Reservations About Preclinical Obesity in Pediatrics

A new viewpoint in JAMA Pediatrics articulates a concern we hear repeatedly about the Lancet Commission on Clinical Obesity. Pediatric obesity experts have reservations about applying the concept of preclinical obesity in pediatrics. Melania Manco is a professor of pediatrics, clinical research scientist, and consultant endocrinologist at the Bambino Gesù Hospital in Rome. She writes:

“According to the Lancet Commission framework, only children with clinical obesity should be considered as having immediate threats to their life or health and should therefore receive treatment. However, this approach leaves less severely ill children untreated, allowing their condition to worsen over time.”

Treatment or “Interventions”?

Francesco Rubino, who chaired the Lancet Commission, takes exception to this characterization. He recently told Healio that “people with both preclinical and clinical obesity should receive care, though that level of care will differ based on each individual’s needs.”

But if we parse the Lancet Commission report carefully, we find that it leaves individuals with preclinical obesity in a kind of limbo that Manco describes in her viewpoint:

“Within the Lancet Commission framework, preclinical obesity is a gray area in which some patients will very quickly progress to clinical obesity and present with increased morbidity in adulthood.”

Getting down to specifics, the commission’s report says that individuals with preclinical obesity should receive “treatment.” In contrast, those with preclinical obesity should receive “health counseling” and, when appropriate, “intervention.” In our view, these are different. Treatment is the provision of care. Intervention is an effort to prompt someone to act.

Splitting Hairs

Through that lens, we understand the reservations about preclinical obesity we keep hearing from obesity experts in pediatrics. Are we splitting hairs? Perhaps, but if so, it is health systems hostile to providing obesity care that have conditioned us to do so.

Click here for Manco’s viewpoint and here to refer to the Lancet Commission report. For further exploration of this ongoing debate, click here and here.

Georgiana Burne Jones and Children in the Background, painting by Edward Burne-Jones / WikiArt

Subscribe by email to follow the accumulating evidence and observations that shape our view of health, obesity, and policy.

May 20, 2025