The criteria for defining obesity as a disease have been questioned for a long time. Several of obesity retractor movements as a disease argue their criticisms in these criteria.
It is important to clarify that the body mass index (BMI) is a relationship between the weight and the square of the size that are important epidemiological and allows health interventions to be carried out. But it is clear that being a size – weight relationship does not explain why the person weighs, there are patients who may have similar BMIs and yet one has obesity due to excess adipose tissue and the other patient to be a healthy athlete who plays rugby with great development of muscle mass. For this reason, it has been advisable to consider for the diagnosis of obesity other parameters such as the percentage of body fat and other anthropometric measures.
Finally, this year an expert commission meets to define the criteria and classification of obesity as a disease. It is important to mention that all guidelines had a degree of 90-100% agreement and that this definition was approved by 76 obesity associations in the world.
The objective of this commission of 58 expert was to define the criteria of obesity as a disease, thus being able to help decisions for the treatment of patients.
The Commission defines obesity as a condition characterized by an excess of adipose tissue; With or without abnormal distribution or function of adipose tissue, with causes that are multifactorial and are not yet completely understood.
Recommends that the BMI be used as a measure at the population level, Its usefulness would be epidemiological and for research.
But at the individual level to define obesity, more measures are required. Excess adiposity should be confirmed by direct measurement of body fat if the method is available. Bioimpedance is one of the ways to know this measure and is accessible to clinical consultation. Another option is to assess some of the anthropometric index such as: waist circumference, waist-salad index or waist-height index. All these indices must be adequate to sex, race and ethnicity.
After the definition of obesity, subdivides this condition in two categories.
A. Clinical obesity: they define it as a systemic, chronic disease, characterized by alterations in the function of tissues, organs, the entire individual or a combination of both due to excess adiposity.
What the expert commission plans is that obesity is clinic and constitutes a disease if this excess dysfunctional adipose tissue generates damage to other target organs. For example, ischemic heart disease, vascular brain disease, accident, kidney failure, etc.
B. Preclinical obesity: they define it as a condition where there is an excess of adipose tissue, but with preserved function.
In this case, the excess of adipose tissue does not generate repercussions on other tissues or target organs, but they are patients with greater risk of developing diabetes mellitus, hypertension among other diseases.
In sum, in order to perform the diagnosis of clinical obesity is required:
First present an excess of adipose tissue and comply with one of the following two criteria:
- Evidence of anomalies in the function of organs or tissues caused by obesity (that is, signs, symptoms or diagnostic tests that show anomalies in the function of one or more tissues or organ systems) systems)
- Substantial limitations adjusted by age of activities such as mobility, other basic activities of daily life for example bathe, dress, go to the bathroom, continence and eat.
There is still much to know about obesity and above all we are still far from being able to find the treatment that solutions the main health problem of humanity. But it seems clear that such a complex and multifactorial condition will not be solved with a pill. The base will continue to be the changes in the lifestyle. If a person has a food, performs physical activity and has eating behavior according to his genetic and metabolic predisposition surely manages to maintain a healthy weight.
This consensus helps to medical actions and surely also the perception of the population of obesity. Not all excess adipose tissue constitutes a disease, if the population must be clarified that an excess of adipocytes can predispose to develop diseases associated with adipocyte dysfunction. At the care level, it will surely force colleagues to be finer when making the obesity diagnosis, looking for predisposing causes and making a more complete and comprehensive assessment.
Patients who meet the criteria of clinical obesity should receive a treatment based on evidence for obesity, which has other objectives of weight decrease, while patients who have pre -clinical obesity should receive advice that modifies their lifestyle to avoid evolution to clinical obesity.
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By CEDOC