How we diagnose and define obesity is set to change – here’s why, and what it means for treatment
10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.
Obesity is linked to many common diseases, such as type 2 diabetes, heart disease, fatty liver disease and knee osteoarthritis.
Obesity is currently defined using a person’s body mass index, or BMI. This is calculated as weight (in kilograms) divided by the square of height (in metres). In people of European descent, the BMI for obesity is 30 kg/m² and over.
But the risk to health and wellbeing is not determined by weight – and therefore BMI – alone. We’ve been part of a global collaboration that has spent the past two years discussing how this should change. Today we publish how we think obesity should be defined and why.
As we outline in The Lancet, having a larger body shouldn’t mean you’re diagnosed with “clinical obesity”. Such a diagnosis should depend on the level and location of body fat – and whether there are associated health problems.
What’s wrong with BMI?
The risk of ill health depends on the relative percentage of fat, bone and muscle making up a person’s body weight, as well as where the fat is distributed.
Athletes with a relatively high muscle mass, for example, may have a higher BMI. Even when that athlete has a BMI over 30 kg/m², their higher weight is due to excess muscle rather than excess fatty tissue.
People who carry their excess fatty tissue around their waist are at greatest risk of the health problems associated with obesity.
Fat stored deep in the abdomen and around the internal organs can release damaging molecules into the blood. These can then cause problems in other parts of the body.
But BMI alone does not tell us whether a person has health problems related to excess body fat. People with excess body fat don’t always have a BMI over 30, meaning they are not investigated for health problems associated with excess body fat. This might occur in a very tall person or in someone who tends to store body fat in the abdomen but who is of a “healthy” weight.
On the other hand, others who aren’t athletes but have excess fat may have a high BMI but no associated health problems.
BMI is therefore an imperfect tool to help us diagnose obesity.
What is the new definition?
The goal of the Lancet Diabetes & Endocrinology Commission on the Definition and Diagnosis of Clinical Obesity was to develop an approach to this definition and diagnosis. The commission, established in 2022 and led from King’s College London, has brought together 56 experts on aspects of obesity, including people with lived experience.
The commission’s definition and new diagnostic criteria shifts the focus from BMI alone. It incorporates other measurements, such as waist circumference, to confirm an excess or unhealthy distribution of body fat.
We define two categories of obesity based on objective signs and symptoms of poor health due to excess body fat.
1. Clinical obesity
A person with clinical obesity has signs and symptoms of ongoing organ dysfunction and/or difficulty with day-to-day activities of daily living (such as bathing, going to the toilet or dressing).
There are 18 diagnostic criteria for clinical obesity in adults and 13 in children and adolescents. These include:
- breathlessness caused by the effect of obesity on the lungs
- obesity-induced heart failure
- raised blood pressure
- fatty liver disease
- abnormalities in bones and joints that limit movement in children.
2. Pre-clinical obesity
A person with pre-clinical obesity has high levels of body fat that are not causing any illness.
People with pre-clinical obesity do not have any evidence of reduced tissue or organ function due to obesity and can complete day-to-day activities unhindered.
However, people with pre-clinical obesity are generally at higher risk of developing diseases such as heart disease, some cancers and type 2 diabetes.
What does this mean for obesity treatment?
Clinical obesity is a disease requiring access to effective health care.
For those with clinical obesity, the focus of health care should be on improving the health problems caused by obesity. People should be offered evidence-based treatment options after discussion with their health-care practitioner.
Treatment will include management of obesity-associated complications and may include specific obesity treatment aiming at decreasing fat mass, such as:
- support for behaviour change around diet, physical activity, sleep and screen use
- obesity-management medications to reduce appetite, lower weight and improve health outcomes such as blood glucose (sugar) and blood pressure
- metabolic bariatric surgery to treat obesity or reduce weight-related health complications.
Should pre-clinical obesity be treated?
For those with pre-clinical obesity, health care should be about risk-reduction and prevention of health problems related to obesity.
This may require health counselling, including support for health behaviour change, and monitoring over time.
