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Seventy percent of Americans may now be classified as obese, according to a new study authored by Harvard Medical School researchers investigating an updated definition for obesity.
This figure is up from 40 percent of the population who meet the old threshold for obesity, defined as a Body Mass Index higher than 30.
The Lancet Diabetes and Endocrinology Commission proposed an amended definition of obesity this year that would consider fat distribution in addition to BMI. This revised definition now “includes anthropometric measurements, which are measurements of body composition — particularly waist circumference and hip circumference,” said HMS professor Steven Grinspoon, who was the senior author on the Harvard study.
HMS assistant professor Lindsay T. Fourman, the study’s lead author, is among the scientists questioning BMI’s reliability as a measure of body composition.
“That one number doesn’t tell you everything,” she said.
These new anthropometric considerations marked what Fourman deemed a “paradigm shift” in how obesity is evaluated. By including patients who may have excess fat despite having a normal BMI, the revised criteria ensure that doctors are “correctly defining someone and not just dismissing their concern about their fat,” she said.
While the new definition of obesity has yet to be fully accepted in the medical world, it has been gaining traction. The American Heart Association and the Obesity Society are among the 76 organizations that have endorsed the definition thus far.
Fourman and Grinspoon’s study found that one in four American adults falls under their anthropometric classification for obesity. Fourman said that the new group, characterized by excess abdominal fat, is said to have an “increased health risk compared to people without obesity.”
But Grinspoon said that the new definition based on body shape is not meant to “stigmatize or shame people.”
“It’s in an effort to help them understand the complexity of the metabolic risk associated with their health,” he added.
Researchers recognized the concern that the potential uptick in obesity diagnoses could overtax the already “strained” health infrastructure in the U.S. But while patients with BMI-only obesity qualify for GLP-1 drugs, like Ozempic, researchers clarified that this treatment may not be appropriate for those with anthropometric-only obesity.
“We are not saying that 70 percent of people need to be treated with a GLP-1,” Grinspoon said. “I really want to be clear about that.”
“It’s one step on a journey of data, but it is a validation of the new definition, that it has clinical consequence and would raise the prevalence to a certain degree,” Grinspoon added.
The results generate two primary areas for further study: the cause of anthropometric-only obesity and appropriate treatment for this new pool of patients.
“What actually causes this anthropometric-only obesity?” Fourman said. “We can’t really fix the problem until we understand what causes it.”
Grinspoon added that research on the topic depends on collaboration across disciplines and institutions.
“This is a multidisciplinary collaboration between clinicians, data scientists, international collaborators, and this resource, the All of Us cohort, created by the federal government in a shining example of what the government can do funding research,” he said. “Harvard’s a great place to do this research, and we’ve benefited greatly from that.”
Grinspoon added that the data, while “very provocative,” is meant to encourage continued study rather than cause alarm.
“I do think it raises awareness to the general problem of obesity in America and throughout the world,” he said.
“Hopefully, with improved understanding, we can actually tackle the problem and improve people’s health,” Fourman added.
