The European Association for the Study of Obesity (EASO) has proposed a new comprehensive framework for managing obesity in adult patients. The framework—which aimed to improve the diagnosis, staging, and treatment of obesity—included recommendations for clinical evaluation, personalized therapeutic targets, and a shift away from the traditional reliance on body mass index (BMI). The approach recognized obesity as a multifactorial, chronic, relapsing disease, focusing on holistic and individualized care.
In the new framework, published in Nature Medicine, a team of investigators—including 21 specialists in endocrinology, nutrition, and internal medicine; five bariatric surgeons; two primary care physicians; and one patient advocacy expert—redefined obesity as an adiposity-based chronic disease, highlighting the importance of a comprehensive clinical evaluation extending beyond BMI cut-offs. A diagnosis of obesity now considers the distribution and function of adipose tissue and includes a systematic assessment of medical complications, functional status, and psychological health. The framework also recommended personalized long-term health goals—incorporating behavioral modifications, psychological therapy, medications, and bariatric procedures as key treatment pillars.
Developed through a modified Delphi study, the consensus process included multiple rounds of voting on initial statements prepared by the EASO steering committee. Agreement was defined as 75% or more among experts, with the final list containing 28 statements covering clinical diagnosis, staging, treatment pillars, therapeutic targets, and intervention levels.
Recommendations on anthropometric measurements and comprehensive clinical evaluation included:
- BMI and Waist-to-Height Ratio (WtHR): BMI ≥ 25 kg/m² and WtHR ≥ 0.5 for high-risk fat accumulation; obesity is defined as BMI ≥ 30 kg/m². A WtHR > 0.5 is associated with increased cardiometabolic disease risk, even in patients with BMI < 35 kg/m² (96% agreement).
- Ethnicity-specific cut-offs and body composition: Utilized when BMI and physical examination results are ambiguous (100% agreement).
- Medical complications: Evaluation includes cost-effective diagnostic assessments of metabolic risk factors (96% agreement).
- Functional status: Assessed via clinical interviews, questionnaires such as the Obesity-Related Disability Questionnaire, and exercise testing (92% agreement).
- Psychological health: Regular screening for depressive symptoms and eating behavior disorders using psychometric tests like the Eating Disorder Examination Questionnaire (87% agreement).
The framework emphasized the long-term, multidisciplinary management of obesity. Among the new treatment recommendations were:
- Behavioral modifications: Nutritional therapy, physical activity, stress reduction, and sleep improvement (83% agreement).
- Psychological therapy: Addressing mental health and behavioral aspects (92% agreement).
- Medications: For patients with BMI ≥ 30 kg/m², or BMI ≥ 27 kg/m² with complications (83% agreement).
- Metabolic/bariatric procedures: For patients with BMI ≥ 40 kg/m², BMI ≥ 35 kg/m² with complications, or BMI ≥ 30 kg/m² with poorly controlled type 2 diabetes despite optimal medical therapy (79% agreement).
The new framework focused on preventing, resolving, and improving obesity-related complications—with an emphasis on quality of life, mental well-being, and physical and social functioning rather than just short-term weight loss. The investigators emphasized that there was 100% agreement on these priorities.
Compared with existing guidelines such as those from the American Association of Clinical Endocrinologists, the new framework placed greater emphasis on individualized care, long-term health goals, and a more comprehensive clinical evaluation. However, implementing this framework may face challenges—including the need for provider training, increased resources, and potential resistance to change. Addressing these barriers may require collaboration among health care organizations, policymakers, and patient advocacy groups.
The investigators hope their new framework introduces a comprehensive approach to obesity management, focusing on individualized care and a broader range of factors contributing to the disease. They suggested that adopting this framework may lead to reduced obesity-related health care costs and improved population health outcomes. Nonetheless, further research may be needed to assess the long-term impact of its implementation. By redefining obesity as a chronic, progressive disease and incorporating comprehensive evaluations, the EASO aimed to improve clinical outcomes and the quality of life of patients living with obesity.
Ethics declarations can be found in the article from Nature Medicine.