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To fully assess obesity, BMI values are still far from sufficient
When it comes to body mass index (BMI), I believe everyone is familiar with
it.
But what is the origin of BMI? Is it really enough to assess obesity BMI? How to achieve standard treatment for obese patients? At this year's Obesity Week, Professor Scott Kahan gave a presentation on the standard treatment of obese patients, answering the above three questions
.
What is the truth? Hurry up and take a look~
Why is the well-known BMI available worldwide?
The BMI weight classification standard developed by the World Health Organization in 1997 is widely used: normal weight, BMI 19-24.
9kg/m2; Overweight, BMI 25-29.
9kg/m2; Grade I obesity, BMI 30-34.
9kg/m2; Grade II obesity, BMI 35-39.
9kg/m2; Grade III obesity, BMI > 40kg/m2
.
In 1998, the National Institutes of Health updated the original standard - overweight (male), BMI > 27.
8kg/m 2, overweight (female), BMI >27.
3kg/m 2 to overweight, BMI >25kg/m 2
。
The US Food and Drug Administration (FDA) industry guidelines (1996/2007) state that drug approval should be based on effectiveness (not just weight loss) and tolerability (not just weeks-months), 5% The magnitude of weight loss is clinically significant; People with a BMI ≥ 30 kg/m 2 or a BMI ≥ 27 kg/m2 with weight-related complications may be considered for pharmacotherapy
.
BMI is a reasonable, widely used indicator of overall levels that minimizes the impact of height on weight, is simple, fast, cost-effective, and can be calculated by anyone, making it a universal indicator for defining obesity and developing public health policy on a global scale
.
Assessment one step further than BMI: obesity staging
However, on the other hand, BMI oversimplifies complex problems, does not predict fat mass, body composition and fat distribution, mixes factors such as age, sex, race, and ethnicity, and has poor predictive power for cost-effectiveness, which may lead to inadequate assessment of patients and lack of understanding whether patients have comorbidities, and the effect of classifying patients based on body size is not ideal
.
Figure 1: People with the same BMI have different amounts of fat
Obesity can cause many complications, including lung disease, obstructive sleep apnea, nonalcoholic fatty liver disease, gallbladder disease, gynecological abnormalities, polycystic ovary syndrome, urinary incontinence, osteoporosis, skin diseases, coronary heart disease, diabetes, cancer, phlebitis, gout, etc
.
Even for patients with the same BMI index, health status and risk of comorbidities vary
.
Therefore, it can be stratified according to health status and degree of disease:
- Obese but healthy, meaning being overweight without any comorbidities, risk factors and impairments in function;
Obesity co-risk factors, which are overweight and have no obvious comorbidities, but have measurable comorbidity risk factors;
Obesity and morbidity refer to comorbidities and functional impairment
caused by overweight and definite obesity.
Common obesity staging methods are King's Obesity Staging Criteria (KOSC) and Edmonton's Obesity Staging System (EOSS)
。
KOSC addresses the medical and psychosocial aspects of obesity and targets nine areas of health to improve ease of use
.
These areas include airway, body mass index, cardiovascular disease, diabetes, complications, functional limitations, gonadal and reproductive axis, health status (perception), and body image
.
For each health area, patients are assigned to stages 0 to 3 according to the specified criteria, with stage 0 indicating normal health; Stage 1 indicates a risk of disease; Stage 2 indicates that there is a definite disease; Stage 3 indicates advanced disease
.
EOSS classifies obese people into 5 grades (0-4) according to their health status (BMI≥30kg/m2).
0 means that there are no obvious health problems, whether it is blood pressure, lipids or blood sugar are within the normal range, and there are no other physical discomforts;
The next 2-4 indicate chronic diseases such as high blood pressure and type 2 diabetes, and the higher the grade, the more severe
the symptoms.
