This Viewpoint article doi:10.1001/jamapediatrics.2025.1038 written by Dr Melania Manco, Co-Chair of the EASO Collaborating Centres for Obesity Management (COMs) and published in JAMA Pediatrics, sets out an articulate critique of the Lancet Commission’s proposed definition of clinical obesity, especially its application to children and adolescents. The Commission distinguishes between preclinical obesity, which involves risk without illness, and clinical obesity, characterised by documented organ dysfunction. It proposes limiting access to pharmacological and surgical treatment to people with clinical obesity to avoid unsustainable healthcare costs.
Dr Manco argues that this approach is problematic for paediatric populations.
Treating pediatric patients and their condition as though they are simply smaller adults is conceptually flawed and could lead to inappropriate management strategies for younger populations.
Children with preclinical obesity may already exhibit early signs of organ impact and, due to their physiological plasticity, respond more effectively to early intervention than adults. Waiting for illness to manifest before allowing treatment could increase lifelong health burdens and healthcare costs.
She also raises ethical concerns, contrasting a utilitarian model that favours those with better long-term outcomes against a deontological model that affirms equal care for all children. The lack of paediatric expertise in the Commission and the adult-centred framework may result in inadequate treatment strategies for young people. Dr Manco’s approach aligns with the updated EASO Framework for the Diagnosis, Staging and Management of Obesity in Adults https://easo.org/a-new-framework-for-the-diagnosis-staging-and-management-of-obesity-in-adults/ Dr Manco advocates for evidence-based, proactive approaches that prioritise early treatment to reduce future morbidity, ensure fairness, and deliver societal benefit.
Melania Manco, MD, PhD,
Unit of Preventive and Predictive Medicine,
Bambino Gesù Children’s Hospital, IRCCS, Scientific
Directorate, Largo S Onofrio 4, Rome 00165, Italy
(melania.manco@opbg.net)
Published Online: May 19, 2025
doi:10.1001/jamapediatrics.2025.1038