It has been revealed that in 2023, almost a third (32 percent) of adults in Scotland were living with obesity – reaching its highest level. This does not help to push the Scots away from our association with unhealthy foods.
However, experts are now saying that millions of people in the country may be being “misdiagnosed” as obese, when they actually aren’t. Academics have suggested that we should not be solely relying on a body mass index (BMI) score to determine if someone is in fact obese.
They say that this score can both under and overestimate the number of people who are obese, as this number could classify someone as obese even though they are very active and their weight is presenting no ill-effects. They argue that more assessments are needed before making a diagnosis.
A new Lancet Commission – made up of over 50 experts from around the world – is calling for a “radical overhaul” for diagnosing obesity. They said that the BMI tool is useful but should only be used as a “surrogate measure of health risk” as we need to go beyond this tool to determine excess body fat.
Additionally, they have advised that obesity should only be diagnosed using BMI as long as clinicians are also taking other measurements, such as waist to hip ratio or waist to height ratio. However, one issue is that taking extra measures to come to a diagnosis could end up being more expensive and time consuming, as ideally body scans would need to be used.
Researchers have called for two new categories for diagnosing obesity. The first is clinical obesity, which is defined as a “chronic systematic illness” whereby excess fat can lead to organ damage and cause “life-altering and potentially life-threatening complications”.
The second is pre-clinical obesity where a person has a variable level of health risk, but no ongoing illness, or “state of excess adiposity”. One topic of serious debate has been whether to class obesity as an illness or not.
Chairman of the commission, Professor Francesco Rubino, said: “Some people who are today classified as having obesity by BMI (but) they might play sports, they’re very active, they might have very strong bones – saying that those people have obesity and then classifying them as having a disease would obviously be an overdiagnosis.”
He said that the main goal of the commission is to find a way of accurately diagnosing and classifying obesity. He added: “No system – the NHS or others – have had these methods yet – I think everybody has been using the old classification for four decades, at least.
“But we are calling for a change, a radical change, because obviously, in the context of one billion people being classified as having obesity in the world today, and with a number that is projected to increase, no country is rich enough to be able to afford inaccuracy in the diagnosis of obesity.”
Obesity has always been classified as a health risk, but for some it is an illness that needs to be diagnosed correctly. As there are different risks for different people, it would make sense that different courses of action will need to be taken for each individual.
Rubino explained that it is not possible to give the same intervention to the billions of people classed as being obese. He said: “Not only is (this) probably economically unsustainable, but it’s also not exactly what each individual needs, because the personalised care is what makes the effectiveness and (the) cost effectiveness of the interventions. And so we cannot afford having a blurry picture of obesity.”
An example of different treatment is the NHS rolling out weight loss jabs for obese people, but only if they meet a certain criteria. In 2022, treating obesity cost NHS Scotland £776 million, with this number set to rise. Obesity in general cost Scotland £5.3 billion that year.
Commenting on the commission, Dr Kath McCullough, special adviser on obesity at the Royal College of Physicians, said: “For too long, we’ve relied on BMI as a simple measure of obesity, which has often misrepresented the condition and fails to fully reflect how excess body fat impacts a person’s health.
“The commission’s distinction between pre-clinical and clinical obesity represents a vital step forward, highlighting the need to identify and intervene early while providing appropriate care to those already experiencing severe health impacts.”
However, Katharine Jenner, director of the Obesity Health Alliance, said: “Our priority should be supporting those living with excess weight, rather than focusing solely on how it is measured. Currently, obesity treatment is inaccessible to those who need it most, namely individuals with the highest levels of excess weight, while our prevention policies remain insufficient.”.
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