Daniela Barros, post graduate student of the Surgical Clinic Program at Ribeirão Preto Medical School, University of São Paulo (FMRP-USP). Ribeirão Preto, SP, Brasil.
This simple classification could help disseminate the concept of clinical benefits derived from modest weight loss, allowing individuals with obesity and their health care professionals to focus on strategies for weight maintenance instead of further weight reduction. The authors highlighted that this proposal is not intended to replace others already published, but to serve as an adjuvant tool (HALPERN et al., 2022).
The main strength of this simple new classification is the emphasis on the achievement of weight loss goals with clinical treatment, as defined in several guidelines. This proposed classification yields a more comprehensive view of the individual’s weight status and establishes future objectives for patients and health care providers.
Halpern et al. believe that this simple and ready-to-use classification can help reduce the stigma of clinical obesity treatment, improve long-term compliance to obesity therapy, and facilitate the understanding that obesity is a chronic and recurrent disease. The only information that must be reliably obtained is the individual’s MWAL, which has previously been proposed as important information in the clinical setting (CALL et al.; KUSHNER et al., WADDEN et al.).
Obesity is a disease associated with several complications, which in turn cause and aggravate other acute and chronic diseases and reduce life expectancy (PROSPECTIVE STUDIES COLLABORATION et al.; FONTAINE et al.; BRAY et al.). Although highly stigmatized and perceived by many as a “lifestyle choice” easily treatable by changes in behavior, obesity is instead associated with considerably high rates of treatment failure and a progressive course across life (BRAY et al.; HALPERN et al., 2015). Obesity is also a chronic disease associated with impaired physical and mental health.
A widespread view in the treatment of obesity is that the goal is to normalize the individual’s body mass index (BMI). However, a modest weight loss (usually above 5%) is already associated with clinical improvement, while weight losses of 10%-15% bring even further benefits, independently from the final BMI. The percentage of weight reduction is accepted as a treatment goal since a greater decrease in weight is frequently difficult to achieve due to metabolic adaptation along with environmental and lifestyle factors.
The stigma of obesity – unfortunately very common in health care and across society – is associated with poorer health outcomes and further weight gain (RUBINO et al.; ROBINSON et al.). With this proposed classification being implemented, future studies can be performed to evaluate its impact on weight stigma.
A classification of obesity based on the presence of comorbidities and disabilities as a staging system (like the classifications used in oncology) has also been proposed, for example, the Edmonton Obesity Staging System (WHARTON et al.; SHARMA et al., 2017; SHARMA et al., 2009). This system is simple and useful to evaluate the risks and benefits of different obesity treatments but has some limitations as, for example, the parameter of “psychological burden” included in the classification cannot be objectively defined. Some professional associations have suggested that the term “obesity” should be changed and that the classification of excess fat impairing health should receive different terminologies – such as adiposopathy or adiposity-based chronic disease (ABCD) – but these recommendations have only been used in limited settings (SHARMA et al., 2017; MECHANICK et al.).
It’s noteworthy that the aim of this proposed classification by Halpern et al. is not to replace traditional and consolidated classifications, but rather be an adjuvant tool to guide clinical treatment and help interpret the findings of clinical research and interventions in the field of obesity. This classification can be further improved in the future and be validated in observational and intervention studies. (HALPERN et al., 2022).
In future studies, this proposed classification can also be an important tool to evaluate possible differences in therapeutic outcomes between individuals with similar BMIs but different weight trajectories (HALPERN et al., 2022).
HALPERN, B., et al. Proposal of an obesity classification based on weight history: an official document by the Brazilian Society of Endocrinology and Metabolism (SBEM) and the Brazilian Society for the Study of Obesity and Metabolic Syndrome (ABESO). Archives of Endocrinology and Metabolism [online]. 2022, vol. 66, no. 2, pp. 139-151 [viewed 20 May 2022]. https://doi.org/10.20945/2359-3997000000465. Available from: https://www.scielo.br/j/aem/a/sJznQT3F56FRKPkSpGTFYSL/
BARROS, D. Brazilian Medical Societies propose a new obesity classification based on weight history [online]. SciELO in Perspective | Press Releases, 2022 [viewed ]. Available from: https://pressreleases.scielo.org/en/2022/06/02/brazilian-medical-societies-propose-a-new-obesity-classification-based-on-weight-history/
The Brazilian Society of Endocrinology and Metabolism (SBEM) and the Brazilian Society for the Study of Obesity and Metabolic Syndrome (ABESO) propose a new obesity classification based on the maximum weight attained in life (MWAL). In this classification called Proposal of an obesity classification based on weight history: an official document by the Brazilian Society of Endocrinology and Metabolism (SBEM) and the Brazilian Society for the Study of Obesity and Metabolic Syndrome (ABESO), individuals losing a specific proportion of weight are classified as having “reduced” or “controlled” obesity.
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