Experts have come up with a new framework to move away from the reliance on Body Mass Index (BMI).

International researchers have proposed a new method that focuses on the distribution of body fat rather than BMI alone.
This shift is expected to enable more individuals to benefit from obesity treatments, even if their BMI falls below the conventional obesity threshold of 30.

The European Association for the Study of Obesity (EASO) has launched a new framework, published in Nature Medicine, which advocates for modernising obesity diagnosis and treatment. This framework incorporates the latest scientific developments and the new generation of obesity medications. 

The existing BMI-centric approach often excludes individuals who might have a substantial risk of health issues due to the distribution of body fat.

The authors of the framework highlight that BMI alone is insufficient as a diagnostic criterion. “An important novelty of our framework regards the anthropometric component of the diagnosis,” the EASO group says. 

“The basis for this change is the recognition that BMI alone is insufficient as a diagnostic criterion, and that body fat distribution has a substantial effect on health.”

A key aspect of the new framework is the recognition of abdominal fat accumulation as a critical risk factor for cardiometabolic complications. 

This risk is present even in individuals with a BMI below 30, challenging the traditional definition of obesity. 

The framework recommends considering people with a waist-to-height ratio above 0.5 for obesity medications, especially if they have medical, functional, or psychological impairments.

The proposed changes aim to reduce the risk of undertreatment in patients with lower BMIs but significant health risks due to body fat distribution. 

The framework also emphasises the importance of behavioural modifications such as nutritional therapy, physical activity, stress reduction, and sleep improvement as primary obesity management strategies. 

Additionally, psychological therapy, obesity medications, and metabolic or bariatric procedures are included as potential treatments.

The EASO steering committee pointed out that current guidelines are often based on clinical trials with inclusion criteria centred around BMI cut-off values. 

This strict adherence can preclude the use of obesity medications or procedures for patients with a substantial burden of obesity-related disease but low BMI values. Therefore, the committee suggests that obesity medications should be considered for patients with a BMI of 25 or higher and a waist-to-height ratio above 0.5, irrespective of traditional BMI cut-off values.

“This statement may also be seen as a call to pharmacological companies and regulatory authorities to use inclusion criteria that are more adherent to the clinical staging of obesity and less to traditional BMI cut-offs when designing future clinical trials with obesity medications,” the authors noted.

The framework aligns obesity management more closely with the management of other chronic diseases, focusing on long-term health benefits rather than short-term weight loss. 

It advocates for personalised therapeutic goals, considering the stage and severity of the disease, available treatment options, and patient preferences.

The authors conclude; “Emphasis on the need for a long-term or life-long comprehensive treatment plan rather than short-term body weight reduction is warranted.”