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A New Framework Expands the Definition of Obesity Beyond BMI
For many years, the obesity as defined by medical practitioners has relied mainly on body mass index (BMI), a calculation which accounts for a person's height and body weight. BMI is easy to use, but it does not show a person’s body composition or where fat mass is stored. It may therefore fail to capture the risk of adverse health outcomes associated with body fat distribution.
A new framework proposed by the European Association for the Study of Obesity (EASO) offers a more comprehensive approach. Anthropometric measures, such as BMI and waist circumference, as well as the health impact excess body fat has on the individual. This allows obesity to be assessed according to its impact on the individual.
BMI remains a useful screening tool, but it cannot distinguish how much of a person's mass is composed of fat or muscle, nor assess central adiposity, which is associated with cardiometabolic risk.
The EASO framework considers additional anthropometric measures of abdominal circumference. A patient’s waist circumference is used with height to calculate waist-to-height ratio. A result greater than 0.5 may indicate excess abdominal fat accumulation and increased health risk.
Under the proposed diagnostic criteria, BMI alone can be used to indicate obesity, with a BMI over 30 indicating that a person is obese. However, under the new framework, a person may be diagnosed with obesity even if they do not meet the BMI criteria. Adults of European descent with a BMI of 25-30 may also be diagnosed when they have a waist-to-height ratio greater than 0.5 and a medical condition or impairment linked to excess adiposity. Ethnicity-specific BMI thresholds are recommended for diverse populations.
The framework also considers whether a person's excess fat is contributing to medical complications, reduced physical function or psychological concerns. It is intended to help clinicians diagnose obesity through a fuller assessment. However, the U.S. study discussed below noted that the framework had not yet been validated.
Research reviewed by Sweatt, Garvey and Martins explains that BMI remains useful for screening and population studies. The World Health Organization commonly defines overweight as a BMI from 25 to 29.9 and obesity as a BMI of 30 or higher. In clinical settings, the authors recommend confirming that an elevated BMI reflects excess adiposity and assessing fat distribution through a measure such as waist circumference or waist-to-height ratio. A health evaluation can then determine the presence and severity of weight-related complications.
The EASO framework views obesity as a chronic, relapsing disease rather than simply a number on a scale. The framework, approved for use in individuals of European decent, giving the study population, recognizes obesity when BMI is 30 or higher.It also expands the definition of obesity to include those with a BMI from 25 to below 30 when their waist-to-height ratio is greater than 0.5 and they have a related medical, functional or psychological impairment or complication. By considering both excess fat and its effects on health and daily functioning, the framework may support more personalized treatment goals and long-term care.
This broader view supports more personalized treatment strategies. At Clinique Michel Gagner, we assess each patient’s health, previous weight-loss efforts and treatment goals before recommending care.
Our weight-loss management services include consultations with obesity specialists, prescription weight-loss medication when appropriate and personalized nutrition support. For eligible patients, our bariatric surgeons offer a range of weight-loss procedures with postoperative follow-up. Information about current procedure costs is available in our fees section.
If excess weight is affecting your health, complete our online questionnaire to help our team understand your circumstances and identify a suitable path forward.
1. Busetto L, et al. A new framework for the diagnosis, staging and management of obesity in adults. Nature Medicine, 2024.
2. Sweatt K, Garvey WT, Martins C. Strengths and limitations of BMI in the diagnosis of obesity: What is the path forward? Current Obesity Reports, 2024.
