Nisha Pandey

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Not Everyone With Obesity Is Unhealthy: New Study Challenges BMI

For years, <span>body mass index</span> (<span>BMI</span>) has been a key health marker to track <span>obesity</span>. But a recent study suggests that not everyone classified as obese based on their BMI may have obesity-related health problems. Researchers say just considering BMI alone may lead to incorrect diagnosis in some people while overlooking others with excess body fat and related health risks.

The international study, involving more than 844,000 adults across China, the UK, the US and Spain, supports a different approach that considers body fat distribution, waist measurement and the impact of excess fat on organ function.

Researchers propose distinguishing between two categories: pre-clinical obesity, in which excess body fat increases health risks but has not impaired organ function, and clinical <a href="https://www.healthandme.com/fitness/new-weight-loss-drug-mazdutide-shows-18-weight-loss-in-32-weeks-how-does-it-compare-to-wegovy-article-156486665" data-type="tilCustomLink">obesity</a>, in which excess fat is already affecting the body's ability to function.

<h2>BMI Alone Not Enough To Diagnose Obesity</h2>

Also read: <a href="https://www.healthandme.com/fitness/why-who-wants-to-use-smartwatches-to-track-physical-activity-sedentary-behaviour-at-a-population-level-article-156487271" data-type="tilCustomLink">Why WHO Wants To Use Smartwatches To Track Physical Activity &amp; Sedentary Behaviour At A Population Level?</a>

BMI is calculated by dividing a person's weight in kilograms by their height in metres squared. It is used to classify people as underweight, normal weight, overweight or obese.

However, BMI does not directly measure body fat or show where fat is distributed. It also cannot distinguish between fat and muscle mass. Consequently, two people with the same BMI may have very different body compositions and health risks.

The researchers found that adding waist circumference and waist-to-height ratio to BMI helped identify people whose excess body fat might otherwise be missed.

The analysis suggested that BMI alone missed obesity level body fat in up to 8.6% of participants, while incorrectly classifying up to 3.1% as having obesity in the study groups.

Professor Francesco Rubino, senior author of the study and Chair of Metabolic and Bariatric Surgery at King's College London, said, “Body mass index alone cannot tell us whether someone is already ill or at risk of illness, or what care they need, leaving people vulnerable to both undertreatment and overtreatment.”

<h2>Difference Between Clinical And Pre-Clinical Obesity</h2>

Also read: <a href="https://www.healthandme.com/health-wellness/loud-snoring-is-not-always-harmless-sleep-apnoea-can-become-a-stroke-risk-concern-article-156438403" data-type="tilCustomLink">Loud Snoring Is Not Always Harmless: Sleep Apnoea can Become a Stroke-Risk Concern</a>

The researchers used a framework proposed by the <span>Lancet Diabetes and Endocrinology Commission</span> in 2025. It separates obesity into two categories based on whether excess body fat has affected a person's health.

<ul><li>Pre-clinical obesity: A person has excess body fat that increases their risk of developing health problems, but their organ function and everyday activities remain unaffected.</li></ul><ul><li><span rel="noindex">Clinical obesity</span>: Excess body fat has impaired organ function or affected a person's ability to perform daily activities. It is considered an active disease that requires clinical assessment.</li></ul>

The study estimated that only around 23% to 31% of people classified as having obesity across the four study populations had clinical obesity. This represented approximately 5.6% to 10.9% of the overall adult populations studied.

<h2>When Do People With Pre-Clinical Obesity Develop Health Problems?</h2>

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The researchers followed participants over time to examine how often pre-clinical obesity progressed to clinical obesity.

They found that approximately 77% to 91% of people classified as having pre-clinical obesity did not progress to clinical obesity over 10 years. However, progression rates differed across the study populations.

Clinical obesity was linked with a higher risk of death while pre-clinical obesity had a more modest increase in risk.

Professor Rubino said, “Preclinical obesity should therefore be neither treated automatically as active disease nor dismissed as harmless. Some people may need preventive treatment, but its intensity should match their individual risk.”

The findings do not mean that people with pre-clinical obesity should ignore excess body fat. Rather, they highlight the importance of assessing individual health risks instead of making treatment decisions based on BMI alone.

People with excess body fat may still benefit from lifestyle hanges, treatment and preventive care even if they have not developed organ dysfunction.

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For years, body mass index (BMI) has been a key health marker to track obesity. But a recent study suggests that not everyone classified as obese based on their BMI may have obesity-related health problems. Researchers say just considering BMI alone may lead to incorrect diagnosis in some people while overlooking others with excess body fat and related health risks.The international study, involving more than 844,000 adults across China, the UK, the US and Spain, supports a different approach that considers body fat distribution, waist measurement and the impact of excess fat on organ function.Researchers propose distinguishing between two categories: pre-clinical obesity, in which excess body fat increases health risks but has not impaired organ function, and clinical obesity, in which excess fat is already affecting the body's ability to function.BMI Alone Not Enough To Diagnose ObesityAlso read: Why WHO Wants To Use Smartwatches To Track Physical Activity & Sedentary Behaviour At A Population Level?BMI is calculated by dividing a person's weight in kilograms by their height in metres squared. It is used to classify people as underweight, normal weight, overweight or obese.However, BMI does not directly measure body fat or show where fat is distributed. It also cannot distinguish between fat and muscle mass. Consequently, two people with the same BMI may have very different body compositions and health risks.The researchers found that adding waist circumference and waist-to-height ratio to BMI helped identify people whose excess body fat might otherwise be missed.The analysis suggested that BMI alone missed obesity level body fat in up to 8.6% of participants, while incorrectly classifying up to 3.1% as having obesity in the study groups.Professor Francesco Rubino, senior author of the study and Chair of Metabolic and Bariatric Surgery at King's College London, said, “Body mass index alone cannot tell us whether someone is already ill or at risk of illness, or what care they need, leaving people vulnerable to both undertreatment and overtreatment.”Difference Between Clinical And Pre-Clinical ObesityAlso read: Loud Snoring Is Not Always Harmless: Sleep Apnoea can Become a Stroke-Risk ConcernThe researchers used a framework proposed by the Lancet Diabetes and Endocrinology Commission in 2025. It separates obesity into two categories based on whether excess body fat has affected a person's health.Pre-clinical obesity: A person has excess body fat that increases their risk of developing health problems, but their organ function and everyday activities remain unaffected.Clinical obesity: Excess body fat has impaired organ function or affected a person's ability to perform daily activities. It is considered an active disease that requires clinical assessment.The study estimated that only around 23% to 31% of people classified as having obesity across the four study populations had clinical obesity. This represented approximately 5.6% to 10.9% of the overall adult populations studied.When Do People With Pre-Clinical Obesity Develop Health Problems?The researchers followed participants over time to examine how often pre-clinical obesity progressed to clinical obesity.They found that approximately 77% to 91% of people classified as having pre-clinical obesity did not progress to clinical obesity over 10 years. However, progression rates differed across the study populations.Clinical obesity was linked with a higher risk of death while pre-clinical obesity had a more modest increase in risk.Professor Rubino said, “Preclinical obesity should therefore be neither treated automatically as active disease nor dismissed as harmless. Some people may need preventive treatment, but its intensity should match their individual risk.”The findings do not mean that people with pre-clinical obesity should ignore excess body fat. Rather, they highlight the importance of assessing individual health risks instead of making treatment decisions based on BMI alone.People with excess body fat may still benefit from lifestyle hanges, treatment and preventive care even if they have not developed organ dysfunction.

not everyone with obesity is unhealthy: new study challenges bmi

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