Do you have a small beer belly or muffin top but are reassured by the results of your body mass index (BMI) that do not indicate you are obese? You may still need anti-obesity drugs such as Ozempic, experts have suggested.
Obesity experts are calling for an overhaul of the BMI system, claiming that many “thin fat” people – those with high levels of excess fat around the stomach – are not receiving the obesity treatments they could benefit from.
This fat, technically called abdominal fat, surrounds vital organs and is considered more dangerous than subcutaneous fat, which is located just under the skin.
High levels of abdominal fat have been linked to an increased risk of heart disease, diabetes, stroke, certain types of cancer and dementia.
But despite the risks, people can have high levels of abdominal fat and be far below the BMI threshold of 30 that the NHS uses to determine whether people are obese.
Obesity experts are calling for an overhaul of the BMI system, arguing that too many “thin fat” people – those with high levels of excess fat around the stomach – are not receiving the obesity treatments they could benefit from.
If the recommendation is adopted, people with a BMI of more than 25 could be advised to take anti-obesity drugs such as semaglutide, sold under the brand names Wegovy and Ozempic, which are currently restricted to people with a BMI of around 30 in the UK.
Experts say this means so-called “fat and thin” people are not receiving treatments that could help improve their health, such as new-generation obesity-fighting drugs like the Ozempic and Wegovy injections.
A coalition of experts from the European Association for the Study of Obesity (EASO) has called for a review of the system we use to administer anti-obesity drugs to people who have a BMI of 30 or more.
They said people with a BMI of more than 25 and a waist-to-height ratio (WHtR) of more than 0.5, as well as the presence of a weight-related health complication such as high blood pressure or diabetes, should also be considered for anti-obesity drugs.
Abdominal fat is most accurately measured with a high-tech scanner, such as an MRI, but these are expensive and few in number, so experts typically use WHtR, which is your waist measurement divided by your height.
A result of 0.5 or more is a general indication that abdominal fat levels are too high.
Writing in the diary Nature Communications EASO experts said there is currently an over-reliance on BMI as a diagnostic criterion for obesity interventions and this needs to change.
“The basis for this change is the recognition that BMI alone is insufficient as a diagnostic criterion and that body fat distribution has a substantial effect on health,” they wrote.
‘More specifically, abdominal fat accumulation is associated with an increased risk of developing cardiometabolic complications and is a stronger determinant of disease development than BMI, even in individuals with a BMI level below the standard cut-off values for obesity diagnosis (BMI of 30).’
They added that pharmaceutical companies might want to use their new diagnostic threshold of BMI above 25 for new clinical trials of obesity interventions.
The 29 EASO experts who drafted the recommendation included specialists in endocrinology, nutrition, internal medicine, bariatric surgery and primary care, as well as a patient advocate.
Overall, 79 percent of experts surveyed agreed that obesity medications should be considered for patients with a BMI greater than 25, a WHtR of 0.5 or more, and the presence of “medical, functional, or psychological impairments or complications.”
According to the BMI system, a score of 18.5 to 25 is considered healthy. A score of 25 to 29 is considered overweight, and a score of 30 or more means a person is obese, the stage at which the chances of getting sick increase.
According to projections from Cancer Research UK, by 2040 more than 42 million adults in the UK will be overweight or obese.
The NHS is one of those health authorities that uses a BMI of 30 or more as a criterion for access to some obesity drugs.
For example, to access semaglutide, the active ingredient in both Ozempic and Wegovy, patients must have a BMI of at least 30, or 27.5 if they are from certain ethnic groups, to be eligible for the drug on the NHS.
Similar BMI restrictions apply to other NHS obesity medicines.
This is not the first time that experts have called for a review of the BMI.
BMI was invented by a Belgian mathematician in the 1830s and has been used by doctors as a measure of obesity for nearly two centuries.
It is backed by the World Health Organization and is used by doctors around the world to determine whether a person is at risk for a range of diseases, from diabetes to heart attacks and strokes, due to excess fat.
But a major flaw is that it is unable to differentiate between fat distribution and muscle mass.
This means that a fit rugby player and a couch potato of exactly the same height and weight share the same scores, even if the former has a ripped physique and the latter carries a spare wheel.
NHS data shows that only 26 per cent of adults have a BMI of 30 or more.
But the average BMI of all adults aged over 40 in the UK ranges between 27.7 and 27.6, suggesting most would be declared obese and at risk under the proposed review.