Obesity Medicine Association Raises Concerns Over Lancet Commission’s New Recommendations on Obesity Diagnosis

January 27, 2025 – The Obesity Medicine Association (OMA) acknowledges the Lancet Commission’s effort to refine obesity diagnosis with the introduction of “preclinical” and “clinical” obesity classifications. However, we express significant concerns about the potential unintended consequences of this framework, which risks redefining obesity from a disease to merely a risk factor, undermining decades of progress in recognizing obesity as a chronic, progressive and relapsing multifactorial disease.

Key Concerns with the New Recommendations

Impact on Insurance Coverage and Patient Access

• By fragmenting obesity into preclinical and clinical categories, there is a real danger of excluding individuals classified as “preclinical” from insurance coverage for essential medical weight management treatments, including medications, behavioral therapies, and surgical interventions.
• In the United States, where insurance often ties coverage to disease status, this change could leave millions of patients without access to evidence-based care. Furthermore, it would delay medical care for individuals living with obesity until the disease progresses to a later stage, making it significantly harder to treat or achieve remission. This reactive approach undermines opportunities for early, effective intervention that could prevent severe complications and improve long-term outcomes.

Shift from Preventive Care to “Sick Care”

• Waiting for obesity to progress to the “clinical” stage, characterized by organ dysfunction or severe complications, represents a reactive rather than proactive approach. This would delay interventions until irreversible damage has occurred, increasing morbidity and mortality rates while driving up healthcare costs.
• Obesity is a chronic, progressive disease. Early intervention is critical to preventing complications such as type 2 diabetes, cardiovascular disease, and certain cancers. Treating obesity as a continuum, rather than segmenting it into stages, ensures timely care.

Complexity in Diagnosing Preclinical vs. Clinical Obesity

• The distinction between preclinical and clinical obesity is inherently ambiguous, given the multifactorial and relapsing nature of obesity. Obesity is not solely defined by overt complications but also by systemic inflammation, hormonal dysregulation, and metabolic disruptions that begin long before visible organ damage occurs. Moreover, obesity can lead to non-metabolic conditions caused by the physical forces of excess fat mass, such as osteoarthritis, obstructive sleep apnea, and stress on the musculoskeletal system. Additionally, mental health conditions like an increased incidence of Major Depressive Disorder have been strongly associated with obesity, further underscoring its profound impact on overall health and well-being.
• Tools like the Edmonton Obesity Staging System (EOSS) already provide a stratified approach to assessing obesity-related risks without relegating some patients to a “preclinical” category that might delay care.

Potential Repercussions on Public Perception and Stigma

• Redefining obesity as a risk factor rather than a disease could exacerbate weight stigma, reinforcing misconceptions that obesity is a personal failure rather than a medical condition requiring compassionate and evidence-based treatment.

The Case for Keeping Obesity Recognized as a Disease

Obesity is a chronic, progressive, relapsing, and multifactorial disease that demands comprehensive management across its continuum. Comparisons to conditions such as prediabetes and type 2 diabetes illustrate the pitfalls of waiting for overt pathology. Early treatment of prediabetes has been shown to prevent progression to diabetes, saving lives and reducing healthcare costs. Similarly, addressing obesity early—before complications or severe complications arise—is paramount.

Moreover, obesity’s systemic impacts such as chronic inflammation from adiposopathy, weight dysregulation centrally in the hypothalamus and peripherally throughout multiple organ systems including adipose tissue as well as visceral adiposity around organs like the heart and liver, create metabolic disruptions that often precede diagnosable organ damage. Addressing these disruptions early can mitigate downstream health consequences and improve long-term outcomes.

Call to Action

The OMA urges policymakers, clinicians, and insurers to approach these new recommendations with caution. We advocate for:

• Maintaining obesity’s recognition as a chronic disease to protect patient access to care.
• Utilizing existing tools like the EOSS to stratify risk without creating barriers to early intervention.
• Focusing on preventive care rather than reactive sick care to improve outcomes and reduce healthcare costs.
• Continued use of BMI as a SCREENING measure in addition to clinical judgment. Continued use of additional means for diagnosis of obesity such as waist-to-hip ratio, waist-to-height ratio and clinical judgment of the clinician during while taking a patient history and physical assessment.

The OMA remains committed to advancing evidence-based strategies for treating obesity and ensuring that all individuals have access to the care they need. Together, we can continue to Treat the Roots, Not the Fruits, of Obesity.