Redefining Clinical Obesity in Asian Populations Beyond BMI: Nature Reviews Endocrinology

Introduction

Obesity in Asian populations is increasingly recognized as a distinct clinical and metabolic phenotype that is inadequately captured by conventional body mass index (BMI)-based definitions. Compared with White populations, Asian individuals often develop excess visceral adiposity, ectopic fat deposition and obesity-related metabolic disease at lower BMI thresholds, challenging the clinical utility of traditional obesity classification.

Problem Statement

Reliance on BMI alone leads to systematic under-recognition of obesity-related disease in Asian populations, delaying diagnosis and treatment despite substantial cardiometabolic risk. This limitation is particularly important in Asian individuals, who often exhibit reduced β-cell reserve, greater visceral fat burden and sarcopenic obesity, all of which contribute to earlier metabolic dysfunction despite relatively modest body weight. A more biologically relevant framework is needed to distinguish excess adiposity from clinically meaningful obesity-related disease.

Summary

This perspective advocates for a major shift in how clinical obesity is defined in Asian populations, moving from a BMI-centric model to an adiposity- and function-based framework. Building on the Lancet Commission’s concept of clinical obesity, the authors propose a more precise classification system that integrates anthropometric measures with body composition, metabolic markers, organ-specific dysfunction and functional impairment. This approach better distinguishes preclinical obesity from clinical obesity and more accurately reflects disease burden in Asian populations, where conventional BMI thresholds often fail to identify high-risk individuals. The proposed framework supports earlier diagnosis, improved risk stratification and stage-based treatment selection, including lifestyle intervention, pharmacotherapy and metabolic surgery. Importantly, the authors emphasize that redefining obesity in this way has implications beyond clinical care, extending to prevention strategies, reimbursement policy and public health planning. This work provides a strong conceptual foundation for more equitable and biologically meaningful obesity care in Asian populations and supports a precision medicine approach to metabolic risk assessment.