Why Getting a DEXA is Important

New Guidelines Redefine Obesity

A recent report published in The Lancet Diabetes & Endocrinology advocates for redefining obesity, emphasizing body fat percentage and associated medical complications rather than solely relying on weight. Reported in the NYT, The new guidelines, endorsed by 76 organizations globally, propose using BMI as a screening tool to identify individuals who should undergo further testing for excess body fat. The report introduces updated criteria for diagnosing obesity, such as a BMI greater than 40, waist circumference measurements exceeding 34.6 inches for women and 40 inches for men, and anthropometric measures like waist-to-hip or waist-to-length ratios. Direct fat mass measurement, such as through DEXA or bioimpedance, is considered more accurate.

The report distinguishes between preclinical obesity, where there is excess adiposity but preserved organ function, and clinical obesity, where there is evidence of reduced organ function or limitations in daily activities due to obesity. The latter includes conditions like type 2 diabetes, cardiovascular disease, and mental health disorders. Clinical assessment of obesity requires confirmation of excess or abnormal adiposity, which can be done through one of the following methods: (a) direct body fat measurement (e.g., by DEXA or bioimpedance), (b) at least one anthropometric criterion (such as waist circumference, waist-to-hip ratio, or waist-to-height ratio) in addition to BMI, or (c) at least two anthropometric criteria regardless of BMI.

The guidelines also emphasize the importance of biochemical markers, including elevated triglycerides, reduced HDL cholesterol, and high blood glucose or HbA1c levels, in diagnosing and managing obesity. Individuals with confirmed obesity should undergo a thorough evaluation for metabolic syndrome, assessing factors such as fasting glucose, waist circumference, blood pressure, cholesterol, and HDL levels.

For those with clinical obesity, comprehensive care is critical to manage and improve the condition, including lifestyle changes, pharmacological treatments, and potentially surgical options. Treatment should be personalized based on individual risks and benefits, with the goal of improving clinical outcomes, quality of life, and preventing the progression of obesity-related diseases.