J Clin Endocrinol Metab
New obesity framework raises concerns about delayed diagnosis, access to care
Clinical takeaway: As obesity definitions evolve, clinicians should continue to assess overall cardiometabolic risk and functional impact—and avoid delaying evidence‑based treatment solely because patients lack formal signs of “clinical” obesity.
In a commentary published April 2, 2026, Endocrine Society experts caution that the Lancet Commission’s proposed obesity framework—while conceptually innovative—may unintentionally delay care and worsen inequities if adopted without safeguards. The framework shifts diagnosis away from BMI alone and requires evidence of obesity‑related organ dysfunction to define “clinical obesity,” relegating patients without such findings to a “preclinical” category.
The authors acknowledge the value of moving beyond BMI, noting that fat distribution and central adiposity better predict cardiometabolic risk. However, they argue that proving causal links between adiposity and organ dysfunction in routine practice is often impractical and may create barriers to treatment, insurance coverage, and early intervention.
“How obesity is defined has real consequences for patients,” said lead author Ranganath Muniyappa, MD, PhD. “Any new framework must be grounded in strong evidence, practical for everyday clinical use and designed to improve, rather than restrict equitable access to effective obesity treatment.”
The authors also question the stability of the “preclinical obesity” concept, warning it may depend more on testing intensity than true risk—and point out that excluding type 2 diabetes from clinical obesity criteria conflicts with existing evidence. They advocate aligning new definitions with established staging systems, using simpler risk‑based approaches, and ensuring mental health and patient‑reported outcomes are considered.
“We need simpler ways to identify obesity earlier…not on proving a single, exact cause,” added coauthor Amy Rothberg, MD.
Source: Muniyappa R, et al. (2026, April 2). J Clin Endocrinol Metab. Defining disease or delaying care? A conceptual and clinical appraisal of the Lancet obesity framework