When it comes to diagnosing obesity, BMI (body mass index) has been the primary tool used by health care professionals. However, it has well-known flaws, such as failing to measure fat distribution and overall metabolic health. Because of this, reliance on BMI can easily result in misdiagnosis, such as fit, muscular people being labeled as overweight.
Overhauling the Definition of Obesity
Researchers of a study published in The Lancet Diabetes & Endocrinology are now calling for a shift in how obesity is diagnosed and treated. Under this model, a person with a high BMI but no metabolic dysfunction would not technically be classified as obese, while someone with a “normal” BMI who has organ damage due to excess fat would be diagnosed as clinically obese.1
• The shortcomings of BMI — The researchers point out that that BMI alone is a poor predictor of health. Instead, they propose a new framework that distinguishes between “preclinical” and “clinical” obesity, with a greater emphasis on identifying functional impairments caused by excess body fat rather than just weight alone.
• BMI doesn’t provide accurate diagnosis — As noted by the researchers, “To mitigate risk of both overdiagnosis and underdiagnosis of obesity, excess adiposity should be confirmed by at least one other anthropometric criterion (e.g., waist circumference) or by direct fat measurement when available.
However, in people with substantially high BMI levels (i.e., >40 kg/m2) excess adiposity can be pragmatically assumed. Confirmation of obesity status defines a physical phenotype, but does not represent a disease diagnosis per se.”2
• Visual obesity versus clinical obesity — Going deeper into the definitions of obesity, the researchers argue for a deeper diagnosis before recommending health interventions. “People with confirmed obesity (that is, with clinically documented excess adiposity) should then be assessed for possible clinical obesity based on findings from medical history, physical examination and standard laboratory tests or other diagnostic tests as appropriate.
As with other chronic illnesses, evidence-based treatment of clinical obesity should be initiated in a timely manner with the aim of improvement (or remission, when possible) of clinical manifestations,” the researchers said.3
• Preclinical obesity — Those who are diagnosed with preclinical obesity do not “generally require treatment with drugs or surgery, and might need only monitoring of health over time and health counselling if the individual’s risk of progression to clinical obesity or other diseases is deemed sufficiently low.”4
The BMI Model Is Failing Millions of People
One of the most striking revelations from The Lancet study is the degree to which BMI-based obesity diagnosis has led to both overdiagnosis and underdiagnosis.
• BMI is not accurate — The study found that individuals with high muscle mass are frequently misclassified as obese, despite having no metabolic dysfunction. Meanwhile, those with “normal” BMIs but excessive visceral fat and metabolic abnormalities are often overlooked, delaying critical intervention.5
• The dangers of BMI misdiagnosis — While it sounds like a minor flaw, a misdiagnosis has serious health consequences. Many people labeled as obese due to BMI alone face unnecessary medical treatments, restrictive diets and even weight loss surgeries when their actual metabolic health does not warrant these interventions.
On the other hand, those with undetected metabolic dysfunction miss out on early treatment, increasing their risk for Type 2 diabetes, cardiovascular disease and other chronic conditions.6
The Weight Stigma Is Making Health Care Harder
Another major finding from the study is that weight stigma in the medical field contributes to misdiagnosis and poor treatment outcomes. Those affected with obesity-related metabolic dysfunction avoid seeking medical care due to past experiences of being judged or dismissed based on their weight. Furthermore, the stigma causes them to shun treatment, even resorting to eating more to cope with the psychological stress.
• The psychological burden caused by stigma — According to the study, “Weight stigma adversely affects mental and physical health beyond that of obesity itself through internalized stigma, stress, social isolation, low self-esteem, anxiety, depression and substance abuse.”7
• The stigma around obesity increases health risks — Obese individuals have a higher risk of binge eating, emotional overeating and indulging in unhealthy food. This increases the risk of weight gain and other obesity-related complications.8
To turn things around, the study emphasizes that obesity should be treated as a medical condition, not a personal failure. Moreover, shifting to a function-based diagnosis will help reduce stigma and encourage more people to seek medical treatment.
