Doctors propose new classification of obesity, focusing on weight loss

Doctors propose new classification of obesity, focusing on weight loss

The idea is to value more the impact of weight loss on health and less on aesthetics. (Photo: Reproduction)

Two of the most important medical institutions in the area in the country, the Brazilian Association for the Study of Obesity and Metabolic Syndrome (Abeso) and the Brazilian Society of Endocrinology and Metabology (SBEM), jointly launched a proposal for a new classification for obesity. The suggestion is to focus more on health than aesthetics. In this way, they propose to focus less on the traditional method with numbers to define the condition, that is, the formula that uses weight and height to predict whether or not a person is overweight, the famous BMI (Body Mass Index). Instead, the amount of weight the person has lost, given the maximum weight they have reached in their lifetime. Thus, a reduction of 5% to 10% would be classified as “reduced obesity”, while the elimination of 10% to 15% would be called “controlled obesity”.

It seems little, but it is not. Experts say that reductions of just 5% in weight already provide a significant change in health indicators. A person with an initial weight of 100 kg and who reaches 95 kg, already begins to experience improvement in metabolic markers, such as increased HDL cholesterol (the “good”), lower risk of depression, decreased joint pain and improved fertility.

A 7% weight loss has been linked to a lower risk of type 2 diabetes. Data from a US Diabetes Prevention Program (DPP) study show that every pound lost was associated with a nearly 16% reduction in weight loss. disease risk.

Weight loss above 10% has important effects on decreasing liver fat and the risk of cardiovascular disease. An 11% weight loss was associated with an almost 23% drop in intra-abdominal adipose tissue, pointing out that weight loss has a positive effect on the accumulation of ectopic fat, which is associated with atherosclerosis. The DIRECT study, carried out by universities in the United Kingdom, found that a weight loss of 10% to 15% led to remission of type 2 diabetes in 57% and 86%, respectively.

In terms of aesthetics, in turn, the reduction of 5% to 15% may not have such an impacting visual effect, but experts say that this weight loss already generates reductions in measurements, especially in abdominal circumference.

the BMI

Currently, obesity is classified worldwide based on BMI. This index is calculated by dividing body weight by height squared (weight/height x height). Based on this result, the patient is classified. People with a BMI of 18.5 less than 25 are considered “healthy”; those with an index between 25 and 30 are classified as “overweight”; from 30 to 35 is obesity grade I; from 35 to 40, obesity grade II (severe) and above 40, obesity grade III (morbid).

The new classification would be indicated for patients with obesity up to grade I in BMI. For those with severe or morbid classification, the indication is bariatric surgery.

“The BMI calculation does not take into account age, body type and family genetics. Sometimes, the person comes from a very skinny family, and then it is easier to maintain the BMI, regardless of life habits and routine. A person who comes from a large, stocky family often cannot reach the ideal BMI even if they are on a diet and physical activity”, comments Claudia Cozer Kalil, endocrinologist at Hospital Sírio Libanês and member of the Department of Psychiatry and Eating Disorders. from Abeso.

For example, a person weighing 100 kg and 1.70 m tall has a BMI of 34.6, that is, within the parameter classified as obesity grade I. To be at a healthy weight, this person would need to lose about 30 kg. Losing so many pounds can be a demotivating factor for the patient. The new classification proposes a gradual weight loss, focusing more on improving health and maintaining the lost weight, than on drastic reduction in the scale. The idea is to avoid, mainly, the accordion effect – of “regaining” the lost weight.

“A patient weighing 100 kg can lose weight and reach 90 kg and not be able to reduce more than that. Looking at it from the BMI perspective, it is very far from the target. This can make him feel frustrated and give up on treatment. However, this reduction would have already brought many benefits to his health”, says Marcio Mancini, one of the authors of the study that proposed the new classification and an endocrinologist at SBEM-SP.

According to Mancini, the idea is to treat obesity as a controllable disease, as well as others already well known by the population. And, by the new proposal, the person feels more stimulated to follow with weight loss care.

No crash diets

The classification proposal suggested by Abeso and SBEM is intended to offer a complementary tool for the evaluation and clinical treatment of patients. Classifying people with obesity by the percentage of weight lost values ​​sustainable weight loss (one that can be maintained), experts say.

Looking at the treatment of obesity from the perspective of the new classification proposal would help patients not to seek, for example, extreme diets – which sometimes provide, yes, a drastic weight reduction, but which is not perpetuated, since it is difficult keep them for life.

In addition to the great possibility of the accordion effect, these radical weight loss proposals often come at a high price for health, which goes against the benefits of losing weight. The use of “slimming” teas, for example, can cause liver problems and even cause death, as happened with nurse Edmara Abreu earlier this year, in São Paulo.

The proposal to change the classification of obesity will be one of the main themes of the next SBEM congress, CBEM 2022, which will take place in São Paulo, between the 3rd and 7th of September.