A critical appraisal of emerging obesity diagnostic frameworks to bridge gaps and refine clinical stratification

Novel obesity definitions that go beyond body mass index (BMI) have been recently suggested. They apply diverse clinical approaches and diagnostic criteria. The clinical utility of these new frameworks compared to the traditional BMI-based classification is currently unknown. We aimed to compare patient classification and their associated cardiometabolic risk profiles using three different systems: the traditional BMI-based classification, the Lancet Diabetes and Endocrinology Commission (LC) criteria, and the EASO New Framework (NF) criteria.

A retrospective analysis was conducted on a cohort of 1002 individuals (mean age 51 years, 61% female). We assessed how each system classified participants and compared key cardiometabolic markers, including glycemic and lipid profiles, across these classifications.

Significant discrepancies are found among the three systems. The traditional BMI and LC systems may underdiagnose people at high cardiometabolic risk. A crucial finding is that a significant proportion of participants labeled with 'Preclinical Obesity' by the LC criteria, but with 'obesity' by the EASO NF, consistently shows adverse metabolic profiles, including elevated glucose levels and unfavorable lipid profiles.

The findings highlight the critical need for a unified diagnostic approach to obesity that more accurately captures the full spectrum of health risks. An improved classification system would ensure timely intervention and personalized management, particularly for those who, despite not being classified as having obesity by traditional or less stringent new criteria, already show significant metabolic risk.