Interpretation of “Definition and diagnostic criteria of clinical obesity”_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

TONG Junle , CAO Yaoquan , ZHU Changyan , WANG Wenbo ,  ZHU Liyong

Department of Bariatric and Metabolic Surgery, The Third Xiangya Hospital, Central South University, Changsha 410013, P. R. China;

Corresponding author：

ZHU Liyong, Email: zly8128@csu.edu.cn

Keywords：

obesity; preclinical obesity; clinical obesity; guideline interpretation

DOI：

10.7507/1007-9424.202508061

Video：

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“Definition and diagnostic criteria for clinical obesity” (referred to as the “Guideline”), jointly developed by The Lancet Diabetes & Endocrinology Commission, was officially released on January 25, 2025. The Guideline presents a groundbreaking perspective by explicitly defining clinical obesity as a chronic disease and establishing a stratified diagnostic system. It mandates the combined use of anthropometric measurements and clinical assessments, promoting a shift in the diagnosis and treatment model from “body weight management” to comprehensive intervention focused on “body fat metabolism and organ function protection”. Through a systematic interpretation of the core content of the Guideline, including the definition of clinical obesity, key diagnostic criteria, criteria for differential diagnosis, and clinical significance, the document emphasizes the profound impact of the Guideline on the adjustment of medical insurance policies, the standardization of clinical practices, and the protection of patient rights, and aims to enhance the precision diagnosis and stratified management of obesity.

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2.	Pan XF, Wang L, Pan A. Epidemiology and determinants of obesity in China. Lancet Diabetes Endocrinol, 2021, 9(6): 373-392.
3.	GBD 2019 Risk Factors Collaborators. Global burden of 87 risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet, 2020, 396(10258): 1223-1249.
4.	Thomas DD, Istfan NW, Bistrian BR, et al. Protein sparing therapies in acute illness and obesity: a review of George Blackburn’s contributions to nutrition science. Metabolism, 2018, 79: 83-96.
5.	Rubino F, Cummings DE, Eckel RH, et al. Definition and diagnostic criteria of clinical obesity. Lancet Diabetes Endocrinol, 2025, 13(3): 221-262.
6.	Carruba MO, Busetto L, Bryant S, et al. The European Association for the Study of Obesity (EASO) endorses the Milan charter on urban obesity. Obes Facts, 2021, 14(1): 163-168.
7.	Bray GA, Kim KK, Wilding JPH, et al. Obesity: a chronic relapsing progressive disease process. A position statement of the World Obesity Federation. Obes Rev, 2017, 18(7): 715-723.
8.	Rathbone JA, Cruwys T, Jetten J, et al. How conceptualizing obesity as a disease affects beliefs about weight, and associated weight stigma and clinical decision-making in health care. Br J Health Psychol, 2023, 28(2): 291-305.
9.	Rubino F, Puhl RM, Cummings DE, et al. Joint international consensus statement for ending stigma of obesity. Nat Med, 2020, 26(4): 485-497.
10.	Vallgårda S, Nielsen MEJ, Hansen AKK, et al. Should Europe follow the US and declare obesity a disease?: a discussion of the so-called utilitarian argument. Eur J Clin Nutr, 2017, 71(11): 1263-1267.
11.	Osen H. Is obesity a disease or a behavior abnormality? Did the AMA get it right? Mo Med, 2014, 111(2): 104-108.
12.	Swinburn BA, Sacks G, Hall KD, et al. The global obesity pandemic: shaped by global drivers and local environments. Lancet, 2011, 378(9793): 804-814.
13.	Lobstein T, Brownell KD. Endocrine-disrupting chemicals and obesity risk: a review of recommendations for obesity prevention policies. Obes Rev, 2021, 22(11): e13332. doi: 10.1111/obr.13332.
