#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#
CS
proLékaře.cz / Journals / Journal of Czech Physicians / 2025 - 3

Clinical obesity – finally a change of paradigm? From BMI to chronic disease

Czech version

Authors: Petr Sucharda
Authors‘ workplace: 3. interní klinika – klinika endokrinologie a metabolismu 1. LF UK a VFN v Praze
Published in: Čas. Lék. čes. 2025; 164: 105-109
Category: Review Article

Overview

The still valid method of defining obesity by the current body mass index (BMI) value does not adequately reflect the severity or health risks of individuals and does not meet the requirements of evidence-based medicine. This definition of obesity has, among other things, led in the past to proposals for such problematic categories as metabolically healthy obesity or obesity with normal weight, and it also contributes to the so-called obesity paradox.

The definition of clinical obesity according to The Lancet Diabetes & Endocrinology Commission addresses these shortcomings and characterizes obesity as a chronic, systemic disease characterized by changes in the function of tissues, organs, the whole individual, or their combinations due to excessive fat accumulation. Conditions with increased amounts of fat tissue without such changes are referred to as preclinical obesity; the recommendations for the care of individuals with preclinical obesity are somewhat problematic.

Keywords:

body mass index, obesity, clinical obesity, preclinical obesity, obesity paradox

Sources
  1. Sucharda P. Pomíjivá sláva metabolického syndromu. Současný pohled na metabolický syndrom a jeho léčbu. Profi Med 2022; 10: 14–15.
  2. Vague J. La différenciation sexuelle, facteur déterminant des formes de l'obésité. Presse Med 1947; 30: 339–340.
  3. Vague J. The degree of masculine differentiation of obesities: a factor determining predisposition to diabetes, atherosclerosis, gout, and uric calculous disease. Am J Clin Nutr 1956; 4: 20–34.
  4. Ashwell M, Cole TJ, Dixon AK. Obesity: new insight into the anthropometric classification of fat distribution shown by computed tomography. Br Med J 1985; 290: 1692–1694.
  5. Kaplan NM. The deadly quartet. Upper-body obesity, glucose intolerance, hypertriglyceridemia, and hypertension. Arch Intern Med 1989; 149: 1514–1520.
  6. Enzi G, Busetto L, Inelmen EM et al. Historical perspective: visceral obesity and related comorbidity in Joannes Baptista Morgagni's 'De sedibus et causis morborum per anatomen indagata'. Int J Obes Relat Metab Disord 2003; 27: 534–535.
  7. Lean ME, Han TS, Morrison CE. Waist circumference as a measure for indicating need for weight management. BMJ 1995; 311: 158–161.
  8. Sucharda P. Klinický význam kvantifikace otylosti. Queteletův index a jeho používání. Čas Lék Čes 1989; 128: 1040–1043.
  9. Keys A, Fidanza F, Karvonen MJ et al. Indices of relative weight and obesity. J Chron Dis 1972; 25: 329–343.
  10. Health implication of obesity. NIH Consensus Development Conference Statement. Ann Intern Med 1985; 103: 147–151.
  11. Report of a WHO consultation on obesity. Obesity: preventing and managing the global epidemic. World Health Organization, Geneva, 1998.
  12. Hruschka DJ, Hadley C. How much do universal anthropometric standards bias the global monitoring of obesity and undernutrition? Obes Rev 2016; 17: 1030–1039.
  13. Bosello O, Donataccio MP, Cuzzolaro M. Obesity or obesities? Controversies on the association between body mass index and premature mortality. Eat Weight Disord 2016; 21: 165–174.
  14. Sims EA. Are there persons who are obese, but metabolically healthy? Metabolism 2001; 50: 1499–504.
  15. Pataky Z, Bobbioni-Harsch E, Golay A. Open questions about metabolically normal obesity. Int J Obes 2010; 34 (Suppl. 2): S18–S23.
  16. Cameron AJ. Metabolically normal obesity: a misnomer? Int J Obes 2012; 36: 164.
  17. Berg C, Strandhagen E, Mehlig K et al. Normal weight adiposity in a Swedish population: how well is cardiovascular risk associated with excess body fat captured by BMI? Obes Sci Pract 2015; 1: 50–58.
  18. Oliveros E, Somers VK, Sochor O et al. The concept of normal weight obesity. Prog Cardiovasc Dis 2014; 56: 426–433.
  19. Jean N, Somers VK, Sochor O et al. Normal-weight obesity: implications for cardiovascular health. Curr Atheroscler Rep 2014; 16: 464.
  20. Fleischmann E, Teal N, Dudley J et al. Influence of excess weight on mortality and hospital stay in 1346 hemodialysis patients. Kidney Int 1999; 55: 1560–1567.
  21. Gruberg L, Weissman NJ, Waksman R et al. The impact of obesity on the short-term and long-term outcomes after percutaneous coronary intervention: the obesity paradox? J Am Coll Cardiol 2002; 39: 578–584.
  22. Simati S, Kokkinos A, Dalamaga M, Argyrakopoulou G. Obesity paradox: fact or fiction? Curr Obes Rep 2023; 12: 75–85.
  23. Whitlock G, Lewington S, Sherliker P et al. Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies. Lancet 2009; 373: 1083–1096.
  24. Lavie CJ, Tutor AW, Carbone S. Is the obesity paradox real? Can J Cardiol 2025: S0828-282X(25)00240-5.
  25. Egom EE, Pharithi RB, Shiwani HA et al. Time to redefine body mass index categories in chronic diseases? Spotlight on obesity paradox. Int J Food Sci Nutr 2018; 69: 513–523.
  26. Carbone S, Lavie CJ, Neeland IJ. Weight changes in obesity: the obesity paradox revisited. Heart 2025; 111: 437–438.
  27. Mechanick JI, Hurley DL, Garvey WT. Adiposity-based chronic disease as a new diagnostic term: The American Association of Clinical Endocrinologists and American College of Endocrinology position statement. Endocr Pract 2017; 23: 372–378.
  28. Sharma AM, Kushner RF. A proposed clinical staging system for obesity. Int J Obes (Lond) 2009; 33: 289–295.
  29. Rubino F, Puhl RM, Cummings DE et al. Joint international consensus statement for ending stigma of obesity. Nat Med 2020; 26: 485–497.
  30. Rubino F, Cummings DE, Eckel RH et al. Definition and diagnostic criteria of clinical obesity. Lancet Diabetes Endocrinol 2025; 13: 221–262.
  31. EASO response to the Lancet Commission Report on Obesity Diagnosis and Management. EASO, 2025. Dostupné na: https://easo.org/easo-response-to-the-lancet-commission-report-on-obesity-diagnosis-and-management
  32. Sung K, Lee SH, Lim S. Beyond body mass index: new criteria for a holistic approach to clinical obesity. Diabetes Metab J 2025; 49: 165–168.

