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Experts Call for Overhaul in Obesity Diagnosis Amid Criticism of BMI Reliance

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Global health experts have called for a fundamental reevaluation of how obesity is diagnosed, urging a shift from the long-standing reliance on body mass index (BMI) to a more nuanced and individualized approach. The recommendations come from a panel of 56 specialists and patients, who published their findings in The Lancet Diabetes & Endocrinology.

A Complex Condition

Obesity, affecting roughly one in eight people worldwide, is a risk factor for numerous health conditions, including type 2 diabetes, cardiovascular disease, and certain cancers. However, experts argue that it is not always synonymous with ill health. The commission has proposed distinguishing between clinical obesity, a chronic disease marked by organ dysfunction or physical limitations caused by excess fat, and preclinical obesity, where individuals have obesity but maintain normal organ function.

“There are some people who have obesity and manage to live a relatively normal life … and on the other hand, you have [people] who may suffer significant health issues due to obesity alone,” said Dr. Francesco Rubino, the commission’s chair and a professor at King’s College London.

BMI Under Fire

BMI, a measure derived from a person’s weight and height, has been the primary diagnostic tool for obesity since the World Health Organization adopted it in the 1990s. A BMI of 30 or higher classifies an adult as obese. While BMI offers a simple proxy for body fat and related health risks, critics say it is flawed and outdated.

“It’s not just how much fat you have, it’s also where the fat is that’s important,” said Dr. Adam Collins, a nutrition expert at the University of Surrey. He highlighted that BMI does not account for fat distribution or differentiate between fat and muscle mass, leading to potential misclassifications.

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Athletes with high muscle mass, for example, may fall into the obese category despite being in excellent health.

A New Framework

The commission has recommended that BMI remain a preliminary screening tool but that an official diagnosis of clinical obesity should involve more comprehensive criteria. These include signs such as obesity-induced breathlessness, heart failure, and joint pain, among others.

Adopting this approach could reduce overdiagnosis and ensure medical care is tailored to an individual’s health needs rather than focusing solely on weight loss. This shift is especially crucial as governments debate how to allocate resources, such as expensive weight-loss drugs like Wegovy and Mounjaro, which are in limited supply.

Changing Perspectives

Beyond medical practice, experts hope the new framework will combat the stigma around obesity and promote better understanding of metabolic health for people of all sizes. “This leads to a change in practice and, maybe even before that, a change in mindsets,” Rubino said.

Though it may take time to implement these changes, advocates believe this step could reshape how obesity is perceived and treated globally.

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France Records 5,764 Excess Deaths During Deadliest Heatwave Since 2003

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At least 5,764 excess deaths were recorded in France during last month’s record-breaking heatwave, making it the country’s deadliest heat event since 2003, according to new figures from the national public health agency.

Between June 17 and July 2, 21,674 people died in France, compared with an estimated 15,910 deaths expected under normal conditions, Santé publique France said in a bulletin published Wednesday.

The agency described the figure as the highest excess all-cause mortality recorded during a heatwave since 2003. That year’s extreme heat event caused nearly 15,000 deaths across France.

The latest heatwave was notable for its timing, intensity and duration. It struck early in the summer, when schools and workplaces were still operating normally, and exposed almost the entire French population to extreme temperatures.

For the first time, the public health agency recorded excess all-cause mortality across every age group from 15 years old and above. The agency said the pattern demonstrated the exceptional intensity and prolonged nature of the heat exposure.

People aged 75 and over accounted for around two-thirds of the provisional death toll, with at least 3,719 excess deaths recorded in that age group. However, deaths also increased among younger adults, making the event different from many previous heatwaves, when the impact was concentrated mainly among the elderly.

Mortality rose in hospitals, private homes and nursing homes. Almost half of the excess deaths occurred in hospitals, according to the preliminary data.

Santé publique France stressed that the excess deaths cannot yet be directly attributed to heat in every individual case. However, the scale and distribution of the increase point to the wider health impact of the extreme temperatures.

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The agency said the findings showed the need for governments and health authorities to introduce prevention and response measures before temperatures reach crisis levels.

“These impacts highlight the importance of implementing management and prevention measures to reduce the impact of heat on the population without waiting for health impacts to become apparent,” the agency said.

The French figures came as other Western European countries reported thousands of additional deaths during a heatwave in early July. Preliminary estimates suggested more than 4,000 people died across the region during that period.

The World Health Organization’s European office called on governments at the end of June to treat extreme heat as a major health crisis and strengthen the ability of health systems to respond.

Public health officials have warned that longer and more intense heatwaves are placing growing pressure on hospitals, care facilities and emergency services, increasing the need for early warnings and stronger protection measures.

