Don’t use BMI alone—add waist measures every time.
Using the Lancet Commission framework, obesity prevalence jumps from 43% to 69% largely by capturing “anthropometric-only” obesity (elevated waist metrics with BMI below traditional cutoffs). Measure and record waist circumference, waist-to-hip ratio, and waist-to-height ratio at routine visits.

Phenotype matters for risk conversations and follow-up.
Two mutually exclusive groups emerged:

• BMI-plus-anthropometric obesity (~43% of cohort) carried higher odds of organ dysfunction (OR ~3.3 vs no obesity).

• Anthropometric-only obesity (~26%) still carried meaningful risk (OR ~1.8).
  Expect anthropometric-only patients to skew older and more often male—don’t be reassured by a “near-normal” BMI if central adiposity is present.

Screen aggressively for organ dysfunction—especially in older adults.
Clinical obesity (obesity + organ dysfunction or physical limitation) affected 36% overall and climbed to 54% of adults ≥70, with 70% of ≥70-year-olds with obesity meeting clinical criteria. Most common manifestations: hypertension, functional limitation, obstructive sleep apnea. Build standing protocols to check BP, mobility/ADL impact, sleep-apnea risk, and cardiometabolic labs across BMI categories.

Risk-stratify care by clinical status, not BMI category.
Compared with no obesity/organ dysfunction:

• Clinical obesity: aHR ~6.1 (diabetes), ~5.9 (CV events), ~2.7 (all-cause mortality).

• Preclinical obesity: intermediate risk (diabetes ~3.3; CV ~1.4; no mortality signal).

• Organ dysfunction without obesity: high risk on its own (diabetes ~2.5; CV ~4.7; mortality ~2.8).
  Prioritize intensive prevention/treatment (BP, lipids, sleep apnea, glycemia, weight-loss interventions) for anyone with organ dysfunction, regardless of BMI.

Re-think pharmacotherapy eligibility and equity.
BMI-only criteria miss patients who warrant therapy and include many who don’t have clinical disease: 22% with clinical obesity weren’t BMI-eligible, while 51% BMI-eligible lacked clinical obesity. Expect the largest relative reclassification among Asian patients (27%→51% obesity). Consider anthropometrics and organ-dysfunction status when discussing GLP-1/GIP agents and other treatments, document phenotypes clearly, and watch for population-specific risks.