A New Approach to Obesity Diagnosis, Staging, and Management

Hi, my name is Luca Busetto and I am Professor of Nutrition and Dietetic Sciences at the Department of Medicine of the University of Padua in Italy.

In this five minutes CPD, I will introduce you to the EASO framework for the diagnosis, staging, and management of obesity in adults.

Let's get started.

Despite the existence of clinical practice guidelines that stipulate that obesity is characterized as an excess and/or dysfunctional adiposity that impairs health, the clinical diagnosis of obesity remain mostly based on the body mass index.

But obesity isn't just about weight and body size.

And while BMI or body mass index has been the go-to diagnostic tool, it is too simplistic.

It doesn't tell the full story of someone's health.

This is That is why the European Association for the Study of Obesity is calling for a change, a shift, to recognize obesity as a chronic disease requiring comprehensive diagnosis, assessment and management.

The new EASO framework for the diagnosis, staging and management of obesity in adults goes beyond BMI.

It focuses on the adiposity-based chronic disease (ABCD) model, a more complete picture that includes body fat distribution and the health effects of excess or dysfunctional fat.

Rather than a one-size-fits-all diagnostic approach, this framework uses disease staging to guide treatment.

That means understanding a person's physical, mental, and functional health to decide the right combination of treatments.

Let's review the steps in the diagnosis, staging, and management of obesity outlined in the EASO framework.

When diagnosing obesity, we start by looking at basic body measurements.

If someone has a BMI of 30 or higher, or if their weight-to-height ratio is 0.5 or above, that's a clear sign to look closer.

Even if the BMI is lower than 30, say 25 or more, but the weight-to-height ratio is still high, it's worth doing a deeper evaluation.

Next, we don't just stop at the anthropometric measurements.

We also check the person's overall health, how their body functions, any medical issues, and their mental well-being.

If someone's BMI doesn't clearly reflect their body fat, for example, they are very muscular or have an unusual body shape, we can use tools like body scans to get a more accurate picture.

And finally, because body composition can vary across different populations, we adjust BMI thresholds based on a person's ethnicity to make the assessment more accurate.

Think of obesity not just as a weight issue but as a long-term, chronic condition that can come and go over time.

To really understand how serious obesity is for someone, we look at how it's affecting their physical health, daily function and mental well-being.

We also check for specific problems like loss of muscle mass combined with obesity, called the sarcopenic obesity, screen for cancers linked to obesity, and keep an eye on mental health concerns like depression or eating disorders.

It's about seeing the full picture and not just the number on the scale.

Improving health behavior such as nutrition, exercise, sleep, and stress management are fundamental interventions for the management of all chronic diseases, including obesity.

However, to support this foundational health behavior intervention, the core evidence-based obesity treatment pillars are psychological and behavioral therapy, medication, and bariatric surgery.

Currently, the goal of obesity treatments is an just weight loss.

Obesity management is about helping people feel better, function better and reduce health risk.

And if the first treatment plan doesn't work well enough, we adjust and strengthen the treatment to make sure health improvement progress continues.

I am Professor Luca Busetto for 5 Minutes CPD.

Thanks for watching.

Be sure to check out additional resources on this page and more learning at ieso.org.