Depending on the person’s individual risk – such as a family history of disease, level of body fat and changes over time – they may opt for one of the obesity treatments above.
Distinguishing people who don’t have illness from those who already have ongoing illness will enable personalised approaches to obesity prevention, management and treatment with more appropriate and cost-effective allocation of resources.
What happens next?
These new criteria for the diagnosis of clinical obesity will need to be adopted into national and international clinical practice guidelines and a range of obesity strategies.
Once adopted, training health professionals and health service managers, and educating the general public, will be vital.
Reframing the narrative of obesity may help eradicate misconceptions that contribute to stigma, including making false assumptions about the health status of people in larger bodies. A better understanding of the biology and health effects of obesity should also mean people in larger bodies are not blamed for their condition.
People with obesity or who have larger bodies should expect personalised, evidence-based assessments and advice, free of stigma and blame.
Louise Baur, Professor, Discipline of Child and Adolescent Health, University of Sydney; John B. Dixon, Adjunct Professor, Iverson Health Innovation Research Institute, Swinburne University of Technology; Priya Sumithran, Head of the Obesity and Metabolic Medicine Group in the Department of Surgery, School of Translational Medicine, Monash University, and Wendy A. Brown, Professor and Chair, Monash University Department of Surgery, School of Translational Medicine, Alfred Health, Monash University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
Don’t Forget…
Did you arrive here from our newsletter? Don’t forget to return to the email to continue learning!
Recommended
Learn to Age Gracefully
Join the 98k+ American women taking control of their health & aging with our 100% free (and fun!) daily emails:
-
Pomegranate vs Apricot – Which is Healthier?
10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.
Our Verdict
When comparing pomegranate to apricot, we picked the pomegranate.
Why?
Both are great! Top tier fruits. But ultimately, pomegranate does have more to offer:
In terms of macros, pomegranate has more protein, carbs, and fiber (and even a little healthy fat—it’s the seeds); the main deciding factor on macros for fruits is almost always the fiber, and that’s the case here, which is why we hand the win to pomegranates in this category.
In the category of vitamins, pomegranates have more of vitamins B1, B2, b5, B6, B7, B9, K, and choline, while apricots have more of vitamins A, B3, and E. A clear win for pomegranates here.
When it comes to minerals, pomegranate has more copper, calcium, magnesium, manganese, phosphorus, selenium, and zinc, while apricots boast just a little more calcium and iron. Another easy win for pomegranates.
Looking at polyphenols, apricots finally win a category, with greater overall polyphenol coverage.
Which is good, but not enough to overcome the other three categories all being in pomegranates’ favor—hence the overall win for pomegranates here!
Of course, the solution is to enjoy both! Diversity is good, for exactly such reasons as this.
Want to learn more?
You might like to read:
Pomegranate’s Health Gifts Are Mostly In Its Peel ← in other words, the one part of the fruit you don’t normally eat. However! It can be dried and ground into a powder supplement, or else made in pomegranate tea.
Enjoy!
Share This Post
-
Hold Me Tight – by Dr. Sue Johnson
10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.
A lot of relationship books are quite wishy-washy. This one isn’t.
This one is evidenced-based (and heavily referenced!), and yet at the same time as being deeply rooted in science, it doesn’t lose the human touch.
Dr. Johnson has spent her career as a clinical psychologist and researcher; she’s the primary developer of Emotionally Focused Therapy (EFT), which has demonstrated its effectiveness in over 35 years of peer-reviewed clinical research. In other words, it works.
EFT—and thus also this book—finds roots in Attachment Theory. As such, topics this book covers include:
- Recognizing and recovering from attachment injury
- How fights in a relationship come up, and how they can be avoided
- How lot of times relationships end, it’s not because of fights, but a loss of emotional connection
- Building a lifetime of love instead, falling in love again each day
This book lays the groundwork for ensuring a strong, secure, ongoing emotional bond, of the kind that makes/keeps a relationship joyful and fulfilling.
