This week I want to highlight an opinion piece in Frontiers of Public Health calling for new obesity terminology. The authors suggest that rather than using terms such as overweight and obese we should use ‘overfat’ and ‘underfat.’ This new terminology would place emphasis on body composition rather than weight- something I have always advocated for. The article does raise some excellent points:
- We need to move away from BMI cutoffs and start using waist circumference and percent body fat as defining metrics.
- When we do so, the obesity/overweight epidemic is even larger (with up to 70% of the world population) having excess body fat (yikes!).
- Abnormally low body fat is an indicator of chronic disease at a later stage and/or eating disorders. Being ‘underfat’ is also linked with mortality.
I agree with the authors on the need for better definitions but I am not sure their categories of ‘overfat’ and ‘underfat’ really solve the problem. They don’t propose specific cutoffs by which we can define these new categories and achieve clinical clarity. Rather, I propose that we simply reconsider the way we define and classify obesity. We need to replace BMI with waist circumference and percent body fat, but I think we may even need to go beyond that and start looking at new metrics such as skeletal muscle to fat ratios. In addition, body composition should not be sole criteria by which to diagnose obesity but rather one of many qualifying criteria. This is what we have managed to do at Enara Health. If we can agree to more complex definition then maybe we can start shedding some of the associated stigma and start to appreciate the need for more resources and nuance in the fight against obesity.