• Challenging obesity requires societal change — According to the Commission that conducted The Lancet study, “Academic institutions, professional organizations, media, public health authorities, patients’ associations and governments should encourage education on weight stigma and facilitate a new public narrative of obesity, consistent with modern scientific knowledge.”9
• It’s not just about weight loss — Healthcare providers often assume that weight loss is the universal solution for all obese patients, even when the underlying issue is metabolic dysfunction rather than weight itself. The study stresses that treating obesity is not about forcing weight loss but rather improving metabolic and functional health.10
Are You Obese?
If you’ve been using BMI as a basis for obesity, The Lancet’s study is a game-changer. It means that instead of focusing on the rigid criteria of the BMI model, it’s better to pay attention to biomarkers that actually indicate a health risk.
• Revisit your diagnosis — If a health care practitioner previously diagnosed you with obesity based on BMI alone, it would be wise to seek additional tests to assess your metabolic health, including blood sugar levels, inflammatory markers and body composition scans.
• Don’t assume you’re healthy if you have a normal BMI — Conversely, if you have a normal BMI but struggle with fatigue, insulin resistance or unexplained health issues, hidden fat accumulation could be the culprit.
As noted by The Lancet researchers, “Current BMI-based measures of obesity can both underestimate and overestimate adiposity and provide inadequate information about health at the individual level, which undermines medically sound approaches to health care and policy.”11
That said, how do you get started for a more accurate measurement of obesity? The chart below provides a more accurate picture of visceral fat levels and disease risk. It’s important for you to keep track of changes in this ratio as you make lifestyle modifications to ensure you’re reducing harmful belly fat. To get the ratio, divide your waist measurement by your hip measurement, then use the values below for reference:
| Waist-to-Hip Ratio | Men | Women |
|---|---|---|
| Ideal | 0.8 | 0.7 |
| Low Risk | <0.95 | <0.8 |
| Moderate Risk | 0.96 – 0.99 | 0.81 – 0.84 |
| High Risk | >1.0 | >0.85 |
Another measurement you can use is the waist-to-height ratio. To calculate the value:
• Waist-to-height formula — Divide your waist circumference by your height, making sure both measurements are in the same unit, either inches or centimeters. For example, if your waist measures 32 inches and your height is 64 inches, your waist-to-height ratio would be 0.50 (32 ÷ 64 = 0.50).
• The ideal ratio for adults — An ideal waist-to-height ratio for adults falls between 0.40 and 0.49, indicating a healthy range.12 A ratio below 0.40 may suggest being underweight, while a ratio between 0.50 and 0.59 indicates excess weight and an increased risk of metabolic and cardiovascular diseases. A ratio of 0.60 or higher signals obesity and a significantly higher health risk.
• Don’t forget your child’s ratio — It’s also wise to check on your child’s waist-to-height ratio from time to time. For children ages 6 to 18, a ratio below 0.46 is considered healthy, while anything above this threshold suggests an increased risk of obesity-related health issues.
Addressing the Root of Obesity
Again, obesity isn’t just about belonging to a particular BMI category — it’s about how excess fat affects your metabolic health, organ function and overall well-being. To truly address the root cause of obesity and its related problems, shifting your focus from simply losing weight to improving how your body functions is key. Here are my recommendations to help you start making meaningful changes:
1. Shift your focus from weight loss to metabolic health — Managing obesity isn’t just about making the number on the weighing scale smaller — it’s also about paying attention to your health markers.
If your energy is low, your blood sugar is unstable or you’re noticing inflammation-related issues, focus on them first. Take a fasting insulin test, check your HOMA-IR score (a test that tests insulin resistance13) and assess your waist-to-hip and waist-to-height ratios to get a clearer picture of where you stand. The goal isn’t just to lose weight — it’s to improve how your body processes nutrients, manages energy and supports vital functions.
2. Prioritize the right carbohydrates for better insulin sensitivity — Your metabolism thrives on the right kind of carbohydrates — not restriction. If you’ve been following low-carb diets or fasting protocols, it’s time to rethink your approach.
Most adults need 250 to 300 grams of carbs daily from whole food sources to support optimal metabolic function, especially if you’re active. Start by introducing easily digestible starches such as whole fruits and white rice.