Dr. Johnson has been recognized in her field with a Lifetime Achievement Award, and the Order of Canada.
Share This Post
-
Protein Immune Support Salad
10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.
How to get enough protein from a salad, without adding meat? Cashews and chickpeas have you more than covered! Along with the leafy greens and an impressive array of minor ingredients full of healthy phytochemicals, this one’s good for your muscles, bones, skin, immune health, and more.
You will need
- 1½ cups raw cashews (if allergic, omit; the chickpeas and coconut will still carry the dish for protein and healthy fats)
- 2 cans (2x 14oz) chickpeas, drained
- 1½ lbs baby spinach leaves
- 2 large onions, finely chopped
- 3 oz goji berries
- ½ bulb garlic, finely chopped
- 2 tbsp dessicated coconut
- 1 tbsp dried cumin
- 1 tbsp nutritional yeast
- 2 tsp chili flakes
- 1 tsp black pepper, coarse ground
- ½ tsp MSG, or 1 tsp low-sodium salt
- Extra virgin olive oil, for cooking
Method
(we suggest you read everything at least once before doing anything)
1) Heat a little oil in a pan; add the onions and cook for about 3 minutes.
2) Add the garlic and cook for a further 2 minutes.
3) Add the spinach, and cook until it wilts.
4) Add the remaining ingredients except the coconut, and cook for another three minutes.
5) Heat another pan (dry); add the coconut and toast for 1–2 minutes, until lightly golden. Add it to the main pan.
6) Serve hot as a main, or an attention-grabbing side:
Enjoy!
Want to learn more?
For those interested in some of the science of what we have going on today:
- Cashew Nuts vs Coconut – Which is Healthier?
- What Matters Most For Your Heart?
- Beyond Supplements: The Real Immune-Boosters!
- Goji Berries: Which Benefits Do They Really Have?
- Our Top 5 Spices: How Much Is Enough For Benefits?
Take care!
Share This Post
Related Posts
-
Master Your Core – by Dr. Bohdanna Zazulak
10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.
In the category of “washboard abs”, this one isn’t particularly interested in how much or how little fat you have. What it’s more interested in is a strong, resilient, and stable core. Including your abs yes, but also glutes, hips, and back.
Nor is the focus on superhuman feats of strength, though certainly one could use these exercises to work towards that. Rather, here we see importance placed on functional performance, mobility, and stability.
Lest mobility and stability seem at odds with each other, understand:
- By mobility we mean the range of movement we are able to accomplish.
- By stability, we mean that any movement we make is intentional, and not because we lost our balance.
Functional performance, meanwhile, is a function of those two things, plus strength.
How does the book deliver on this?
There are exercises to do. Exercises of the athletic kind you might expect, and also exercises including breathing exercises, which gets quite a bit of attention too. Not just “do abdominal breathing”, but quite an in-depth examination of such. There are also habits to form, and lifestyle tweaks to make.
Of course, you don’t have to do all the things she suggests. The more you do, the better results you are likely to get, but if you adopt even some of the practices she recommends, you’re likely to see some benefits. And, perhaps most importantly, reduce age-related loss of mobility, stability, and strength.
Bottom line: a great all-rounder book of core strength, mobility, and stability.
Click here to check out Master Your Core and enjoy the more robust health that comes with it!
Don’t Forget…
Did you arrive here from our newsletter? Don’t forget to return to the email to continue learning!
Learn to Age Gracefully
Join the 98k+ American women taking control of their health & aging with our 100% free (and fun!) daily emails:
-
Widen the Window – by Dr. Elizabeth Stanley
10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.
Firstly, about the title… That “window” that the author bids us “widen” is not a flowery metaphor, but rather, is referring to the window of exhibited resilience to stress/trauma; the “window” in question looks like an “inverted U” bell-curve on the graph.
In other words: Dr. Stanley’s main premise here is that we respond best to moderate stress (i.e: in that window, the area under the curve!), but if there is too little or too much, we don’t do so well. The key, she argues, is widening that middle part (expanding the area under the curve) in which we perform optimally. That way, we can still function in a motivated fashion without extrinsic threats, and we also don’t collapse under the weight of overwhelm, either.
