BMI versus obesity subtypes in the era of precision medicine

The current epidemic of obesity represents a huge challenge to public health authorities and clinical practice. Typically defined by a BMI of 30 kg/m2 or more, obesity is associated with increased morbidity and mortality. 1 Jensen MD Ryan DH Apovian CM et al. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. Circulation. 2014; 129: S102-S138 Crossref PubMed Scopus (2016) Google Scholar Although BMI has been useful for monitoring rapid growth in the prevalence of obesity and its association with chronic conditions, 1 Jensen MD Ryan DH Apovian CM et al. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. Circulation. 2014; 129: S102-S138 Crossref PubMed Scopus (2016) Google Scholar there can be considerable variation in the health status of people with identical BMI values when compared. 2 Després JP Carpentier AC Tchernof A Neeland IJ Poirier P Management of obesity in cardiovascular practice: JACC Focus Seminar. J Am Coll Cardiol. 2021; 78: 513-531 Crossref PubMed Scopus (28) Google Scholar , 3 Tchernof A Després JP Pathophysiology of human visceral obesity: an update. Physiol Rev. 2013; 93: 359-404 Crossref PubMed Scopus (1611) Google Scholar Age, sex, smoking, body composition, and lifestyle habits modulate the health risk associated with a given BMI and the term metabolically healthy obesity has been proposed to describe a subgroup of individuals with a BMI over 30 kg/m2 but who are at the low end of the obesity-health-risk spectrum. 2 Després JP Carpentier AC Tchernof A Neeland IJ Poirier P Management of obesity in cardiovascular practice: JACC Focus Seminar. J Am Coll Cardiol. 2021; 78: 513-531 Crossref PubMed Scopus (28) Google Scholar , 3 Tchernof A Després JP Pathophysiology of human visceral obesity: an update. Physiol Rev. 2013; 93: 359-404 Crossref PubMed Scopus (1611) Google Scholar