More than one-quarter of adults who have a normal body mass index (BMI) have underlying “clinical obesity,” according to a
study published today in
Annals of Internal Medicine.
Introduced by the Lancet Diabetes & Endocrinology Commission last year, clinical obesity is a condition characterized by physiological problems such as high blood pressure or liver damage that are related to excess fat mass.
Why It’s Relevant
Obesity is associated with poorer psychological and physical health. Further, managing patient weight is an important facet of psychiatric care, given that many frontline medications for conditions such as depression or schizophrenia have weight gain as a prominent side effect.
By the Numbers
- Researchers analyzed physical exam data from 5,642 adult respondents to the 2021-2023 National Health and Nutrition Examination Surveys (NHANES).
- Overall, 41% of respondents had excess fat mass based on the criteria of a BMI of 30kg/m2 and one other abnormal body measurement (waist circumference, waist-to-hip ratio, or waist-to-height ratio).
- However, 77% of adults had excess fat when using a criterion of two or more abnormal body measurements—regardless of BMI.
- After adjustments for age, sex, and ethnicity, 26% of adults with a “normal” BMI (18.5 to 24.9 kg/m2) met the criteria for clinical obesity—excess fat coupled with metabolic/organ dysfunction—as did 50% of adults considered overweight (BMI of 25 to 29.9 kg/m2).
The Other Side
Certain problems associated with clinical obesity such as raised intracranial pressure, atrial fibrillation, and chronic joint stiffness are not included in NHANES. Further, the concept of clinical obesity is currently an expert opinion and not yet a validated diagnostic measure.
Takeaway Message
Current clinical guidelines for screening patients for obesity-related medical conditions and providing treatments such as GLP-1 receptor agonists still rely on BMI, the study authors noted. These findings suggest that clinicians need to examine broader anthropometric data to identify individuals at risk for obesity-related health complications.
Related Information
Source
Hirsh Elhence, et al. National prevalence of clinical obesity by BMI class: a national cross-sectional study. Annals of Internal Medicine. Published online June 1, 2026. doi:10.7326/ANNALS-25-05287
(Image: Getty Images/iStock/JDawnInk)