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Las medidas actuales de obesidad basadas en el Peso e IMC (índice de masa corporal) pueden subestimar y sobreestimar la adiposidad y proporcionar información inadecuada sobre el nivel de la salud del individuo, lo que socava los enfoques médicamente sólidos de la atención y las políticas de salud. Esta Comisión busco definir la obesidad clínica como una condición de enfermedad de manera similar a la noción de enfermedad crónica en otras especialidades medicas, lo que resulta directamente del efecto del exceso de adiposidad sobre la función de órganos y tejidos.
El objetivo específico de la Comisión era establecer criterios objetivos para el diagnóstico de enfermedades, ayudando a la toma de decisiones clínicas, priorización de la intervenciones terapéuticas y estrategias de salud pública.
Para tal fin, un grupo de 58 expertos, que representan a varias especialidades médicas y países discutieron la evidencia disponible y participaron en un proceso de desarrollo de consenso. Entre estos comisionados había personas con experiencia de vida en obesidad para garantizar la consideración de perspectivas de los pacientes.
La Comisión define la obesidad como una condición caracterizada por exceso de adiposidad, con o sin distribución o función anormal del tejido adiposo tejido, y con causas que son multifactoriales y que aún es comprendida de forma incompleta.
Definimos la obesidad clínica como una enfermedad sistémica crónica caracterizada por alteraciones en la función de los tejidos, órganos, todo el individuo, o una combinación de los mismos, debido al exceso de adiposidad.La obesidad clínica puede provocar daños graves en los órganos afectados, causando cambios vitales y complicaciones potencialmente mortales (p. ej., ataque cardíaco, accidente cerebrovascular y falla renal ).
Definimos la obesidad preclínica como un estado de exceso de adiposidad con función preservada de otros tejidos y órganos y una variación incrementada de mayor riesgo de desarrollar obesidad clínica y otras enfermedades no transmisibles (p. ej., diabetes tipo 2, enfermedades cardiovasculares, ciertos tipos de cáncer y trastornos mentales).
Aunque el riesgo de mortalidad y enfermedades asociadas a la obesidad pueden aumentar como un continuo a través de niveles crecientes de masa grasa. Diferenciamos entre obesidad preclínica y clínica (es decir, salud vs. enfermedad) para fines clínicos y relacionados con políticas de salud.
Recomendamos que el IMC se utilice sólo como sustituto de medida del riesgo para la salud a nivel poblacional, por estudios epidemiológicos o con fines de detección, más que como una medida individual de salud. El Exceso de adiposidad debe ser confirmada por vía directa con la medición de la grasa corporal, cuando esté disponible, o al menos un criterio antropométrico (p. ej., circunferencia de la cintura, relación cintura-cadera, o relación cintura-altura) además de IMC, utilizando métodos validados y puntos de corte apropiados para la edad, género y etnia.
Sin embargo en la práctica aquellas en personas con IMC muy alto (es decir, >40 kg/m²), el exceso de adiposidad puede ser asumido y no se requiere confirmación. También recomendamos que personas con estado de obesidad confirmado (es decir, exceso adiposidad con o sin función anormal de órgano o tejido ) deben evaluarse para detectar la existencia de obesidad clínica.
El diagnóstico de obesidad clínica requiere uno o ambos de los siguientes criterios principales:
· Evidencia de reducción de la función de órganos o tejidos debido a la obesidad (es decir, signos, síntomas o pruebas de diagnóstico que muestren anomalías en la función de uno o más tejidos o sistemas de órganos); y/o
· Sustancial limitación de las actividades diarias ajustadas por edad que reflejen el efecto específico de la obesidad sobre la movilidad, otros básicos u otras actividades básicas de la vida diaria (p. ej., bañarse, vestirse, ir al baño, continencia y alimentación)
Personas con obesidad clínica deben recibir un tratamiento oportuno basado en evidencia con el objetivo de inducir la mejora (o la remisión, cuando sea posible) de las manifestaciones clínicas de obesidad y prevenir la progresión de daño al órgano objetivo.
Las personas con obesidad preclínica debe someterse a un estudio basado en la evidencia, asesoramiento sanitario, seguimiento de su estado de salud con el tiempo y, cuando corresponda, una intervención adecuada para reducir el riesgo de desarrollar obesidad clínica y otras enfermedades relacionadas con la obesidad, según corresponda el nivel de riesgo para la salud individual.
Todas las recomendaciones presentadas en este Comisión han sido acordados con el más alto nivel de consenso entre los comisionados (grado de acuerdo 90-100%) y han sido respaldados por 76 organizaciones de todo el mundo, incluidas científicas sociedades y grupos de defensa de pacientes.
Fuente : The Lancet Diabetes & Endocrinology Commission Lancet Diabetes Endocrinol 2025 Published Online January 14, 2025
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