Carrillo-Larco Rodrigo M, Guzman-Vilca Wilmer Cristobal, Tarazona-Meza Carla, Xu Xiaolin, Bernabe-Ortiz Antonio
Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America.
CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru.
PLOS Glob Public Health. 2025 Jul 24;5(7):e0004838. doi: 10.1371/journal.pgph.0004838. eCollection 2025.
Obesity is commonly defined using body mass index (BMI), but BMI alone does not capture the metabolic and functional consequences of excess weight. We examined the prevalence of clinical obesity, a new definition that incorporates BMI alongside metabolic and functional impairments. We analyzed nationally representative surveys. Clinical obesity was defined as BMI ≥ 30 kg/m2 and waist-to-height ratio ≥0.5 or BMI ≥ 40 kg/m2 with at least: self-reported diabetes, fasting plasma glucose ≥126 mg/dl, self-reported hypertension, blood pressure ≥140/90 mmHg, or total cholesterol ≥200 mg/dl. We estimated the survey-weighted and age-standardized prevalence of clinical obesity and BMI-only obesity by country and sex. Data from 56 countries were included (n = 142,250). The prevalence of clinical obesity ranged between 0% and 29%. The prevalence of clinical obesity was < 10% in 41 countries for men and 30 for women. In men, the largest shift in prevalence of BMI-only obesity and clinical obesity was observed in Malawi (0.7% vs 0.2%, relative change: -68%); in women, the largest shifts in prevalence were seen in Malawi (5.6% vs. 2.6%, relative change: -53%) and Rwanda (2.7% vs. 1.3%, relative change: -52%). The adoption of clinical obesity criteria revises obesity prevalence estimates and highlights metabolic and functional impairments beyond BMI. Our results emphasize the need to carefully consider how obesity is defined in population surveillance to ensure its relevance to health outcomes.
肥胖通常使用体重指数（BMI）来定义，但仅BMI并不能反映超重带来的代谢和功能后果。我们研究了临床肥胖的患病率，这是一个将BMI与代谢和功能损害相结合的新定义。我们分析了具有全国代表性的调查。临床肥胖的定义为BMI≥30 kg/m²且腰高比≥0.5，或BMI≥40 kg/m²且至少具备以下一项：自我报告的糖尿病、空腹血糖≥126 mg/dl、自我报告的高血压、血压≥140/90 mmHg或总胆固醇≥200 mg/dl。我们按国家和性别估算了临床肥胖和仅基于BMI定义的肥胖的调查加权患病率及年龄标准化患病率。纳入了56个国家的数据（n = 142,250）。临床肥胖的患病率在0%至29%之间。在41个国家，男性临床肥胖患病率<10%，女性为30个国家。在男性中，仅基于BMI定义的肥胖和临床肥胖患病率变化最大的是马拉维（0.7%对0.2%，相对变化：-68%）；在女性中，患病率变化最大的是马拉维（5.6%对2.6%，相对变化：-53%）和卢旺达（2.7%对1.3%，相对变化：-52%）。采用临床肥胖标准会修正肥胖患病率估计值，并突出BMI之外的代谢和功能损害。我们的结果强调在人群监测中需仔细考虑肥胖的定义方式，以确保其与健康结果的相关性。
