WHO has revised approaches to the treatment of obesity

In addition, among scientists, disputes do not subside, which parameters for diagnosing obesity are considered correct. Previously, the body mass index (BMI) was considered the “gold standard”, but today scientists say that everything is not so simple, and turn their eyes to the waist area.

Not only that: there are more and more works on the topic of the so-called obesity paradox: in patients with a number of diseases, excess weight turns out to be a good prognostic factor.

New highly effective weight loss drugs are not a panacea for solving the problem of obesity, said Francesco Branca, head of the World Health Organization’s Division of Nutrition and Food Safety. For the first time in more than 20 years, WHO is revising recommendations for the treatment of obesity. The latest WHO data show that the percentage of children and adolescents aged 5 to 19 who are obese or overweight rose to just over 18% in 2016 from 4% in 1975, and is now over 340 million.

WHO last issued global guidelines on this topic in 2000. The new ones will include the most up-to-date scientific data. The organization has already commissioned the Mario Negri Institute for Pharmacological Research in Milan to evaluate the evidence for the use of all medicines for children and adolescents, from older options to newer, more effective drugs. Medications to treat obesity are certainly important, the WHO says, but they should be part of a comprehensive approach. They want to bet on diet and exercise, which are crucial for the treatment of obesity.

At the same time, many drugs that are massively used today all over the world to get rid of extra pounds (even without a doctor’s recommendation, but as part of self-medication), for the most part, are designed to treat type 2 diabetes mellitus to help control blood glucose levels. They belong to a class of drugs known as GLP-1 agonists, given by weekly injections, and work by interfering with hunger signals in the brain and slowing the rate of gastric emptying, making a person feel full longer. They really help to lose up to 15% of the weight, but they have a lot of side effects and should be used strictly according to indications, doctors do not get tired of repeating. But recently, pop singers have begun to actively advertise them, which has created a new wave of rush demand around them.

American medical groups are also reviewing their recommendations for treating obesity. Some experts advocate the widespread use of drugs, while others recommend prescribing them only to high-risk patients with diseases such as diabetes or cardiovascular disease that are exacerbated by overweight.

But experts around the world cannot decide not only on unified approaches to the treatment of obesity, but also to the diagnosis of this disease. In particular, before everything was simple: the diagnosis of obesity was based on BMI, which is calculated using the formula “weight divided by height squared.” It was believed that an indicator of up to 24 is the norm, from 25 to 29 indicates the presence of excess weight, 30–35 is stage 1 obesity, 35–40 is stage 2, and above 40 is stage 3. But everything turned out to be not so clear. For example, as the assistant of the Department of Therapy and Preventive Medicine of the Moscow State Medical University named after M.V. Evdokimova Ekaterina Gubernatorova, the Mongoloid race has lower norms (stage 3 obesity, for example, they are diagnosed with a BMI above 37.5, and the norm should not exceed 23.

However, from the point of view of diagnostics, the indicator is also not the best – it depends on the race and on the accuracy of the measurement. Recently, Dr. Marina Harris stated that the BMI formula has only been in use for 50 years, it was proposed by the physiologist-hygienist Ansel Case and colleagues in the Journal of Chronic Diseases in 1972. They immediately said that they did not claim to be an absolute truth, but BMI is simple and convenient and, in general, suitable for screening. And, of course, you should not focus only on it. “BMI is more of a “proxy for obesity” than its direct indicator, it works especially badly for people of small and, conversely, impressive growth, for athletes with developed muscles and in a bunch of other special cases, leaving entire ethnic groups out of the norm. I remember very well what happened when this very BMI was introduced into the schedule of diseases, and we were obliged to be guided by it when selecting young replenishment for our training. Firstly, a bunch of absolutely healthy, but at the same time just lean people did not pass the criteria of training. For those who strongly asked, they simply added the necessary kilos, why refuse motivated people. Secondly, “fattening platoons” were created with a light regime and supplementary nutrition, which included both those who really needed it and those who simply did not fit into mathematics, but at the same time quite healthy soldiers. Well, at least they quickly figured it out, and in addition to BMI, tests for physical development and other additional criteria appeared, ”says a well-known therapist, military doctor Alexei Vodovozov.

Since 2015, the American Heart Association has recommended measuring your waist circumference (if you can find it, of course). As Ekaterina Gubernatorova says, for women it should not exceed 80 cm, for men – 94 cm. “There is a belief in India that a wife should be chosen with a thin waist, she will be healthy and live long,” says Dr. Gubernatorova.

As Vodovozov says, since 2022, the British National Institute for Health and Excellence has also clarified in its recommendations that if the BMI is 35 and above, then in general everything is clear and understandable. But if it is lower, then it is necessary to additionally measure the waist-to-height ratio index (WHtR, the ratio of waist circumference to height, measured either in inches or in cm, who has which tape measure), and if it is below 0.5, then there are increased risks for health are absent.

In a recent scientific work, the paradox of “healthy obesity” (this term today describes the phenomenon when extra pounds work not for harm, but for good) in people with heart failure with a reduced ejection fraction was investigated: it turned out that the lower their BMI, the worse they are. feel, the higher their risk of death and health complications. This is if you calculate according to the BMI formula. But when using the WHtR index, this phenomenon was no longer observed.

And yet, the WHtR index is also not the most accurate. “It must be measured correctly, each time finding the waist in the same place, so that the results are comparable not only between different people, but also in the same person. In general, everything is complicated, ”Vodovozov notes.

By the way, about the paradox of obesity. According to some studies, mortality among people with a BMI greater than 25 (that is, people who are obese and markedly overweight) is less than among people with a normal BMI. Recently, another study appeared, published in the European Heart Journal. “Studying almost 10,000 men and women with and without obesity, scientists took into account not only the actual weight and BMI, but also other characteristics associated with an increased risk of cardiovascular mortality – this is the main cause of death for all people. In particular, they looked at the ratio of waist to height, edema, and the ratio of adipose and muscle tissue. And it turned out that when a person has one or more of these factors, the obesity paradox disappears: that is, the more risk factors he has, the higher the likelihood that he will die from problems with the heart and blood vessels. In other words, weight and BMI are too rough parameters, and it is impossible to make a relevant prediction by evaluating them alone, without taking into account concomitant factors. That is, one cannot directly compare, say, a young, tall, athletic woman with a high BMI, who has excess weight mainly on her hips, and an elderly, sedentary, short man with excess weight on his stomach (localization of adipose tissue is very important if it is on the stomach – is a serious risk factor). And definitely obesity is not a protective factor, it is a risk factor. It’s just that for some people this risk is somewhat less than for others, ”says well-known biologist Irina Yakutenko.

However, recently Russian scientists from Sechenov University also came up with data from a study on the paradox of obesity, this time in centenarians over 90 years old. According to their data, only 30% of centenarians had normal body weight. In 70%, it was overweight or obese was established (it concerned every third participant in the study). So for now, doctors can advise you to monitor your body weight for up to 90 years, and then this process can be let go.