EASO response to the Lancet Commission Report on Obesity Diagnosis and Management

EASO response to the Lancet Commission Report on Obesity Diagnosis and Management

The European Association for the Study of Obesity (EASO) has raised significant concerns about the recent Lancet Commission report on the definition and diagnostic criteria of clinical obesity, highlighting potential risks to obesity management and patient care.

Understanding Obesity as a Chronic Disease

Obesity is an adiposity-based chronic disease (ABCD) that profoundly impacts both physical and mental health. It is a highly prevalent and deeply stigmatised non-communicable disease (NCD), affecting virtually every system in the body. The updated EASO framework published in 2024 emphasises that obesity cannot be diagnosed on the individual level through body mass index (BMI) alone, and advocates for a more holistic and personalised approach that includes factors such as waist-to-height ratio (WtHR).

The Lancet Commission report introduces problematic concepts that could potentially harm patient care.

Preclinical vs. Clinical Obesity Distinction

The report’s proposed classification of ‘preclinical obesity’ as a state of preserved health is deeply concerning. This approach suggests a watchful waiting strategy that could:

  • Delay crucial early interventions
  • Increase health risks for children, adolescents and adults
  • Potentially worsen long-term health outcomes

Misguided Treatment Recommendations and Diagnostic Limitations

The report’s suggestion that type 2 diabetes does not necessitate obesity treatment directly contradicts existing scientific evidence. Effective obesity treatment has been shown to reduce type 2 diabetes complications.

The report lacks a clear, clinically validated definition of “excess” adiposity. The proposed diagnostic criteria:

  • Relies heavily on epidemiological data
  • Lacks sensitivity and specificity for individual diagnosis
  • Fails to provide insights into the underlying causes of obesity

Potential Negative Consequences

The EASO Trustees and Executive Committee warn that the Lancet Commission’s approach could

  • Increase stigma and discrimination
  • Create barriers to accessing medical care
  • Delay diagnosis and treatment
  • Complicate clinical decision-making
  • Potentially reduce insurance coverage for obesity treatments

A More Comprehensive Approach

As described in our updated framework, EASO advocates for

  • Evidence-based medicine
  • Early intervention
  • Comprehensive clinical evaluation
  • Holistic management across the patient lifecycle
  • Equitable access to care regardless of BMI or WtHR

The report’s approach is fundamentally flawed when compared with management of other chronic conditions. Unlike diabetes or osteoporosis, where early diagnosis and prevention are standard, the Lancet Commission criteria proposes waiting for clinical manifestation of obesity-related complications.

It is important to have debate and discussion of models of care in medicine. We believe the proposed Lancet framework represents a potential setback in obesity management for children, adolescents and adults. It risks prioritising semantic discussions over practical, patient-centred care. EASO strongly recommends a more nuanced, comprehensive approach that recognises obesity as a chronic disease requiring proactive, individualised management. By focusing on early intervention and providing comprehensive treatment, we can more effectively address the significant health challenges posed by obesity.

References:

A New Framework for the Diagnosis, Staging and Management of Obesity in Adults

https://doi.org/10.1038/s41591-024-03095-3

https://easo.org/wp-content/uploads/2025/01/Framework-Infographic-Final-10012024.pdf

Providing a common language for obesity: The EASO Obesity Taxonomy

https://doi.org/10.1038/s41366-024-01565-9

https://easo.org/wp-content/uploads/2024/09/EASO-obesity-taxonomy-1-pager-_v7.pdf

Definition and Diagnostic Criteria of Clinical Obesity

https://doi.org/10.1016/S2213-8587(24)00316-4