Study Group Recommends Widespread Use of Obesity Medications and Surgery

European association promotes treatments for people not diagnosed with obesity.

Doctor measuring obese man waist body fat. grinny/Shutterstock

A new treatment guideline published Friday challenges current guidelines on treating obesity. The authors propose that rather than focusing on the body mass index score alone to qualify for medications and surgery, high abdominal fat accumulation in people with lower BMI scores should also receive these kinds of treatments for obesity.

“The system for diagnosing and managing obesity can no longer be about just body mass index (BMI), which is excluding many people who would benefit from obesity treatment,” the European Association for the Study of Obesity said in a press release.

Obesity diagnoses are based “solely on BMI cut-off values,” but do not take into consideration the distribution of body fat and the role that plays in the severity of the disease, the statement said. It added that this new recommendation challenges body measurement criteria as the sole component of the obesity diagnosis.

The accumulation of body fat is associated with an increased risk of conditions such as heart attacks, strokes, and diabetes, and is a stronger cause of disease than BMI—even in people with levels lower than the standard measure of obesity, a BMI of 30, the statement said.

BMI, a person’s weight measurement divided by height, is a method of categorizing people as obese, overweight, healthy weight, or underweight. BMI is not a measurement of body fat, but tends to be linked to direct body fat measurements.

Challenging Accepted Norms

According to categories published by the U.S. Centers for Disease Control and Prevention, the BMI for an obese person is 30 and above. As an example, a person 5 foot 9 inches tall, weighing 203 pounds or more, would be categorized as obese. A man, woman, or child of the same height, weighing 169 to 202 pounds, is labeled as overweight.

The new framework said abdominal fat accumulation is an important factor for deteriorating health, including people with a low BMI score and those “free of overt clinical manifestations.” 

Its new recommendations for treatment would also include those now diagnosed as overweight instead of obese, as well as those with increased abdominal fat and obesity symptoms, such as functional or psychological impairment.

These people were not included in the old guidelines.

The authors of this framework said they agree with current guidelines for treating obesity, which emphasize changes in behavior such as improved nutrition, physical activity, reduction in stress, and better sleep habits. Their recommendations for pharmaceutical and surgical treatments for more people do not exclude recognition of these basic recommendations for obese and overweight people.

Recommending Drugs and Surgery

The steering committee of this association proposed that there should be an increase in people who take obesity medications, weight-loss surgery, and non-surgical procedures to examine digestive tracts.

This increase should include those who are labeled as overweight, but not obese, with a BMI of 25 to 30, a waist-to-weight ratio of over 0.5, and “medical, functional or psychological impairments or complications.”

Someone with a 37-inch waist who is 6 feet tall would qualify in the waist-height category. 

“This statement may also be seen as a call to pharmacological companies and regulatory authorities to use inclusion criteria that are more adherent to the clinical staging of obesity and less to traditional BMI cut-offs when designing future clinical trials with obesity medications,” the authors said in their press release.

“This statement will move obesity management closer to the management of other non-communicable chronic diseases, in which the goal is not represented by short-term intermediate outcomes, but by long-term health benefits.”

Other studies have shown that lifestyle changes alone like regular exercises of 200 minutes per week and changing diets can also result in weight loss.

Bariatric surgery has not been as popular as expected since its introduction in the early 1980s. About 280,000 patients undergo a form of weight loss surgery each year—about 1 percent of those who are eligible—according to an article in the Journal of Surgery for Obesity and Related Diseases.

Vertical banded gastroplasty, referred to as “stomach stapling surgery,” is a form of bariatric surgery that has largely been phased out after many complaints from patients. They complained of poor weight loss, late regain of weight, dysphagia, and intolerance of solid foods.

The Ethics Declaration of the seven authors of this statement, urging pharmaceutical treatments and bariatric surgery for more people, reports widespread funding from multiple pharmaceutical companies. Three authors report personal funding, two received payment of honoraria, and one of the honorarium recipients also received consulting fees. One author reported pharmaceutical company funding of his university for a study in which he participated. One author reported no funding from any pharmaceutical company.