The Clinical Outcomes of Preclinical and Clinical Obesity Across Multiple Cohorts

OBJECTIVE: The Lancet Diabetes & Endocrinology Commission proposed a new definition for clinical obesity. However, its prognostic value remains unclear. METHODS: Clinical obesity was defined using the Commission's criteria in the China Health and Retirement Longitudinal Study (CHARLS), the English Longitudinal Study of Aging (ELSA), and the National Health and Nutrition Examination Survey (NHANES). Prevalence estimation was conducted across four categories based on obesity and organ dysfunction status. Cox proportional hazards models were used to assess associations with clinical outcomes. RESULTS: The prevalence of clinical obesity was 2.50% (CHARLS), 6.18% (ELSA), and 9.08% (NHANES), respectively. Overall, older adults and men had lower prevalence, while older men in NHANES showed higher prevalence. Compared with non-obesity without dysfunctions, clinical obesity and non-obesity with dysfunctions showed higher risks of cardiovascular outcomes. Compared with preclinical obesity, clinical obesity elevated cardiovascular risk in CHARLS (HR = 2.49, 95% CI: 1.32-4.70) and ELSA (HR = 1.80, 95% CI: 1.02-3.17) and increased all-cause (HR = 1.88, 95% CI: 1.23-2.87) and cardiovascular (HR = 3.11, 95% CI: 1.49-6.50) mortality risk in NHANES. CONCLUSIONS: The prevalence of clinical obesity varied by age, sex, and country. Overall, the prevalence was lower among older adults and men. Clinical obesity was associated with increased cardiovascular event risk across cohorts and increased all-cause mortality risk in NHANES, highlighting its value for risk stratification.