  

Labels
Addictology Allergology and clinical immunology Angiology Audiology Clinical biochemistry Dermatology & STDs Paediatric gastroenterology Paediatric surgery Paediatric cardiology Paediatric neurology Paediatric ENT Paediatric psychiatry Paediatric rheumatology Diabetology Pharmacy Vascular surgery Pain management Dental Hygienist
From war zones to city streets: Challenges for emergency medicine and traumatology in an era of increasing violence
Operability of lung cancer at the Department of Pulmonology, 2nd Faculty of Medicine, Charles University and Motol University Hospital in Prague in 2024 and its development in the Czech Republic in the last 45 years
Comparison of performance between artificial intelligence and radiologists in detecting abnormalities on chest X-rays
The benefits of the MEDEVAC project for the Czech healthcare system
Dyslipidemias as rare diseases
How to feed patients with obesity in intensive care?
Czech doctors in Ukraine – MEDEVAC mission
Shooting at the Faculty of Arts of Charles University and activation of the trauma plan at the First Surgical Clinic of the General Teaching Hospital
Professor Charvát's clinic in reminiscences
Amiodarone-induced thyreopaties
Article was published in

Journal of Czech Physicians

Issue 3
2025 Issue 3
Download issue PDF
Most read in this issue
Topics Journals
Login
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account

#ADS_BOTTOM_SCRIPTS#