High Prevalence of Anthropometric-Only Obesity and Cardiometabolic Risk: Evidence from a Population-Based Study

Background/Objectives: The Lancet Commission proposes a new obesity definition that combines body mass index (BMI) with anthropometric measurements to distinguish adipose tissue excess more effectively. This study aims to determine the prevalence of obesity based on the new definition and to examine cardiometabolic risk factors and lifestyle habits across different obesity phenotypes in the urban population of Lithuania. Methods: This study was conducted among residents of Kaunas city from 2020 to 2024. A total of 3426 adults aged 25-69 years (57.1% of the random sample) were participated. Three individuals were excluded due to missing anthropometric data. Participants were categorized into three phenotypes: (1) no obesity (BMI < 30 kg/m² and no or one elevated anthropometric measure, (2) anthropometric-only obesity (BMI < 30 kg/m² and at least 2 elevated anthropometric measures), and (3) BMI-plus-anthropometric obesity (BMI ≥ 30 kg/m² plus at least one elevated anthropometric measure or BMI ≥ 40 kg/m²). Standardized anthropometric, biochemical, and clinical measurements were collected, along with self-reported dietary habits and leisure-time physical activity. Results: Anthropometric-only obesity was highly prevalent, affecting 36.1% of males and 22.7% of females (p < 0.05). The prevalence of BMI-plus-anthropometric obesity was 24.1% among males and 21.4% among females. Individuals with anthropometric-only obesity had significantly higher odds of metabolic syndrome (OR 8.64; 95% CI 6.97-10.71), diabetes (OR 3.01; 95% CI 1.72-5.25), coronary heart disease (OR 1.48; 95% CI 1.12-1.97), and several lipid abnormalities compared with those without obesity. The highest cardiometabolic risk was observed in the BMI-plus-anthropometric obesity group. Greater adiposity was associated with higher intake of red meat, junk foods, and sugary drinks, while physical activity levels declined across obesity categories. Conclusions: Anthropometric-only obesity is a common and metabolically adverse phenotype that cannot be detected using BMI alone. A new obesity definition enhances identification of high-risk individuals and supports targeted prevention strategies.