Time to redefine obesity?
“Obesity is …”
How you finish that sentence probably reflects your professional training, and perhaps your life experience.
If we took a survey of everyone reading this, we’d expect to see a wide range of responses.
Among them: “Obesity is a BMI of 30 or above.”
That’s the official cutoff for obesity.
Thus, by that standard, 42 percent of American adults have obesity.1
But what do those 100 million Americans have in common, beyond their BMI?
Are they all currently unhealthy, or at high risk of the physical, medical, and social challenges we associate with obesity?
And what about the majority of American adults whose BMI is currently below 30? What assumptions can we make about their current and future health status?
The questions are unanswerable. But we can, if nothing else, attempt a more precise definition of obesity.
The first line of a new study offers this one:
“Obesity is a multifactorial, chronic, relapsing, non-communicable disease marked by an abnormal and/or excessive accumulation of body fat that presents a risk to health.”2
That thorough definition leads to four crucial questions the study tries to answer:
How should medical professionals diagnose obesity?
How should they decide on a treatment plan, and what do they hope the plan will accomplish?
How do they know if it’s working?
What do they do if it isn’t?
How the study worked
The authors sit on the steering committee of the European Association for the Study of Obesity (EASO).
They conducted a “modified Delphi study,” which worked like this:
▶ First, they recruited a panel of 29 obesity specialists, including experts in nutrition, endocrinology, bariatric surgery, internal medicine, and patient advocacy.
▶ Then, they sent their experts a series of statements about obesity and asked them to assign each statement a grade from 1 (strongly disagree) to 5 (strongly agree).
▶ Next, they used feedback from the experts to refine the statements, with the goal of reaching a consensus on diagnosis, treatment, and goals.
What the study found
The experts eventually reached consensus on 28 statements, which means at least two-thirds of them gave the statement a grade of 4 or 5.
Here are a few key areas of agreement:
Diagnosis should include both anthropometric and clinical information.
“Anthropometric” refers to information derived from physical measurements. That includes BMI, waist-height ratio, and body-fat percentage.
“Clinical” includes everything a healthcare practitioner would typically observe, measure, and analyze with regard to a patient’s health—such as heart rate, blood pressure, blood sugar, and cholesterol levels.
The goal is to avoid diagnosing or not diagnosing obesity based on BMI alone.
Imagine two patients:
The first one is active and healthy by all clinical measures except one: a BMI north of 30.
The second, who’s sedentary, has a BMI below 25. But their high blood pressure and rapid heart rate sets off alarm bells.
Only one of those two patients requires medical intervention, and it’s not the one with the higher BMI.
Doctors should “apply ethnicity-specific cutoffs for BMI.”
This statement merited unanimous agreement. Implementation, however, could be trickier.
A 2021 study correlated BMI with type 2 diabetes risk for people of different ethnicities.3
This next part is complicated.
As a baseline for comparison, the researchers used the diabetes risk for a white person whose BMI is 30. Then, looking at non-white populations, they found the BMI associated with an equivalent diabetes risk.
Here’s what they found:
That last one is a shocker:
A South Asian adult who wouldn’t even be considered “overweight” has the same diabetes risk as a white person with obesity.
The cutoffs are even lower for specific South Asian subgroups like Pakistanis, Sri Lankans, Tamils, and Bangladeshis.
Why is there such a high diabetes risk at relatively low BMIs? The authors say it “remains unclear” if it’s because of diet, physical activity levels, body composition, or unspecified “lifestyle-gene interactions.”
A treatment plan shouldn’t focus on weight loss alone.
An immediate goal is to address a patient’s obesity-related health problems.
The plan should also focus on ways to prevent future problems—to keep high blood glucose from advancing to full-blown type 2 diabetes, for example.
Those could include beginning or maintaining an exercise program, choosing an eating plan that helps regulate blood sugar, and/or lifestyle modifications to reduce stress.
Of course, many of these approaches often lead to body fat loss. Body fat loss often makes these outcomes improve even more (and gives clients psychological reinforcement that their plan is working). However, weight loss alone is not the desired outcome.
Takeaways
1. Coaches can help clients follow through on their doctor’s instructions.
One statement, which was unanimously accepted by the experts who voted, encourages doctors to discuss with the patient “the appropriate initial level of intervention, taking previous therapeutic attempts into account.”
In other words, get buy-in from the patient before finalizing a plan.
Which, of course, is exactly what a good coach does.
I don’t simply tell a client how much weight they need to lose and how they should do it. I collect as much information as I can, collaborate with the client about actions they’re willing and able to take, and then test out the efficacy of those actions.
But a doctor doesn’t typically have the time to do all that. That’s where I come in.
If a physician has given you outcomes to achieve like” lose weight,” “get more exercise,” or “eat healthier”—I can help you break that goal down into practical steps and daily actions.
I can also help keep you accountable, monitor consistency and progress, and troubleshoot solutions when obstacles arise. This is the work where goals turn into reality.
2. If you have a high BMI for your ethnic group, talk to your doctor.
Your health status can only be assessed by a doctor.
However, a coach can offer perspective on how they perceive that status.
Let’s say you tell me your physician has never raised any concerns. On the other hand, I see some potential red flags.
Partly, that’s because your ethnicity means your BMI puts you at risk for obesity-related metabolic disorders like hypertension and diabetes.
Partly, it’s because of what I measure and observe as a coach. I see low strength and a high body fat percentage. I’m also alarmed at your poor conditioning level and how little physical activity you accumulate.
In these cases, I can suggest you ask your doctor for a more comprehensive assessment.
Closing Thoughts
Obesity isn’t just about numbers or labels—it’s about understanding health in a way that’s unique to each person. As your coach, I focus on more than just weight. Together, we’ll look at the full picture: your habits, your goals, and your overall well-being.
This research reminds us that health isn’t one-size-fits-all. What works for someone else might not work for you, and that’s okay. The goal isn’t just weight loss; it’s building a healthier, happier, and more fulfilling life.
Whether we’re adjusting your eating habits, exploring new ways to stay active, or finding strategies to reduce stress, every small step matters. Let’s keep working together to create a plan that fits you—because your health journey is yours, and it’s worth every bit of effort.
Michael Beiter
Personal Trainer
Nutrition, Sleep, Stress Management, and Recovery Coach
References
“FastStats.” 2023. December 27, 2023. https://www.cdc.gov/nchs/fastats/obesity-overweight.htm.
Busetto, Luca, Dror Dicker, Gema Frühbeck, Jason C. G. Halford, Paolo Sbraccia, Volkan Yumuk, and Gijs H. Goossens. 2024. A New Framework for the Diagnosis, Staging and Management of Obesity in Adults. Nature Medicine 30 (9): 2395–99.
Caleyachetty, Rishi, Thomas M. Barber, Nuredin Ibrahim Mohammed, Francesco P. Cappuccio, Rebecca Hardy, Rohini Mathur, Amitava Banerjee, and Paramjit Gill. 2021. Ethnicity-Specific BMI Cutoffs for Obesity Based on Type 2 Diabetes Risk in England: A Population-Based Cohort Study. The Lancet. Diabetes & Endocrinology 9 (7): 419–26.
