[Emerging classifications of cardiometabolic risk in obesity]

Obesity, historically defined by body mass index and waist circumference, is a major risk factor for cardiometabolic complications; however, these indicators do not capture the phenotypic heterogeneity or the underlying pathophysiology. Adipose dysfunction, characterized by hypertrophy, chronic inflammation, and ectopic lipid deposition, promotes insulin resistance, lipotoxicity, and vascular abnormalities. In contrast, muscle mass and strength exert protective effects through glucose uptake, increased energy expenditure, and secretion of anti-inflammatory myokines. These mechanisms explain phenotypes such as metabolically healthy obesity, normal-weight obesity, sarcopenic obesity, and the lean-weak phenotype. In response, functional stratification systems such as the Edmonton Obesity Staging System, the Cardiometabolic Disease Staging System, and the Metabolic Syndrome Severity Score have been proposed, in addition to regional models that integrate body composition, waist circumference, and muscle strength. Inflammatory and atherogenic biomarkers, along with imaging techniques such as computed tomography, magnetic resonance imaging, dual-energy absorptiometry, and coronary artery calcium scoring, provide additional value in anticipating events. The integration of these approaches marks the transition from isolated anthropometry to functional risk stratification. This review analyzes the limitations of classic indicators, emerging phenotypes, staging systems, and the role of biomarkers, imaging, artificial intelligence, and telemedicine in personalizing clinical and population-based management.