BMI alternative for identifying obesity ‘could prevent misdiagnosis in millions’
Source: Guardian Health ↗
An international team of researchers led by Professor Francisco Rubino of King’s College London has proposed a new diagnostic framework that combines body‑mass index (BMI) with waist measurements and organ‑function tests to identify obesity more accurately, arguing that the current reliance on BMI alone misclassifies millions of people worldwide. Analyzing health records from over 800,000 adults in the United Kingdom, United States, China and Spain, the study found that BMI by itself fails to detect excess body fat in 5‑9 % of adults while incorrectly labeling up to 3 % as obese, a misclassification that could affect tens of millions of individuals. Under the new definition, a BMI above 40 still signals obesity, but lower BMIs are evaluated against waist circumference (over 102 cm for men, 88 cm for women) and waist‑to‑height ratio (approximately 0.57), with a BMI of 30‑plus plus a raised waist or ratio, or a BMI of 25‑29.9 plus both elevated measures, also qualifying as obese.
The revised approach further separates “clinical obesity,” where excess fat is already impairing organ function, from “pre‑clinical obesity,” a state of elevated risk without current dysfunction, allowing clinicians to target interventions more precisely. When applied to the dataset, overall obesity prevalence shifted only slightly, yet only a quarter to a third of those classified as obese under the new criteria—equating to 5‑10 % of the broader population—were identified as having clinical obesity and therefore faced a substantially higher mortality risk. Notably, the researchers reported that 80‑90 % of individuals with pre‑clinical obesity did not progress to clinical disease over the subsequent ten years, suggesting that many people currently labeled obese by BMI alone may not require aggressive treatment.
Rubino emphasized that while the new protocol adds complexity to clinical practice, it enables personalized care, ranging from lifestyle counseling to GLP‑1‑based pharmacotherapy or bariatric surgery, thereby improving safety, efficacy and resource allocation. The findings, published in *Nature*, also highlighted that some individuals with high BMI but normal waist metrics had lower mortality than those deemed healthy by BMI alone, underscoring the bluntness of the traditional metric. Rubino concluded that adopting this multifactorial assessment in routine practice is essential for accurate diagnosis and optimal treatment of obesity.
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