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Up to Five Cups of Coffee a Day May Be Safe for Most Adults, Review Finds

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Drinking up to five cups of coffee a day may be safe for most adults and could be associated with a lower risk of several health problems, according to a major review by the American Heart Association.

The review found that consuming up to 400 milligrams of caffeine a day, roughly equivalent to five cups of caffeinated coffee, does not generally increase cardiovascular risk for most adults. Moderate consumption, particularly between two and four cups daily, was also linked to the lowest risk of death in the research examined.

“The equivalent of up to five cups of caffeinated coffee per day without added sugars or fillers is safe and does not increase cardiovascular risk,” said Gregory M. Marcus, a co-author of the paper and professor of medicine at the University of California, San Francisco.

The analysis found that moderate coffee consumption may be associated with better heart health and a lower risk of conditions including heart failure, heart disease and stroke. Some individuals also appeared to have a lower risk of high blood pressure and type 2 diabetes.

Coffee is the main source of caffeine for many adults, but daily intake can also come from tea, chocolate, fizzy drinks and some over-the-counter and prescription medicines. The researchers said less is known about the effects of caffeine from these sources, particularly at high levels.

Energy drinks were highlighted as an area requiring further study because large amounts of caffeine and other ingredients may pose cardiovascular risks.

Caffeine is processed by the liver and usually reaches its highest concentration in the blood within about an hour of consumption. The way people respond to it varies widely, however, depending on genetics, metabolism, age and previous caffeine intake.

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Regular coffee drinkers may develop some tolerance, while others can experience strong effects from relatively small amounts.

“Although research suggests that caffeine consumption may be associated with certain cardiovascular benefits for some people, it’s important to remember that there is no ‘one-size-fits-all’ strategy for safe caffeine consumption,” Marcus said.

He added that an amount that is reasonable for one person could cause side effects such as heart palpitations, anxiety or sleep disruption in another.

The researchers also warned that the way coffee is prepared can affect its overall health impact. Large amounts of added sugar, flavoured syrups and high-calorie dairy products can significantly increase calorie intake and may reduce the potential benefits associated with coffee itself.

The findings suggest that moderate, unsweetened coffee consumption can fit into a healthy lifestyle for many adults, but individual tolerance remains an important factor when deciding how much caffeine to consume.

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Summer Heat Linked to Seasonal Depression as Mental Health Concerns Rise Worldwide

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Seasonal depression is commonly associated with the short, dark days of winter, but health experts are warning that hot weather and prolonged heatwaves can also trigger a lesser-known form of the condition during the summer months.

Medical professionals say Summer Seasonal Affective Disorder (SAD) is a recognised type of depression that follows a seasonal pattern and can significantly affect daily life. Although far less common than winter SAD, experts stress that it should be treated as a serious mental health condition.

According to a recent study, summer SAD affects around 0.57% of the global population, compared with about 5% for the winter form of the disorder. Rising temperatures, frequent heatwaves and tropical nights have been identified as factors that can contribute to symptoms in vulnerable individuals.

Unlike winter depression, which is often linked to reduced daylight and social isolation, summer SAD is associated with excessive heat, disrupted sleep and physical discomfort. Symptoms may include insomnia, loss of appetite, anxiety, agitation and persistent low mood. In severe cases, the condition can interfere with work, relationships and everyday activities.

Adam Borland, a clinical psychologist at the Cleveland Clinic, said people experiencing symptoms may benefit from maintaining a regular daily routine, limiting exposure to extreme heat and making sleep a priority. He added that anyone with severe or persistent symptoms should seek professional medical care.

The warning comes as mental health conditions continue to rise across the world. A recent analysis from the Global Burden of Disease Study, published in The Lancet, estimated that approximately 1.2 billion people, or around 15% of the global population, were living with a mental health condition in 2023.

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The study found that the number of people affected by mental health disorders increased by 95% between 1990 and 2023. During the same period, mental disorders climbed from the 12th to the fifth leading cause of health loss worldwide.

Major depressive disorder and anxiety disorders recorded some of the sharpest increases. Cases of major depression rose by 131%, while anxiety disorders increased by 158%, making them the two most common mental health conditions globally.

Researchers behind the Global Burden of Disease Study said meeting the growing demand for mental health services should be regarded as a public health priority, particularly for vulnerable groups.

The situation is also a concern across Europe. The World Health Organization estimates that one in six people in the European region, around 140 million individuals, lives with a mental health condition. Despite the high number of cases, only one in three people suffering from depression receive the treatment they need.

Health experts have also highlighted the lasting impact of the COVID-19 pandemic. Depression and anxiety among young people have increased by an estimated 25% since the pandemic, while suicide has become the leading cause of death among people aged 15 to 29 in the European region.

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