Health
Experts Call for Overhaul in Obesity Diagnosis Amid Criticism of BMI Reliance
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 While BMI offers a simple proxy for body fat and related health risks, critics say it is flawed and outdated.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.
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.
Health
World Cup Emotion Can Strain the Heart, Cardiologists Warn Fans at Risk
As the World Cup begins, medical experts are cautioning football fans with underlying heart conditions that the emotional intensity of matches can place unexpected strain on the cardiovascular system.
Cardiologists say that the excitement, tension, and anxiety generated during high-stakes games can trigger physical reactions similar to intense exercise, raising heart rate, blood pressure, and stress hormones.
“Intense emotions, whether positive or negative, can act as ‘precipitating risk factors’ for cardiovascular events such as heart attack,” said Paola Santalucia, a cardiologist and board member of the European Heart Network.
She explained that moments of extreme excitement, such as a decisive penalty shootout or a last-minute goal, may pose risks for people already living with heart disease. Those with additional risk factors, including hypertension, obesity, or smoking habits, are also advised to be cautious during emotionally charged matches.
Research using wearable devices has shown that during major football events, some fans experience heart rates climbing as high as 150 beats per minute. That level is comparable to sprinting and reflects how strongly the body reacts to emotional stress.
A study examining supporters during the 2025 German Cup final found that even watching from home can significantly affect physiological responses. “They still had an increase in heart rate that compares to walking, even though they didn’t walk,” said Christian Deutscher, professor of sports economics at Bielefeld University and co-author of the study.
He noted that the most intense reactions often occur not during goals themselves, but during moments of uncertainty such as VAR checks, penalty shootouts, or shots striking the post. These unpredictable situations, he said, are what drive the strongest emotional and physical responses among fans.
Deutscher also pointed out that stadium spectators may experience even greater strain due to environmental factors such as heat and alcohol consumption.
However, experts emphasize that football itself is not inherently dangerous. Instead, it is the body’s natural response to excitement that can create temporary stress.
“The adrenergic stimulation is at its max: extreme high blood pressure, high heart rate, and adrenaline, cortisol, skyrocketing,” said Dan Atar, professor of cardiology at Oslo University Hospital. In rare cases, he added, this surge can contribute to the rupture of arterial plaque in vulnerable individuals, potentially leading to a heart attack.
Atar stressed that such events can occur in everyday situations as well, including physical exertion like shoveling snow. “It is in no way dangerous to watch a football game,” he said. “All this is physiologic. It’s not dangerous to be excited.”
Still, he acknowledged that combining emotional stress with alcohol, heat, and pre-existing conditions can increase risk for some viewers.
Doctors advise those at higher risk to continue prescribed medications, limit alcohol intake, avoid smoking, and watch for warning signs such as chest pain or irregular heartbeat.
“The key message is not to avoid enjoying the match, but to do so with moderation and awareness,” Santalucia said.
Health
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Health
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