Prevalence of Pre-Clinical Obesity Among US Adults Receiving Medical and Surgical Obesity Treatment

We sought to determine how the proportion of adults historically receiving obesity interventions would be classified under the recently proposed "pre-clinical" and "clinical" obesity classifications and the impact of this change on safety and outcomes.

A retrospective analysis of adults with BMI ≥ 35 who received bariatric surgery (BS) or antiobesity medications (AOMs) between 2017 and 2023 was conducted using the Merative MarketScan database. Patients had ≥ 6-month continuous enrollment before treatment. Clinical obesity was defined as presence of ≥ 1 obesity-related condition and pre-clinical obesity defined as absence of such. Treatment-related complications were identified within 90 days of treatment initiation. Multivariable logistic regression was used to compare the odds of treatment-related complications by obesity classification.

A total of 120,499 individuals (46.1%) underwent BS and 140,909 (53.9%) received AOMs. Among BS patients, 12.7% (n = 15,334) had pre-clinical obesity. Of AOM users, 38.1% (n = 53,633) had pre-clinical obesity. Clinical obesity patients were older with a higher comorbidity burden compared to pre-clinical obesity. Clinical obesity was associated with higher odds of post-treatment complications (AOM: aOR 1.10, BS: aOR 1.39, both p < 0.001).

This novel framework would reclassify a significant proportion of patients as having pre-clinical obesity. Use of these definitions to determine treatment eligibility could potentially delay intervention and shift care to older, sicker populations.