Advantages and Critical Reappraisal of New Clinical Obesity Definition Proposed by Lancet Commission
- 1Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
- 2Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
- 3Pennington Biomedical Research Center, Baton Rouge, LA, USA
Abstract
Obesity has traditionally been defined by body mass index (BMI), a pragmatic but biologically limited measure that fails to capture adiposity distribution, tissue dysfunction, and heterogeneity in disease risk. To address these limitations, a recent Lancet Diabetes & Endocrinology Commission proposed a disease-oriented redefinition of obesity, distinguishing clinical obesity—excess adiposity causing organ dysfunction or functional impairment—from preclinical obesity, characterized by excess adiposity without established dysfunction. This shift has important implications for diagnosis, epidemiology, and health policy. In this review, we critically appraise the conceptual framework, emerging evidence, and implementation challenges of the new Lancet Commission definition of clinical obesity. Population-based studies from diverse regions consistently demonstrate marked discordance between BMI-defined and clinical obesity, with clinical obesity showing stronger associations with cardiometabolic disease, mortality, functional limitation, and cancer risk. These findings highlight the limitations of universal BMI thresholds, particularly in Asian populations with a predisposition to visceral adiposity at lower BMI levels. We compare the Lancet Commission framework with existing staging systems, including the Edmonton Obesity Staging System and the European Association for the Study of Obesity framework, and identify key challenges related to causal attribution, binary classification, scalability, and ethnic adaptation. Finally, we propose a refined, population-sensitive and pragmatic approach that conceptualizes preclinical and clinical obesity as stages along a trajectory, incorporates ethnicity-adapted adiposity thresholds, and emphasizes readily available clinical criteria for determining dysfunction and disease. The resulting definition of clinical obesity should support more precise and equitable obesity care.
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BibTeX
@article{lim2026advantages,
title = {{Advantages and Critical Reappraisal of New Clinical Obesity Definition Proposed by Lancet Commission}},
author = {Soo Lim and Hun Jee Choe and Donna H. Ryan},
journal = {Journal of Obesity \& Metabolic Syndrome},
year = {2026},
month = oct,
doi = {10.7570/jomes26008},
url = {https://doi.org/10.7570/jomes26008},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Advantages and Critical Reappraisal of New Clinical Obesity Definition Proposed by Lancet Commission
AU - Soo Lim
AU - Hun Jee Choe
AU - Donna H. Ryan
PY - 2026
DA - 2026/10/08
JO - Journal of Obesity & Metabolic Syndrome
DO - 10.7570/jomes26008
UR - https://doi.org/10.7570/jomes26008
AB - Obesity has traditionally been defined by body mass index (BMI), a pragmatic but biologically limited measure that fails to capture adiposity distribution, tissue dysfunction, and heterogeneity in disease risk. To address these limitations, a recent Lancet Diabetes & Endocrinology Commission proposed a disease-oriented redefinition of obesity, distinguishing clinical obesity—excess adiposity causing organ dysfunction or functional impairment—from preclinical obesity, characterized by excess adiposity without established dysfunction. This shift has important implications for diagnosis, epidemiology, and health policy. In this review, we critically appraise the conceptual framework, emerging evidence, and implementation challenges of the new Lancet Commission definition of clinical obesity. Population-based studies from diverse regions consistently demonstrate marked discordance between BMI-defined and clinical obesity, with clinical obesity showing stronger associations with cardiometabolic disease, mortality, functional limitation, and cancer risk. These findings highlight the limitations of universal BMI thresholds, particularly in Asian populations with a predisposition to visceral adiposity at lower BMI levels. We compare the Lancet Commission framework with existing staging systems, including the Edmonton Obesity Staging System and the European Association for the Study of Obesity framework, and identify key challenges related to causal attribution, binary classification, scalability, and ethnic adaptation. Finally, we propose a refined, population-sensitive and pragmatic approach that conceptualizes preclinical and clinical obesity as stages along a trajectory, incorporates ethnicity-adapted adiposity thresholds, and emphasizes readily available clinical criteria for determining dysfunction and disease. The resulting definition of clinical obesity should support more precise and equitable obesity care.
SN - 2508-6235
SN - 2508-7576
ER -