Reclassification of obesity and diagnosis of obesity based on individuals' metabolic status

Obesity has been widely accepted as a metabolic disease and its occurrence is closely related to the genetics, environment, and inflammation. Up to now, body mass index is still regarded as the standard diagnostic criterion for obesity. It has not been revised for decades and could not meet the needs of clinical diagnosis and demands for specific treatment at present. In 2013, the concept of metabolic obesity was introduced at the American Diabetes Association (ADA) annual conference, and it was further proposed that obesity should be classified according to the metabolic status and its related complications at the 2014 American Association of Clinical Endocrinologists (AACE) annual conference. This means that scientists and clinicians have realized that the etiology of obesity may vary with different outcomes, the treatment should be focused on the metabolic regulation, not merely on weight loss. With years of clinical practice and research in obesity, we have observed and treated numerous obese patients, and we have found that obesity has a lot of phenotypes and clinical features which are related to the metabolic status. Based on our clinical findings, combined with the experience of Chinese traditional medicine, we now propose a new clinical classification and diagnosis of obesity based on individuals' metabolic status, which, we believe, can facilitate clinicians' practice. Based on the metabolic status and skin features of obese patients, obesity is divided into metabolic healthy obesity ('white obesity') and metabolic unhealthy obesity. Then, the latter is further divided into three groups including high metabolic obesity ('red obesity'), low metabolic obesity ('yellow obesity'), and severe metabolic disorder with inflammation obesity ('black obesity'). If we also consider to add normal weight metabolic obesity to this classification, there should be five types of obesity to be classified as presented. We wish this proposed classification of obesity can play a valuable role in enabling clinicians to have a better understanding of obesity in relation to its metabolism, and to develop individualized treatment according to the metabolic status of the patient. As a result, we may finally achieve the desired outcomes through making appropriate diagnosis and treatments. (Chin J Endocrinol Metab, 2015, 31: 655-658) Key words: Obesity; Classification; Diagnosis; Inflammation; Metabolism