3. Get rid of the hidden fat disrupting your metabolism — Excess consumption of vegetable oils (also known as seed oils) is sabotaging your health from the inside out. It drives inflammation, thus impairing mitochondrial function and promoting fat storage in all the wrong places.
To cut out vegetable oils from your life, avoid all forms of processed foods, restaurant meals, and even “healthy” alternatives like nut butters and seed-based snacks. Instead, use healthy fats like grass fed butter, tallow and ghee. Coconut oil is also a viable alternative for cooking healthy meals at home. Focus on eating whole, nutritious foods as well to restore your cellular health.
4. Fix your micronutrient deficiencies — If your energy levels are tanking, consider testing for certain micronutrients deficiencies. Magnesium and vitamin D, for example, play key roles in metabolism, and deficiencies in these make it hard for your body to regulate fat properly.
To optimize your vitamin D, get daily sun exposure at solar noon, but only after eliminating vegetable oils from your diet for at least six months, as these oils significantly raise your risk of sunburn and skin damage. For more detailed instructions, read “Vitamin D Deficiency Complicates Autoimmune Diseases.”
5. Train your body to burn energy efficiently — If you’ve been told that more exercise is the key to fixing obesity, you’ve been misled because it’s just one piece of the puzzle. The problem isn’t lack of movement. Obesity stems from the downregulation of your metabolic rate due to an unhealthy diet and exposure from environmental toxins.
In other words, most Americans have slow metabolisms while eating too many unhealthy calories and living unhealthy lifestyles, thus contributing to weight gain.
In addition to the recommendations already mentioned above, one way to boost your metabolic rate is focusing on strength training. This type of exercise signals your body to direct nutrients toward muscle growth and repair instead of fat storage.
Moreover, I encourage you to take walks every day to help improve your overall fitness. For an in-depth look at how the simple act of walking will help improve your health, read my article “Interval Walking Training — Going Beyond Step Count.”
Frequently Asked Questions on Rethinking Obesity and the BMI Model
Q: Why is BMI an inaccurate way to diagnose obesity?
A: BMI is a flawed measure because it only considers weight and height without assessing fat distribution or metabolic health. This leads to misdiagnosis — muscular individuals are labeled obese, while people with normal BMI but high visceral fat go undiagnosed despite having metabolic dysfunction.
Q: What is the new approach to diagnosing obesity?
A: Researchers propose a shift from BMI-based obesity diagnosis to a function-based model. This model distinguishes between preclinical obesity (excess fat with no metabolic issues) and clinical obesity (excess fat causing organ damage or metabolic dysfunction). Instead of focusing on weight alone, diagnosis also includes metabolic health markers like insulin levels and the presence of inflammation.
Q: How does weight stigma impact medical treatment?
A: Weight stigma in health care leads to misdiagnosis, delayed treatment and poor patient outcomes. Those misdiagnosed as obese due to BMI alone receive unnecessary treatments, while individuals with undiagnosed metabolic dysfunction miss early intervention. Stigma also increases stress and unhealthy eating behaviors, worsening preexisting health conditions.
Q: How can you assess obesity more accurately at home?
A: Instead of relying on BMI alone, use these more precise markers as a guide:
• Waist-to-hip ratio (Ideal: ≤0.8 for women, ≤0.95 for men)
• Waist-to-height ratio (Ideal: 0.40–0.49; ratios ≥0.50 indicate increased health risks)
• Metabolic health markers like fasting insulin, HOMA-IR score (for insulin resistance) and inflammation levels
Q: What are key lifestyle changes to improve metabolic health?
A: Focus on metabolic function, not just weight loss — assess blood sugar stability, energy levels, and inflammation. In addition, choose the right carbohydrates such as fruits and white rice to support insulin sensitivity.
Don’t forget to minimize your vegetable oil intake as this promotes fat storage and inflammation; replace with healthier fats like butter, tallow, and coconut oil. Optimizing vitamin D and incorporating regular moderate-intensity exercise will also help promote better health.
Source:
articles.mercola.com
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