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The end of one-size-fits-all: Obesity diagnosis enters a new era

Jan 18, 2025 04:08 PM IST

A new report from the Lancet Global Commission calls for a shift in how obesity is diagnosed, moving beyond the traditional Body Mass Index (BMI).

For years, Body Mass Index (BMI) has been the standard for diagnosing obesity. However, a new report from the Lancet Global Commission urges a shift in how we assess it. The study argues that BMI fails to account for important health factors and advocates for a more comprehensive approach.

The report proposes additional measures, including waist circumference and waist-to-hip ratio.
The report proposes additional measures, including waist circumference and waist-to-hip ratio.

Metrics beyond BMI

Supported by over 75 medical organisations, including India’s All Indian Association for Advancing Research in Obesity (AIAARO), the report calls for additional measures like waist circumference and waist-to-hip ratio to assess better health risks tied to obesity.

“Waist circumference is a measure of the waist’s narrowest part, often above the belly button, used to estimate abdominal fat linked to health risks like heart disease and diabetes,” says fitness expert Aman Jain. He further explains that the Waist-to-hip ratio (WHR) divides the waist circumference by hip circumference, evaluating fat distribution. Plus, tools such as DEXA scans allow doctors to measure body fat directly, offering a more precise assessment of obesity.

Why BMI needs rethinking

BMI, calculated by dividing weight (in kilograms) by height (in meters squared), has been favoured for its simplicity. However, the method has clear limitations. It doesn’t consider muscle mass, fat distribution, or ethnicity, which means two people with the same BMI could have very different health risks.

“Other factors, such as muscle mass, age, sex, and the presence of comorbidities, should also be considered when defining obesity in the general population or in patients suffering from obesity,” says Dr Bhushan Bhole, Senior Consultant at PSRI Delhi.

Plus, a major flaw with BMI is that it doesn’t differentiate between subcutaneous fat (just beneath the skin) and visceral fat (around internal organs). The latter is far more dangerous, linked to higher risks of heart disease, diabetes, and other serious health conditions.

“BMI has long been used as a simple measure, but it doesn’t tell the whole story of an individual’s health. By adding measures like waist circumference and introducing categories like clinical and pre-clinical obesity, we can better tailor care to each person’s needs,” says Dr RR Dutta, Head of Internal Medicine at Paras Health in Gurugram.

To top it all, Dr Nikhil Agnihotri, Senior Consultant at Aakash Super Specialty Hospital in Delhi, stresses the need to move beyond BMI. He further explains that more advanced techniques can also be used. “To directly assess visceral fat, advanced imaging techniques like CT scans can be used, or during surgery, we can directly observe and measure the visceral fat,” he mentions.

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