New obesity framework: looking beyond BMI

Obesity experts are introducing a new framework for the diagnosis, staging and management of obesity in adults. This framework bases diagnosis on abdominal fat accumulation and an evaluation of physical and mental problems, rather than solely on body mass index (BMI). It is the result of an international consensus survey among obesity experts conducted by the European Association for the Study of Obesity led by Prof. Gijs Goossens of Maastricht UMC+ and Dr. Luca Busetto of EASO. The study was published today in Nature Medicine.

Although obesity now is recognized as a multifactorial, chronic disease resulting in many other disorders and chronic diseases, in practice, not enough attention is paid to the complexity of the disease process. A group of 29 obesity experts from Europe and North America agree: the diagnosis of obesity should go beyond measuring BMI (based on a person's weight and height). The new framework, drawn from the consensus of these experts, includes not only abdominal fat accumulation but also medical, functional and psychological impairments in the diagnosis and management of obesity.

Threshold value

More than just BMI, it is precisely too much belly fat that increases the risk of cardiovascular disease and type 2 diabetes. People with a BMI below the obesity threshold of 30 can also develop serious health problems due to an excessive accumulation of abdominal fat. Moreover, these people may additionally suffer from other health complaints, such as joint pain or mental health problems. Goossens explains: 'Even if people do not meet the BMI criteria for obesity, there may still be serious health risks and functional limitations, which can greatly reduce quality of life. Therefore, based on expert consensus, we recommend that the diagnosis of obesity should be based on a more complete clinical evaluation of the individual, identifying medical, functional or psychological impairments, in addition to assessment of abdominal fat accumulation. Such a holistic approach is also used in other chronic conditions.'

Personalized approach 

The framework provides tools for more tailored strategies to prevent and treat obesity-related complications. A healthy lifestyle remains the cornerstone of obesity management, and ideally you should prevent obesity and related complications', says Goossens. 'But we must also be able to take action if lifestyle changes do not result in sufficient health gains. It is important not to medicalize obesity, but waiting too long can also carry risks. Based on physical and mental health, the causes and factors contributing to obesity, and any contraindications to a particular treatment, a decision on the available treatment options has to be made in consultation with the patient. If, with timely treatment, we can prevent type 2 diabetes or a heart attack in someone with excessive abdominal fat accumulation, we should not wait until someone exceeds a certain BMI threshold.' The experts further recommend focusing not only on weight loss, but rather on the prevention and improvement of health problems and quality of life.


The framework came about through a so-called Delphi study. The researchers presented statements to 29 international experts on obesity from different disciplines, including experts by experience. In three rounds, the propositions were adapted based on the experts' feedback and presented again to reach consensus.