DeutschThe Erdem Hospital appreciates the Lancet Commission’s initiative to redefine the classification of obesity by introducing the terms “preclinical” and “clinical” obesity. Nevertheless, Erdem Hospital harbors serious reservations about the possible negative effects of this proposal, which may inadvertently shift the perception of obesity from a recognized disease to a mere indicator of health risk. This shift would potentially undo years of progress in establishing obesity as a complex, recurring, and chronic condition with multifaceted causes.
Major Concerns Regarding the Proposed Classification System
Implications for Insurance Coverage and Healthcare Access
Segmenting obesity into preclinical and clinical stages could pose a significant risk to individuals who may fall into the “preclinical” category. These individuals might be denied insurance coverage for vital obesity-related treatments such as pharmacotherapy, structured behavioral interventions, or metabolic surgery.
In the U.S., where access to treatment is frequently dependent on whether a condition is officially classified as a disease, this redefinition could exclude millions from receiving timely care. It would also likely result in postponed intervention until obesity advances to a more severe form, at which point it becomes more resistant to treatment. This model discourages early, preventive action that could otherwise minimize future complications and promote better long-term health.
From Prevention to Reaction: A Dangerous Paradigm Shift
Allowing obesity to progress unchecked until “clinical” indicators such as organ impairment or severe comorbidities arise encourages a reactive healthcare model rather than a proactive one. This delays critical interventions until after irreversible damage is already present, which can raise mortality rates, increase complications, and amplify healthcare spending.
Given that obesity evolves over time, early and continuous care is crucial to mitigating risks such as type 2 diabetes, heart disease, and cancer. A model that treats obesity as a spectrum allows healthcare providers to intervene early—before major harm occurs.
Diagnostic Challenges Between Preclinical and Clinical Obesity
Drawing a clear line between preclinical and clinical forms of obesity is problematic due to the intricate, cyclical nature of the disease. Long before physical signs such as organ failure become apparent, individuals may already experience chronic inflammation, hormonal disturbances, and metabolic dysregulation.
Obesity can also lead to mechanical issues such as joint degradation, sleep apnea, and strain on the musculoskeletal system, independent of metabolic complications. Furthermore, research has consistently linked obesity to mental health conditions like Major Depressive Disorder, emphasizing its broad impact on both physical and psychological health.
Tools like the Edmonton Obesity Staging System (EOSS) already offer a nuanced framework for evaluating the severity of obesity-related health risks without segregating patients into an ambiguous preclinical stage that may delay critical treatment.
Risk of Reinforcing Stigma and Misconceptions
Rebranding obesity as a risk factor rather than a bona fide disease might unintentionally fuel social stigma and support the misleading belief that obesity stems solely from individual shortcomings rather than being a legitimate medical issue requiring structured treatment and support.
Why Obesity Must Continue to Be Treated as a Disease
Obesity should remain recognized as a chronic and relapsing illness that necessitates a holistic and continuous treatment approach. Similar to how early management of prediabetes can halt the progression to full-blown diabetes, early care in obesity can prevent the development of life-threatening complications.
Systemic effects of obesity—such as chronic inflammation caused by adipose tissue dysfunction, dysregulation within the hypothalamus and peripheral organs, and the harmful buildup of visceral fat around vital organs—often manifest long before any clinical diagnosis is made. Addressing these internal disruptions early is essential for safeguarding long-term health.
Erdem Hospital’s Recommendations and Call to Action
Erdem Hospital calls upon healthcare leaders, policymakers, and insurance providers to take a cautious approach to the Lancet Commission’s proposed classifications. We recommend:
- Preserving the designation of obesity as a disease to ensure uninterrupted access to medical care.
- Using existing validated tools like the EOSS to assess risk without delaying intervention.
- Prioritizing early, preventive care strategies over late-stage treatment models.
- Retaining Body Mass Index (BMI) as a basic screening tool, supported by additional diagnostic methods such as waist-to-hip and waist-to-height ratios, alongside clinical evaluation based on patient history and physical examination.