Dr. Robert Kushner- What is Obesity and Explaining the Lancet Consensus on Pre-Clinical vs Clinical Obesity
With the recent publication of The Lancet‘s consensus article, there’s much to discuss regarding its implications for obesity treatment and care. To delve into this topic, I’m joined by Dr. Robert Kushner, a true expert in the field.
Dr. Kushner is a professor at Northwestern University Feinberg School of Medicine and has authored over 250 publications and multiple books on nutrition and obesity. He also played a key role in founding the American Board of Obesity Medicine - talk about thorough credentials for today’s episode! His latest book, Patient-Centered Weight Management, provides practical strategies for healthcare professionals and helps us continue to work toward best practice in the field of obesity medicine.
Looking at Obesity Differently
The Obesity Medicine Association (OMA) defines Obesity as a chronic, relapsing disease linked to excess body fat that affects metabolism, movement, and overall well-being. Or more simply, obesity is present when extra body fat starts causing or increasing the risk of health problems. So, the real question isn’t just about numbers on a scale—it’s whether weight loss could improve health. Factors like medical history, lifestyle, and lab results all play a role in understanding the bigger picture.
For years, BMI has been the go-to measure for obesity, with a BMI of 30 or higher classified as obese. But BMI has its flaws—it doesn’t distinguish between muscle and fat. A bodybuilder might have a BMI over 30 but low body fat, while someone with a “normal” BMI could have high body fat and related health risks.
Because of these limitations, other measurements like waist circumference and body fat percentage are now considered. This is especially important for groups like postmenopausal women, who may have a normal BMI but still deal with high body fat and metabolic issues.
A recent Lancet article pushes for moving beyond BMI in diagnosing obesity. While BMI remains popular because it’s simple, newer methods like DEXA scans and bioelectrical impedance provide a more accurate picture of body composition. The downside? They’re expensive and not always accessible.
BMI still has its place, but as research advances, better tools will help identify and address obesity in a way that goes beyond just a number. The goal isn’t just to classify people—it’s to help them manage their health effectively.
Clinical Obesity
For years, obesity has been seen as a risk factor for diabetes, heart disease, and even cancer. But is obesity itself a disease, or just something that leads to other conditions? This question has sparked a shift in thinking—one that separates clinical obesity from preclinical obesity.
Clinical obesity means excess body fat is already affecting health, not just increasing the risk of future problems. Researchers have identified 18 signs that indicate body fat is causing harm, including shortness of breath, joint pain, urinary incontinence, heart issues, headaches with snoring, and certain skin changes. These aren’t just warnings—they’re signs the body is already struggling.
For those with clinical obesity, seeking medical support is often recommended. Treatment options range from lifestyle changes to medication, bariatric surgery, working with a dietitian, and psychological support. The goal is to manage these health issues early, before they turn into something more serious.
Preclinical Obesity
Preclinical obesity refers to individuals who have excess body fat but don’t yet show any health issues or reductions in daily functioning. They may have an elevated waist circumference or high body fat percentage, but they can still carry out daily activities without difficulty.
For these individuals, the focus is on maintaining a healthy lifestyle—eating well, staying active, and monitoring health over time. While immediate treatment may not be necessary, future health risks depend on factors like family history. If someone has a strong genetic risk for diabetes or heart disease, early intervention might still be beneficial.
Should Preclinical Obesity Be Treated?
The question of whether to treat preclinical obesity—where extra body fat hasn’t yet caused noticeable health issues—is a bit of a gray area. Some folks in this category might benefit from early intervention, especially if they have a strong family history of metabolic diseases. However, current guidelines often recommend waiting until clinical obesity develops before starting treatment, potentially missing the chance for early action. For example, the American Gastroenterological Association strongly recommends adding medication to lifestyle changes for adults regardless of other conditions with a BMI of 30 or higher.
This approach raises concerns that healthcare systems might hold off on treatment until a person reaches clinical obesity, rather than considering early intervention when it makes sense. Ultimately, deciding when to start treatment should be a conversation between the patient and their healthcare provider, taking into account individual risk factors and health history, rather than being dictated solely by classification.
A New Approach to Obesity Assessment
The distinction between clinical and preclinical obesity is a step toward improving how obesity is assessed and treated. It’s not about restricting treatment options but about refining the approach to obesity care. As research continues, the goal is to move beyond outdated BMI-based definitions and toward a more nuanced understanding of obesity, ensuring that healthcare resources are directed where they’re needed most while allowing flexibility for personalized care.
For a deeper dive into this topic, I invite you to listen to the full episode featuring Dr. Robert Kushner, where we explore these concepts in greater detail.
Take Care!
Connect with Dr. Kushner: https://drrobertkushner.com/
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