Overview
- A Nature study of more than 844,000 adults published Wednesday, Nov. 11, tested the Lancet Commission’s two‑step framework that combines waist measures or DEXA with an assessment of organ or functional harm.
- The study found BMI alone missed obesity in about 8.6% of people and wrongly labeled about 3.1% as obese because it cannot measure fat amount or distribution.
- Researchers divided cases into 'clinical' obesity, where excess fat already impairs organs or daily function, and 'preclinical' obesity, where fat is present but organ function is intact, and found very different outcomes for each group.
- People with clinical obesity faced roughly a 69% higher risk of death while those with preclinical obesity had about a 19% higher risk, and 77%–91% of preclinical cases did not progress to clinical disease over 10 years.
- Authors and reporters say the framework could change who gets drugs, counseling, and monitoring but note the evidence is observational and practical issues remain such as defining cutoffs by ethnicity, standardizing workflow tests, and training clinicians.