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When are we considered obese? Specialists call to redefine the criteria

Some sixty researchers from around the world recommend redefining obesity but also clarifying its diagnosis. According to them, taking into account only the BMI is a source of errors.

How to diagnose obesity? And above all, when is obesity considered a disease? A commission made up of about sixty international researchers, whose report was published on Wednesday in the prestigious medical journal The Lancet Diabetes and Endocrinology, investigated the topic.

For these experts, diagnosing obesity based solely on the calculation of body mass index (BMI) is irrelevant and even a source of error. “BMI is not enough to determine obesity,” Karine Clément, professor in the nutrition department at the Pitié-Salpêtrière hospital and one of the three French members of this commission, explains to BFMTV.com.

“This can misclassify a person as having excess body fat or not, and also lead to underdiagnosis of many people with poor health status and overdiagnosis of many healthy people,” they write.

As a reminder, BMI is obtained by dividing weight by height squared. However, by current standards, a person with a BMI between 25 and 29.9 is considered overweight; from the age of 30 in a situation of obesity, indicates the World Health Organization, which considers that one in eight people in the world is obese.

However, some people who nevertheless have excess fat mass do not always have a BMI greater than 30. Others, who have a high level of muscle mass, may tend to show a BMI greater than 30 despite having a Fat index within normal.

Preclinical obesity and clinical obesity.

“The players of the French rugby team have a BMI greater than 30 and yet they are not obese,” François Pattou, head of the general and endocrine surgery service at the Lille University Hospital and member of the commission.

“The challenge is to go beyond BMI,” insists Karine Clément, director of a research unit at the Sorbonne University and Inserm on the pathophysiology of obesity and associated disorders.

For this group of researchers, it is important to qualify the diagnosis and take into account the patient’s general health status to distinguish between preclinical obesity and clinical obesity.

In the first case, the patient does indeed have excess adiposity but without symptoms, without organic dysfunction and without limitation in their daily activities, but with a greater health risk. In the second, obesity does cause a reduction in the ability to carry out daily activities, symptoms and organic dysfunctions.

Obesity, this disease mocked

19:33

“Obesity is still defined as excess adiposity, which does not change,” Jacques Delarue, professor of nutrition at Brest University and head of the nutrition department at CHRU Brest, tells BFMTV.com. “What the commission proposes is to differentiate preclinical obesity from clinical obesity. We can draw a parallel with diabetes and prediabetes.”

“Obesity is still a disease”

What worries Anne-Sophie Joly, founder of the National Collective of Obese Associations (CNAO), does not see it that way. She believes these experts are disconnected from the “base reality” that obese patients experience. “It is counterproductive to the public health message,” he denounces.

Concerns that Jacques Delarue, also president of the French Nutrition Society, understands. “In France, obesity is not one of the pathologies classified as long-term diseases, but is a real issue for patients suffering from obesity.”

“Obesity is still a disease,” says François Pattou, also director of the translational research laboratory on diabetes that brings together the University of Lille, Inserm, the University Hospital and the Pasteur Institute of Lille.

“But we differentiate two stages: preclinical obesity, which does not require the same treatments as clinical obesity.”

Clinical obesity is then defined as “a chronic and systemic disease, linked to excess adiposity in numerous organs and tissues whose functions are altered,” details the National Academy of Medicine in response to the commission’s publication.

“We still confuse risk factors and disease,” continues Karine Clément. “Yes, obesity can be a disease, but we can certainly have excess fat mass, which is actually a risk factor, without it being at the disease stage.”

Developing support

Therefore, it is imperative for researchers to adopt a new diagnostic approach to obesity. Specifically, they believe that we should no longer rely solely on BMI, which does not reflect either possible excess fat or general health.

Therefore, experts advise taking into account other measurements, such as waist circumference, waist/hip ratio or even waist/height ratio. “We can also use an impedance scale that allows us to measure body composition, muscle mass and fat mass,” adds Karine Clément, also president of the French Association for the Study and Research of Obesity.

Clearly, regarding the waist circumference, it is considered too high if it is greater than or equal to 80 cm for a woman, 94 cm for a man, specifies Health Insurance.

Although Jacques Delarue welcomes the work of the experts, he nevertheless points out certain limits. “Certain methods of measuring excess body fat are not available in general practitioners’ offices. As for other measurements, thresholds have yet to be established by age, sex and ethnicity.”

But this doctor recognizes that these new recommendations “will push us to change our practices.” Furthermore, the objective of the commission, according to Karine Clément, in addition to medical training issues, “is also to develop awareness and management of the disease.”

According to the latest study by Public Health France, which defines obesity by a BMI greater than or equal to 30, around 17% of French people are obese. With the new proposed definition, according to François Pattou, also president of the French and Francophone Society for Surgery of Obesity and Metabolic Diseases, “10% of the French population is affected by clinical obesity.” “We can imagine that fewer patients means better care.”

Author: Céline Hussonnois-Alaya
Source: BFM TV

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