Obesity experts have thrown aside their BMI charts as they reveal it is possible to be both fat and fit.
Huge numbers of the 17.6million Brits who have been told that they are overweight are in fact perfectly healthy, the scientists have revealed.
And they have proposed a ‘radical overhaul’ of how obesity is diagnosed and treated to stop them being misdiagnosed.
A body mass index (BMI) score is not ‘nuanced’ enough to measure obesity and more assessments are needed before someone is told they are obese, the new Lancet Commission of more than 50 experts from around the world found.
Doctors should only diagnose patients as clinically obese if they have illnesses directly caused by obesity alone, such as type 2 diabetes, they say.
The revolutionary model could see people being shifted into two new subtypes to distinguish between people who are fat but perfectly healthy – or ‘pre-clinical obesity’ – and those who are genuinely sick with ‘clinical obesity’.
NHS doctors were told yesterday to use the new diagnoses in guidance from the National Institute for Health and Care Excellence. They had already been stopped from using just BMI.
Under the guidance some fat patients will not be told they need to lose weight.
Professor Francesco Rubino, commission chair of King’s College London, said lines are currently ‘blurred’ surrounding obesity.
He explained: ‘Some people who are today classified as having obesity by BMI (but) they might play sports, they’re very active, they might have very strong bones – saying that those people have obesity and then classifying them as having a disease would obviously be an overdiagnosis.
‘This commission has been trying to deal with a more accurate way of diagnosing and classifying obesity in the first place.
‘No system – the NHS or others – have had these methods yet – I think everybody has been using the old classification for four decades, at least.
‘But we are calling for a change, a radical change, because obviously, in the context of one billion people being classified as having obesity in the world today, and with a number that is projected to increase, no country is rich enough to be able to afford inaccuracy in the diagnosis of obesity.’
Obesity costs the NHS £6 billion every year and is expected to rise to more than £9.7bn each year by 2050.
Some 29 per cent of adults and one in ten children are obese by the time they start secondary school, according to the latest Health Survey for England.
But the current standards rely too heavily on BMI, meaning some who are heavy but healthy are needlessly being told to diet while others are slipping through the net.
Professor Rubino continued: ‘The message remains that obesity can be a health risk.
‘What we’re proposing is to say that ‘it’s not only a health risk, for some it is actually an illness and that needs to be diagnosed’.
‘And I think it’s sensible to understand what is this level of risk to decide what is the best course of action?
‘If we were to give exactly the same intervention to everybody who has obesity – we have a billion people (with obesity) and you have to give the same intervention to everybody.
‘Not only is (this) probably economically unsustainable, but it’s also not exactly what each individual needs, because the personalised care is what makes the effectiveness and (the) cost effectiveness of the interventions.
‘And so we cannot afford having a blurry picture of obesity.’
The new recommendations have been endorsed by numerous organisations, including the Royal College of Physicians.
Dr Kath McCullough, special adviser at the RCP, said: ‘For too long, we’ve relied on BMI as a simple measure of obesity, which has often misrepresented the condition and fails to fully reflect how excess body fat impacts a person’s health.
‘The commission’s distinction between pre-clinical and clinical obesity represents a vital step forward, highlighting the need to identify and intervene early while providing appropriate care to those already experiencing severe health impacts.’
Katharine Jenner, director of the Obesity Health Alliance, said: ‘Our priority should be supporting those living with excess weight, rather than focusing solely on how it is measured.
‘Currently, obesity treatment is inaccessible to those who need it most, namely individuals with the highest levels of excess weight, while our prevention policies remain insufficient.’
It comes as the NHS has initiated the rollout of weight loss jabs for obese people meeting certain criteria.
Asked specifically about the National Childhood Measurement Programme, which measures the level of obesity in children using their height and weight to calculate their BMI score, Professor Louise Baur, chairwoman of child and adolescent health at the University of Sydney, said: ‘I’m just very pleased that actually, height and weight are actually being measured in children and young people because it’s a great measure of linear growth of failure to thrive, of overweight and multiple other things.
‘So if paediatric people stop measuring height and weight, I think that’s almost the death of paediatrics to some extent – growth is part of childhood and abnormalities and growth are actually part of highlighting health problems.’
Commenting on the commission, Dr Kath McCullough, special adviser on obesity at the Royal College of Physicians, said: ‘For too long, we’ve relied on BMI as a simple measure of obesity, which has often misrepresented the condition and fails to fully reflect how excess body fat impacts a person’s health.
‘The commission’s distinction between pre-clinical and clinical obesity represents a vital step forward, highlighting the need to identify and intervene early while providing appropriate care to those already experiencing severe health impacts.’
An NHS England spokesperson said: ‘Nice (the National Institute for Health and Care Excellence) has published updated guidance regarding the identification, assessment, treatment and personalised care of people who are overweight or living with obesity.
‘Nice independently assesses the evidence and NHS England follows the guidance as published.’