Figure 2: Schematic diagram of the clinical, psychological, and functional levels of EOSS
Obesity staging is not as simple as BMI calculation, it can objectively and comprehensively assess the impact of obesity on an individual's health status, complications, quality of life, and functioning, can inform treatment decisions, identify criteria for improvement, and identify those most likely to benefit from interventions, requiring a comprehensive clinical assessment of comorbidities or complications, health status and function in obese patients, with the potential to improve outcomes and cost-effectiveness
.
Obesity management methods for standard treatment
Moderate weight loss (3% to 10%) can improve risk factors and some comorbidities, but whether losing 5% of original weight is sufficient to improve health depends on the patient's status
.
More weight loss (10% to 15%+) generally confers greater benefits, including underlying disease changes, disease mitigation, and reduced mortality
.
Of course, other feasible indicators can also be used instead of weight loss to assess the degree of improvement in comorbidities, such as waist circumference, changes in body composition, and visceral fat
.
Standard-compliant treatment is an aggressive disease management process in which clinicians work with patients to develop individualized treatment goals, implement a structured testing and monitoring plan, and adjust treatment as needed to reduce disease activity, improve symptoms and quality of life, improve efficacy, and have been shown to be effective for a number of disease states, including inflammatory diseases, chronic pain, and other chronic conditions
.
The process of achieving treatment includes individualized goal setting and treatment based on health status and obesity stage, active testing and monitoring of the degree of weight loss required to improve comorbidities, re-evaluation and adjustment of treatment based on patient feedback and changes in health status, and shared decision-making
throughout the process.
Standardised treatment supports active obesity management, improves obesity-related symptoms and offers potential benefits, encourages shared decision-making, combines increasingly sophisticated obesity treatment regimens, and combats treatment inertia, better aligns patient needs with treatment options, and enables a more equitable allocation
of resources.
In summary, although a large number of data show that BMI is a limited value for the individual level, it still has its meaning
.
Depending on the degree of obesity and the severity of comorbidities/complications, the implementation of structured compliance treatments, patient assessment, and obesity management has the potential to improve the overall obesity management process
.
Reference source:
Audit Specialist
Zhang Manna
- Deputy Chief Physician of the Tenth People's Hospital Affiliated to Tongji University, Master Supervisor, Shanghai Yangfan Talent
. - He currently serves as the secretary of the Diabetes and Related Endocrine Diseases Group of the 9th Committee of the Diabetes Association Branch of the Chinese Medical Association
- Member of the Endocrinology Group of the Adolescence Medical Professional Committee of the Chinese Medical Doctor Association
- Member of the Gonadology Group of the Endocrinology Branch of the Chinese Medical Association
- Member of the Diabetes and Related Endocrinology Group of the Endocrinology Branch of the Chinese Medical Association
- Vice Chairman of the Youth Committee of the 8th Diabetes Branch of Shanghai Medical Association
- Youth member of Shanghai Gonadism Committee
- He has published more than 30 academic papers in important journals at home and abroad, including more than 20 SCI-indexed papers as the first author or corresponding author
.
Associate editor and co-editor of 2 books
. - He has presided over or participated in more than 10 national, provincial and ministerial scientific research projects, including the National Natural Science Foundation of China Youth Fund, the National Natural Science Foundation of China Major Research Program Cultivation Project, the Shanghai Municipal Science and Technology Commission Sail Talent Program, etc.
, and participated in major projects such as the 973 of the Ministry of Science and Technology and the key projects of the National Natural Science Foundation of China as the main academic backbone - In 2016, he was selected as a Shanghai Yangfan talent
- In 2018, he was selected into the Pujiang Talent Cultivation Program of the Tenth People's Hospital Affiliated to Tongji University
- Awarded the 2019-2020 Harvard Medical School Global Clinical Research Scholar Professional Certificate
- Clinically, he specializes in the diagnosis and treatment of endocrine system diseases such as polycystic ovary syndrome, hypothalamic-pituitary disease, sexual retardation, and young diabetes
Where to see more endocrinology clinical knowledge?
Come to the "doctor's station" and take a look 👇
