Obesity Given Credibility as a Diagnosis

Clinicians and professional organizations such as the Obesity Society, the American Society of Metabolic and Bariatric Surgery, the National Institutes of Health, and the World Health Organization have believed that obesity is a disease for decades. Even the US Internal Revenue Service considers obesity as a disease, but some large and influential organizations have been steadfast in their refusal to call it such. However, obesity’s standing as a diagnosis advanced leaps and bounds after the American Medical Association (AMA) formally recognized it as a disease in June 2013.

As experts have accepted obesity as more than just poor lifestyle choices, they have also started to understand that it has a plethora of causes, contributing factors, and presentations. Body mass index (BMI), which was formerly the main measure of obesity, is no longer a sufficient tool, as clinicians now know that some people who are obese are metabolically healthy, while others are not. Physicians’ experience with bariatric surgery has also revealed that patients lose weight in vastly different ways, and their risk of cardiometabolic disease may not decrease after surgery and weight loss. Like all diseases, obesity’s presentation depends on ethnicity, gender, environment, and culture.

Supported in part by grants from the National Institutes of Health, researchers at Boston University compiled an overview of obesity in its many forms and tried to identify better ways to determine health status in obese individuals. They noted that some obese patients appear to be protected from some of obesity’s expected cardiometabolic complications, but other lean patients experience cardiometabolic complications despite their low BMIs. It’s those fringe populations that need more study so that doctors can differentiate health status.

The researchers suggested that small ectopic fat depots — especially those in the pericardial region and brown fat stores — are metabolically active and inflamed. While those properties don’t noticeably increase BMI, they elevate risks of cardiometabolic diseases and obesity-associated cancers. In the future, the measure of pericardial fat and brown fat stores with MRI or other imaging techniques may be used in combination with blood cytokine and adipokine concentrations to stratify risk in patients who are obese, and even some patients who are lean.