

An Impressive Milestone

Any way we look at it, this is an impressive milestone. This commission has forged a global consensus that brings patient advocates, clinicians, and scientists together for a better understanding of the most prevalent complex chronic disease we face. To those who see ways to build upon this consensus, we say come and join the conversation.

Click here for the report, here, here, and here for further reporting on it. To register for tomorrow’s global launch event, click here.

Hygiea at the Centraal Apotheek, photograph by C Messier, licensed under CC BY-SA 4.0

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January 15, 2025

4 Responses to “Lancet Commission on Clinical Obesity: It’s All About Health”

  1. January 15, 2025 at 7:05 am, Michael Jones said:

    I look forward to the day when we begin to see clinical obesity research unmoored from BMI as an endpoint.

  2. January 15, 2025 at 12:36 pm, Angela Golden said:

    I am so disappointed that they put access behind a firewall. For those of us not in academia this prevents us from reading it. Sort of sad.

    • January 16, 2025 at 3:37 am, Ted said:

      Angela, access is free. All you have to do is register for free.

  3. January 17, 2025 at 11:17 am, Sean Manning said:

    An impressive body of work and a further step towards a more global understanding of Obesity without a doubt.

    The slight drawbacks are

    a) the inclusion of separate Obesity and Clinical Obesity diagnoses- this poses a dilemma for unfamiliar observers. Which is the disease?

    b) minimal consideration of the pathophysiological basis of Obesity

    Many thanks for your ongoing leadership in this field.