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Overcoming Obstacles in Obesity

CE / CME

Breaking Barriers in Obesity Care: Applying Emerging Evidence to Primary Care Practice

Physician Assistants/Physician Associates: 1.00 AAPA Category 1 CME credit

ABIM MOC: maximum of 1.00 Medical Knowledge MOC point

Physicians: maximum of 1.00 AMA PRA Category 1 Credit™

Nurse Practitioners/Nurses: 1.00 Nursing contact hour

Released: December 10, 2025

Expiration: December 09, 2026

Christopher Weber
Christopher Weber, MD, FAAP, FACP, CSCS, dABOM, FOMA
CME/CE Information

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Lancet Diabetes & Endocrinology Commission Guidance: Key Points

The Lancet Diabetes and Endocrinology Commission was formed primarily to address the underlying problem that BMI is not a perfect measurement for diagnosing obesity. It can be used as a screening tool, but there is much more to obtaining a diagnosis than just 1 number. The Commission's aim was to identify other criteria for diagnosing obesity as a disease outside of just BMI.1

Subsequently, the Commission published 3 definitions of obesity: First, obesity is the physical state caused by excess adiposity and confirmed by measures other than or in addition to BMI, not BMI alone. Then, preclinical obesity is confirmed obesity with preserved function of tissues and organs. Finally, clinical obesity is the presence of chronic illness in which confirmed obesity results in altered function of tissues, organs, mobility, or other aspects of the individual's quality of life.1

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Confirming Excess Adiposity (Obesity)

Given that the new definitions of obesity hinge on excess adiposity, the question that follows is, how do you confirm excess adiposity?

You can start with BMI as a screening tool, but that alone should generally not be used to diagnose obesity, according to the Commission. The presence of obesity should be confirmed via non-BMI measures.1

One option for doing so is direct body fat measurements via dual-energy x-ray absorptiometry (DXA) scan or bioimpedance. Excess adiposity can also be confirmed if patients have an elevated BMI and meet 1 or more anthropometric criteria of obesity, such as waist circumference, waist-to-height ratio, or waist-to-hip ratio. Excess adiposity can be confirmed in the presence of 2 or more anthropometric criteria, without BMI. The 1 exception is a BMI of 40 or greater. In this case, you can pragmatically assume that the patient does have obesity, even without additional measurements of excess adiposity.1-4

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Diagnostic Criteria for Clinical Obesity in Adults: Reduced Function Due to Excess Adiposity

If BMI screening and other measures of excess adiposity suggest obesity, the next step is distinguishing between preclinical and clinical obesity. The key to a correct diagnosis here is how obesity can affect other body systems.1

Excess adiposity can negatively affect many different body systems, including the central nervous system and the respiratory system, as well as CV and metabolic pathways, just to list a few examples. Many chronic conditions can be caused by excess adiposity. Thus, the presence of any of the chronic conditions on this slide and excess adiposity is considered clinical obesity.1

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Goals of Obesity Treatment

New definitions of obesity also necessitated redefining the goals of obesity treatment accordingly.

In the earliest cases where patients do not meet the criteria for preclinical obesity but are experiencing adipose tissue expansion, the goal is primary prevention. The causes of adipose tissue expansion are manifold; genetic, environmental, and psychological factors all play a role, as do countless other unknown causes. However, the goal of foundational primary prevention is simply to prevent further expansion of adipose tissue with healthy nutrition, physical activity, and adequate sleep.1

With preclinical obesity, patients are already experiencing increased risk to their health because of the excess adipose tissue—but not chronic illness—so the goal here is risk reduction. This includes more frequent monitoring for progression and consideration of prophylactic intervention.1

Finally, with clinical obesity, or excess adiposity with systemic chronic illness, the approach and the goal of treatment is therapeutic intervention to improve manifestations of those clinical chronic illnesses and to prevent end-organ damage.1

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