Validation of clinical and preclinical obesity across global cohorts.

Using 844,108 adults from China, the UK, the USA, and Spain, combining waist circumference and waist-to-height ratio with BMI changes obesity classification versus BMI alone by shifting prevalence and mortality associations.

• Why it matters: BMI-based obesity labels can misclassify people, obscuring the distinction between adiposity with organ dysfunction and excess adiposity with preserved function, which matters for care and policy.
• What they did: They compared the Lancet Commission framework (clinical vs preclinical obesity) against BMI-only classification using prevalence, incidence, and mortality data across four adult cohorts, adding waist measures to confirm status.
• The result: BMI alone overestimated obesity by 1.2–3.1% and underestimated it by 5.2–8.6%, while the combined definition increased prevalence by 3.3–7.4%; clinical obesity showed higher all-cause mortality (HR 1.69, 95% CI 1.64–1.73) and preclinical obesity only modest risk (1.19, 1.14–1.24).

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