A new cross-sectional and longitudinal analysis evaluated how the European Association for the Study of Obesity’s (EASO) recently introduced framework reclassifies obesity levels and examined mortality risk among those newly identified as having obesity under this framework.
The study, published in Annals of Internal Medicine, found that the EASO criteria reclassified approximately 1 in 5 U.S. adults as having obesity, although their mortality risk was similar to that of adults with normal weight. Researchers suggest that the EASO framework could offer a more sensitive tool for identifying obesity-related disease earlier than body mass index (BMI) alone.
The EASO framework incorporates anthropometric measures beyond BMI and includes clinical comorbidities, but it has not yet been validated. To assess its impact, researchers from Ariel University, Tel Aviv University, and Holon Institute of Technology analysed data from 44,030 adults aged 18 to 79 who participated in the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2018. They examined the distribution of overweight and obesity, prevalence of related complications, and mortality risk under the new classification.
Under the EASO criteria, 18.8% of participants who were previously categorised as overweight based on BMI alone were newly classified as having obesity. Among the NHANES participants, 31.3% had a normal weight (BMI < 25), 33.3% had an overweight (BMI 25–29.9), and 35.4% had obesity (BMI ≥ 30). Among these newly identified individuals, the most common comorbidities were hypertension (79.9%), arthritis (33.2%), diabetes (15.6%), and cardiovascular disease (10.5%). While mortality risk among these newly classified individuals was similar to that of adults with normal weight, individuals with a BMI of 30 kg/m² or higher had nearly a 20% increased risk of death.
When compared with adults with normal weight and no major comorbidities, newly identified individuals with obesity under the EASO framework had a 50% higher risk of death. However, this elevated risk was comparable to the risk seen among individuals with normal weight but with comorbidities. Elevated mortality risk was also observed among individuals classified as having obesity under both the EASO framework and traditional BMI criteria when compared with individuals with overweight.
Those newly classified under the EASO criteria also had a higher burden of comorbidities, with 57.5% having at least one and 42.5% having more than one, compared with 34.3% and 38.7%, respectively, among those with BMI-defined obesity. Comorbidities were more prevalent in the newly classified group, with hypertension (79.9%), arthritis (33.2%), and cardiovascular disease (10.5%) all exceeding rates seen in the BMI-defined obesity group (60.3%, 28.2%, and 8.6%, respectively), except for diabetes, which was more common in the BMI-defined obesity group (19.0% vs. 15.6%).
After adjustment, individuals classified as overweight under the EASO framework did not have a significantly increased mortality risk compared with those with normal weight and no comorbidities. In contrast, individuals with obesity under the EASO framework, those with BMI-defined obesity, and those with normal weight and comorbidities all had significantly increased mortality risk during follow-up.
The study highlights the need for further research to determine whether individuals newly identified as having obesity under the EASO framework would benefit from targeted obesity treatment.
Source: American College of Physicians
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