Obesity has traditionally been viewed as a risk factor for other conditions and the concept of obesity as a standalone disease remains a subject of debate.¹ In a landmark 2025 publication, the Lancet Diabetes & Endocrinology Commission redefined obesity through a clinical lens—shifting away from body mass index (BMI)-based assessments and introducing a diagnostic framework that recognizes clinical obesity as a chronic, systemic illness when specific clinical criteria are met.¹ Growing evidence shows that excess adiposity, independent of other obesity-related diseases, can directly and adversely affect the organ function and overall health of an individual, leading to the typical clinical manifestations of illness.¹ To address the gap in current clinical characterization, the Commission defines clinical obesity as a chronic, systemic disease characterized by functional impairments in tissues, organs, or the individual, directly caused by excess adiposity.¹ The redefinition aims to provide a more medically meaningful framework to guide diagnosis, inform clinical decisions, and shape healthcare policies.¹

The Lancet Commission proposes a two-step approach for diagnosing clinical obesity.¹ First, obesity status must be confirmed through direct measures of body fat, such as dual-energy X-ray absorptiometry (DEXA) or bioimpedance analysis (BIA), or by using anthropometric indicators like waist circumference or waist-to-hip ratio.¹ Once excess fat is confirmed, the diagnosis of clinical obesity requires further evidence of disease impact, such as signs of organ or tissue dysfunction related to obesity, or significant, age-adjusted limitations in daily activities.¹ The Commission also introduces a crucial distinction between two clinical states: preclinical obesity and clinical obesity.¹ Preclinical obesity refers to individuals with excess adiposity but no apparent organ or tissue dysfunction.¹ While they may be symptom-free, these individuals face an increased risk of developing non-communicable diseases like type 2 diabetes, cardiovascular conditions, and certain cancers.¹ By recognizing clinical obesity as a disease, the focus of treatment shifts from merely addressing secondary conditions, such as diabetes, to providing medical intervention based on the direct health risks of obesity itself.¹ Table 1 presents the selected highlights of the consensus statements on the definitions and recommendations on pre-clinical and clinical obesity.¹

In an interview with Omnihealth Practice, Dr. Suhairul Sazali, a family medicine specialist from Malaysia with a special interest in obesity management in primary care setting, shared his valuable insights into the challenges of managing clinical obesity and offered tailored recommendations for improving patient care.

Q1: What is your perspective on redefining obesity and distinguishing preclinical from clinical obesity? How useful is this framework in everyday practice?

Dr. Suhairul: Obesity is a major public health issue in Asia, with 54.4% of Malaysian adults classified as overweight or obese. We refer to it as “three-plus-one” due to its association with diseases like diabetes, hypertension, and hypercholesterolemia.

The new consensus redefines obesity as a chronic disease, moving beyond BMI for diagnosis. It distinguishes between preclinical and clinical obesity, improving diagnostic precision and highlighting alternative adiposity measures like DEXA and BIA. This approach fosters a patient-centered strategy for managing obesity, leading to better identification, personalized interventions, and improved health outcomes in primary care. It has also enhanced obesity management by addressing patients' mental health and shifting perceptions of obesity beyond just weight management.

Q2: The report introduces the idea of remission in clinical obesity. What clinical indicators do you use to determine if a patient is in remission?

Dr. Suhairul: Achieving remission in clinical obesity requires a collaborative effort between physician and patient, with personalized goals and a comprehensive management plan. True remission is defined by sustained target weight maintenance and improvement or resolution of obesity-related comorbidities, such as hypertension, diabetes, or dyslipidemia, without rebound weight gain. Equally important is managing the patient's mindset. Patients must understand that maintaining progress is an ongoing effort, even after reaching their target weight or stopping medications. Remission should be viewed as a continuous commitment to long-term health, crucial for preventing relapses and ensuring lasting success.

The IMWG consensus offers comprehensive recommendations on CAR-T therapy for R/R MM, covering patient selection, toxicity management, response assessment, and real-world applicability. In Asia, factors such as healthcare access, infrastructure, and cost constraints influence treatment decisions. While core principles of CAR-T therapy remain universal, adapting these guidelines to local settings is essential for optimizing patient outcomes. Collaborative initiatives, such as the Asian Myeloma Network (AMN) play a key role in advancing clinical research and regional treatment strategies.

Q3: What strategies or changes would you recommend to improve obesity management, both at the clinical level and within the broader healthcare system?

Dr. Suhairul: ​Physicians must educate patients on the importance of comprehensive assessment tools, like BIA, in guiding obesity management. Obesity should be viewed as a chronic disease requiring comprehensive management, lifestyle changes and medical interventions, from pharmacotherapy to bariatric surgery, particularly as new therapies continue to emerge. In my practice, we use a multidisciplinary team, including dietitians, physiotherapists, and counselors, to provide holistic care. As part of this approach, clinicians should also be proficient in motivational interviewing techniques to effectively support behavior change and long-term management.

A shift in societal views on obesity is also crucial, particularly in an obesogenic environment. We must move beyond normalizing weight gain or dismissing weight loss as unattainable, especially in childhood obesity, which often goes unnoticed until it becomes severe. Addressing obesity requires a collective effort including family members, with continued progress in policies, public awareness, and access to affordable treatments.