The Struggle with Current Illness and Future Risks of Obesity

We’ve been living with the consensus report of the Lancet Commission on Clinical Obesity now for two months. Enough time has passed for feelings about the strengths and limitations of this work to take shape. A new commentary in the BMJ yesterday brings a sharp focus to the struggle of defining and dealing with current illness and future risks of obesity.

Oliver Mytton, Denise Campbell-Scherer, Ian Reckless, and Clare Llewellyn find a problem with merely drawing a line between clinical and preclinical obesity. They write about the problems of limiting clinical care until end organ damage occurs and conclude:

“All of this points to a challenge with only having two groups. A more nuanced approach to classifying risk or staging will be needed to guide obesity treatment, like the Edmonton and King’s staging systems, which is absent from the commission’s work.”

The Problem in Pediatrics

The simple, sharp line between risks and illness is a particular problem for pediatric and adolescent obesity. This is because much of pediatric healthcare is all about dealing with risks that threaten a child’s future health.

Discussing this in Acta Paediatrica, Annika Janson concludes that, for pediatrics, drawing a line isn’t helpful. In fact, she says it complicates things:

“Obesity per se can safely remain a diagnosis for children, and it should entitle them and their families to the care they need to help them preserve their future health. We need a straightforward and relevant classification that can be easily communicated to parents and other stakeholders. Instead of battling over criteria, we need to focus our attention on disseminating and following the most useful guidelines.”

A Disease in Progress

Really, none of this is surprising. Tidy definitions for obesity have long been elusive. In part, this is because the visible signs of obesity overwhelm our knowledge of the biological disorder.

The work of the Lancet Commission is helpful, but far from the final word on diagnostic criteria for this clinical disease. And it does nothing for identifying persons with preclinical obesity for whom clinical care is most urgent.

But folks who suggest it will empower payers to deny access to care for obesity are making a silly argument. Payers are doing this quite thoroughly without a bit of help from the Commission.

Instead of squabbling about the limitations of the Lancet Commission’s work, energy should go into building upon its strengths.

Click here for the new commentary in the BMJ and here for the commentary from Janson. For a discussion of this framework between psychologist and dietitian Nina Crowley and ConscienHealth’s Ted Kyle, click here.

Suprematism, painting by Kazimir Malevich / WikiArt

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March 18, 2025