How obesity diagnosis and treatment have changed, according to a leading expert

Obesity is no longer viewed simply as a consequence of overeating and inactivity. It is now understood as a complex, chronic, and multidimensional disease, shaped by biological and psychological factors, affecting nearly every aspect of life. In Argentina, the scale of the problem is significant: the World Obesity Federation's Atlas 2025 reports that 73% of adults are overweight and 39% live with obesity. Concurrently, the methods for diagnosing and treating the condition are undergoing a radical transformation.

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The body mass index is only height and weight. It is a measure of body size. You can think of it as the size of clothing. Someone saying they wear size 18 is not a medical diagnosis.

Dr. Arya Sharma, a leading obesity specialist and creator of the Edmonton Obesity Staging System (EOSS), exemplifies this paradigm shift. Published in 2009, the EOSS classifies obesity not by weight but by its consequences across three dimensions: physical health, mental health, and functional capacity. Sharma, who has dedicated three decades to this field, primarily in Canada before relocating to Germany, advocates for evaluating obesity based on its impact on these areas, moving beyond mere body weight.

During the Latin American Forum on Weight Loss and Its Impact on Health in Panama, Sharma explained that the goal of obesity treatment should shift from simply shedding pounds to preventing complications and enhancing quality of life. Improvements in blood pressure, diabetes, fatty liver disease, sleep apnea, mobility, mental health, or the ability to perform daily activities are far more relevant indicators of success than isolated weight loss. This approach gains further significance with the advent of GLP-1 receptor agonists, a new generation of medications revolutionizing obesity treatment by targeting appetite regulation, a central mechanism of the disease.

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It is true that as BMI increases, it is more likely to find complications. With a BMI of 40 or 50, it is very difficult to find someone who does not have health problems. But there can also be a person with a BMI of 27 who has no problems and another who does have hypertension, diabetes or sleep apnea.

Sharma critiques the overreliance on Body Mass Index (BMI), which he likens to a clothing size. While higher BMIs correlate with a greater likelihood of health complications, BMI alone does not diagnose a patient's health status. A person with a BMI of 27 might be perfectly healthy, while another with the same BMI could suffer from hypertension, diabetes, or sleep apnea. Therefore, Sharma stresses that a comprehensive assessment, considering physical, mental, and functional impacts, is crucial for effective obesity management.

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Therefore, BMI, by itself, does not tell us about the patient's health status.