The main strength of this book, however, lies in its practical exercises to accomplish that—and more.
“And more”, because the subtitle also promised recovery from trauma, and the author delivers in that regard too. In this case, it’s about widening that same window, but this time to allow one’s parasympathetic nervous system to recognize that the traumatic event is behind us, and no longer a threat; we are safe now.
Bottom line: if you would like to respond better to stress, and/or recover from trauma, this book is a very good tool.
Don’t Forget…
Did you arrive here from our newsletter? Don’t forget to return to the email to continue learning!
Learn to Age Gracefully
Join the 98k+ American women taking control of their health & aging with our 100% free (and fun!) daily emails:
-
Undoing Creatine’s Puffiness Side Effect
10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.
It’s Q&A Day at 10almonds!
Have a question or a request? We love to hear from you!
In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small 😎
❝Creatine is known to increase “puffiness”, especially in my face. Are there any supplements that do the opposite?!❞
So first, let’s examine why this happens: creatine is most often taken to boost muscle size and performance. Your muscles are, of course, mostly water by mass, and so building your muscles requires extra water, which triggers systemic water retention.
In other words: you take creatine, exercise, and as the muscles start growing, the body goes “oh heck, we are running out of water, better save as much as possible in order to keep hydrating the muscles without running out” and starts putting it anywhere it can that’s not your bladder, so this will largely be the soft tissues of your body.
So, this results in classic water retentions symptoms including bloating and, yes, facial puffiness.
How much this happens, and how long the effects last, depend on three main things:
- What daily dose of creatine you are taking
- What kind of exercise you are doing
- What your hydration is like
The dose is relevant as it’s most common to get this puffiness during the “loading” phase, i.e. if you’re taking an increased dose to start with.
The exercise is relevant as it affects how much your body is actually using the water to build muscles.
The hydration is relevant because the less water you are taking, the more the body will try to retain whatever you do have.
This means, of course, that the supplement you are looking for to undo the facial puffiness is, in fact, water (even, nay, especially, if you feel bloated too):
Water For Everything? Water’s Counterintuitive Properties
Additionally, you could scale back the dose of creatine you’re taking, if you’re not currently doing heavy muscle-building exercise.
That said, the recommended dose for cognitive benefits is 5g/day, which is a very standard main-phase (i.e., post-loading) bodybuilding dose, so do with that information what you will.
See also: Creatine’s Brain Benefits Increase With Age
On which note: whether or not you want to take creatine for brain benefits, however, may depend on your age:
Creatine: Very Different For Young & Old People
Most research on creatine’s effects on humans has usually been either collegiate athletes or seniors, which leaves quite a research gap in the middle—so it’s unclear at what age the muscle-building effects begin to taper off, and at what age the cognitive benefits begin to take off.
Want a quicker fix?
If you want to reduce your facial puffiness acutely (e.g., you have a date in an hour and would like to not have a puffy face), then there are two things you can do that will help immediately, and/but only have short-term effects, meaning you’d have to do them daily to enjoy the results every day:
The first is an ice bath; simply fill a large bowl with water and ice cubes, give it a couple of minutes to get down to temperature, hold your breath and plunge your face in for as long as you can comfortably hold your breath. Repeat a few times, and towel off.
This helps by waking up the vasculature in your face, helping it to reduce puffiness naturally.
The second is facial yoga or guā shā, which is the practice of physically manipulating the soft tissues of your face to put them where you want them, rather than where you don’t want them. This will work against water retention puffiness, as well as cortisol puffiness, lymphatic puffiness, and more:
7-Minute Face Fitness For Lymphatic Drainage & Youthful Jawline
Enjoy!
Don’t Forget…
Did you arrive here from our newsletter? Don’t forget to return to the email to continue learning!
Learn to Age Gracefully
Join the 98k+ American women taking control of their health & aging with our 100% free (and fun!) daily emails:
