Reacción a "A research shows that taking other measures into account alongside BMI helps to identify more cases of obesity"

This is a high-quality article, as it evaluates a large number of patients from different countries. The analysis carried out provides solid evidence that body mass index, which is widely used in clinical practice, does not correctly classify patients with obesity, leading to overestimation or underestimation. It is proposed that additional measures be used, such as the waist-to-height ratio and other measures related to organ function, which provide a more accurate classification and enable a treatment strategy better tailored to each patient’s individual situation. These measures are easily applicable in routine clinical practice and would help to avoid the over- or under-diagnosis of obesity.

The study distinguishes between clinical and preclinical obesity, demonstrating that patients classified as having preclinical obesity have lower mortality rates and that only a small number of those with preclinical obesity progress to clinical obesity within 10 years. This classification would enable the establishment of a preventive treatment strategy for patients with preclinical obesity and help determine the urgency of treatment, without implying inaction in the management of these patients. However, the fact that organ function was not assessed using biochemical or molecular measures constitutes a limitation of the study and may lead to an underestimation of the true clinical status. In this regard, I believe that for the future of obesity classification, in addition to incorporating various anthropometric and body composition measures, it would be necessary to carry out biochemical and molecular measurements in order to adequately quantify organ function. In fact, there is an epigenetic memory in adipose tissue that indicates dysfunction in that tissue, and it is possible that this is not being adequately assessed in patients classified as having preclinical obesity, who may present biological abnormalities that we are not yet detecting using conventional diagnostic tools.

The major challenge is not merely to classify obesity more effectively, but to identify biological dysfunction at an early stage so that we can anticipate its complications and move towards truly personalised medicine.