14.	Mohajer N, Du CY, Checkcinco C, et al. Obesogens: how they are identified and molecular mechanisms underlying their action. Front Endocrinol (Lausanne), 2021, 12: 780888. doi: 10.3389/fendo.2021.780888.
15.	Pontzer H, Raichlen DA, Wood BM, et al. Hunter-gatherer energetics and human obesity. PLoS One, 2012, 7(7): e40503. doi: 10.1371/journal.pone.0040503.
16.	Leibel RL, Rosenbaum M, Hirsch J. Changes in energy expenditure resulting from altered body weight. N Engl J Med, 1995, 332(10): 621-628.
17.	Rosenbaum M, Kissileff HR, Mayer LE, et al. Energy intake in weight-reduced humans. Brain Res, 2010, 1350: 95-102.
18.	No authors listed. Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser, 2000, 894: i-xii,1-253.
19.	Mechanick JI, Hurley DL, Garvey WT. Adiposity-based chronic disease as a new diagnostic term: the American Association of Clinical Endocrinologists and American College of Endocrinology position statement. Endocr Pract, 2017, 23(3): 372-378.
20.	GBD 2015 Obesity Collaborators, Afshin A, Forouzanfar MH, et al. Health effects of overweight and obesity in 195 countries over 25 years. N Engl J Med, 2017, 377(1): 13-27.
21.	国家卫生健康委食品安全标准与监测评估司, 中国疾病预防控制中心营养与健康所, 成人肥胖食养指南编写专家组. 成人肥胖食养指南(2024年版). 卫生研究, 2024, 53(3): 347-351.
22.	Després JP. BMI versus obesity subtypes in the era of precision medicine. Lancet Diabetes Endocrinol, 2023, 11(6): 382-384.
23.	Stanford FC, Lee M, Hur C. Race, ethnicity, sex, and obesity: is it time to personalize the scale?. Mayo Clin Proc, 2019, 94(2): 362-363.
24.	Ross R, Neeland IJ, Yamashita S, et al. Waist circumference as a vital sign in clinical practice: a consensus statement from the IAS and ICCR Working Group on visceral obesity. Nat Rev Endocrinol, 2020, 16(3): 177-189.
25.	Brunani A, Perna S, Soranna D, et al. Body composition assessment using bioelectrical impedance analysis (BIA) in a wide cohort of patients affected with mild to severe obesity. Clin Nutr, 2021, 40(6): 3973-3981.
26.	Palmas F, Ciudin A, Guerra R, et al. Comparison of computed tomography and dual-energy X-ray absorptiometry in the evaluation of body composition in patients with obesity. Front Endocrinol (Lausanne), 2023, 14: 1161116. doi: 10.3389/fendo.2023.1161116.
27.	国家卫生健康委员会肥胖症诊疗指南编写委员会, 张忠涛, 纪立农. 肥胖症诊疗指南(2024年版). 中国循环杂志, 2025, 40(1): 6-30.
28.	Tareque MI, Saito Y, Chan A, et al. Years of life with and without limitation in physical function and in activities of daily living by body mass index among older adults. Int J Obes (Lond), 2019, 43(11): 2244-2253.
29.	Fjeldstad C, Fjeldstad AS, Acree LS, et al. The influence of obesity on falls and quality of life. Dyn Med, 2008, 7: 4. doi: 10.1186/1476-5918-7-4.
30.	Sharma AM, Kushner RF. A proposed clinical staging system for obesity. Int J Obes (Lond), 2009, 33(3): 289-295.
31.	Aasheim ET, Aylwin SJ, Radhakrishnan ST, et al. Assessment of obesity beyond body mass index to determine benefit of treatment. Clin Obes, 2011, 1(2-3): 77-84.
32.	Wharton S, Lau DCW, Vallis M, et al. Obesity in adults: a clinical practice guideline. CMAJ, 2020, 192(31): E875-E891. doi: 10.1503/cmaj.191707.
33.	Gebran SG, Knighton B, Ngaage LM, et al. Insurance coverage criteria for bariatric surgery: a survey of policies. Obes Surg, 2020, 30(2): 707-713.
34.	Kaplan LM, Golden A, Jinnett K, et al. Perceptions of barriers to effective obesity care: results from the national ACTION study. Obesity (Silver Spring), 2018, 26(1): 61-69.
35.	Sharma AM, Bélanger A, Carson V, et al. Perceptions of barriers to effective obesity management in Canada: results from the ACTION study. Clin Obes, 2019, 9(5): e12329. doi: 10.1111/cob.12329.

1. NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3 663 population-representative studies with 222 million children, adolescents, and adults. Lancet, 2024, 403(10431): 1027-1050.
2. Pan XF, Wang L, Pan A. Epidemiology and determinants of obesity in China. Lancet Diabetes Endocrinol, 2021, 9(6): 373-392.
3. GBD 2019 Risk Factors Collaborators. Global burden of 87 risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet, 2020, 396(10258): 1223-1249.
4. Thomas DD, Istfan NW, Bistrian BR, et al. Protein sparing therapies in acute illness and obesity: a review of George Blackburn’s contributions to nutrition science. Metabolism, 2018, 79: 83-96.
5. Rubino F, Cummings DE, Eckel RH, et al. Definition and diagnostic criteria of clinical obesity. Lancet Diabetes Endocrinol, 2025, 13(3): 221-262.
6. Carruba MO, Busetto L, Bryant S, et al. The European Association for the Study of Obesity (EASO) endorses the Milan charter on urban obesity. Obes Facts, 2021, 14(1): 163-168.
7. Bray GA, Kim KK, Wilding JPH, et al. Obesity: a chronic relapsing progressive disease process. A position statement of the World Obesity Federation. Obes Rev, 2017, 18(7): 715-723.
8. Rathbone JA, Cruwys T, Jetten J, et al. How conceptualizing obesity as a disease affects beliefs about weight, and associated weight stigma and clinical decision-making in health care. Br J Health Psychol, 2023, 28(2): 291-305.
9. Rubino F, Puhl RM, Cummings DE, et al. Joint international consensus statement for ending stigma of obesity. Nat Med, 2020, 26(4): 485-497.
10. Vallgårda S, Nielsen MEJ, Hansen AKK, et al. Should Europe follow the US and declare obesity a disease?: a discussion of the so-called utilitarian argument. Eur J Clin Nutr, 2017, 71(11): 1263-1267.
11. Osen H. Is obesity a disease or a behavior abnormality? Did the AMA get it right? Mo Med, 2014, 111(2): 104-108.
12. Swinburn BA, Sacks G, Hall KD, et al. The global obesity pandemic: shaped by global drivers and local environments. Lancet, 2011, 378(9793): 804-814.
13. Lobstein T, Brownell KD. Endocrine-disrupting chemicals and obesity risk: a review of recommendations for obesity prevention policies. Obes Rev, 2021, 22(11): e13332. doi: 10.1111/obr.13332.
14. Mohajer N, Du CY, Checkcinco C, et al. Obesogens: how they are identified and molecular mechanisms underlying their action. Front Endocrinol (Lausanne), 2021, 12: 780888. doi: 10.3389/fendo.2021.780888.
15. Pontzer H, Raichlen DA, Wood BM, et al. Hunter-gatherer energetics and human obesity. PLoS One, 2012, 7(7): e40503. doi: 10.1371/journal.pone.0040503.
16. Leibel RL, Rosenbaum M, Hirsch J. Changes in energy expenditure resulting from altered body weight. N Engl J Med, 1995, 332(10): 621-628.
17. Rosenbaum M, Kissileff HR, Mayer LE, et al. Energy intake in weight-reduced humans. Brain Res, 2010, 1350: 95-102.
18. No authors listed. Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser, 2000, 894: i-xii,1-253.
19. Mechanick JI, Hurley DL, Garvey WT. Adiposity-based chronic disease as a new diagnostic term: the American Association of Clinical Endocrinologists and American College of Endocrinology position statement. Endocr Pract, 2017, 23(3): 372-378.
20. GBD 2015 Obesity Collaborators, Afshin A, Forouzanfar MH, et al. Health effects of overweight and obesity in 195 countries over 25 years. N Engl J Med, 2017, 377(1): 13-27.
21. 国家卫生健康委食品安全标准与监测评估司, 中国疾病预防控制中心营养与健康所, 成人肥胖食养指南编写专家组. 成人肥胖食养指南(2024年版). 卫生研究, 2024, 53(3): 347-351.
22. Després JP. BMI versus obesity subtypes in the era of precision medicine. Lancet Diabetes Endocrinol, 2023, 11(6): 382-384.
23. Stanford FC, Lee M, Hur C. Race, ethnicity, sex, and obesity: is it time to personalize the scale?. Mayo Clin Proc, 2019, 94(2): 362-363.
24. Ross R, Neeland IJ, Yamashita S, et al. Waist circumference as a vital sign in clinical practice: a consensus statement from the IAS and ICCR Working Group on visceral obesity. Nat Rev Endocrinol, 2020, 16(3): 177-189.
25. Brunani A, Perna S, Soranna D, et al. Body composition assessment using bioelectrical impedance analysis (BIA) in a wide cohort of patients affected with mild to severe obesity. Clin Nutr, 2021, 40(6): 3973-3981.
26. Palmas F, Ciudin A, Guerra R, et al. Comparison of computed tomography and dual-energy X-ray absorptiometry in the evaluation of body composition in patients with obesity. Front Endocrinol (Lausanne), 2023, 14: 1161116. doi: 10.3389/fendo.2023.1161116.
27. 国家卫生健康委员会肥胖症诊疗指南编写委员会, 张忠涛, 纪立农. 肥胖症诊疗指南(2024年版). 中国循环杂志, 2025, 40(1): 6-30.
28. Tareque MI, Saito Y, Chan A, et al. Years of life with and without limitation in physical function and in activities of daily living by body mass index among older adults. Int J Obes (Lond), 2019, 43(11): 2244-2253.
29. Fjeldstad C, Fjeldstad AS, Acree LS, et al. The influence of obesity on falls and quality of life. Dyn Med, 2008, 7: 4. doi: 10.1186/1476-5918-7-4.
30. Sharma AM, Kushner RF. A proposed clinical staging system for obesity. Int J Obes (Lond), 2009, 33(3): 289-295.
31. Aasheim ET, Aylwin SJ, Radhakrishnan ST, et al. Assessment of obesity beyond body mass index to determine benefit of treatment. Clin Obes, 2011, 1(2-3): 77-84.
32. Wharton S, Lau DCW, Vallis M, et al. Obesity in adults: a clinical practice guideline. CMAJ, 2020, 192(31): E875-E891. doi: 10.1503/cmaj.191707.
33. Gebran SG, Knighton B, Ngaage LM, et al. Insurance coverage criteria for bariatric surgery: a survey of policies. Obes Surg, 2020, 30(2): 707-713.
34. Kaplan LM, Golden A, Jinnett K, et al. Perceptions of barriers to effective obesity care: results from the national ACTION study. Obesity (Silver Spring), 2018, 26(1): 61-69.
35. Sharma AM, Bélanger A, Carson V, et al. Perceptions of barriers to effective obesity management in Canada: results from the ACTION study. Clin Obes, 2019, 9(5): e12329. doi: 10.1111/cob.12329.

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