Abstract

Obesity is widely recognized as a chronic disease characterized by excessive adipose tissue accumulation, which poses significant risks for metabolic and cardiovascular complications. Although the body mass index (BMI) has long been a standard diagnostic tool owing to its simplicity and utility in epidemiological studies, growing evidence highlights substantial limitations in its accuracy when assessing individual health status. BMI does not accurately reflect body composition, adipose tissue distribution, functional limitations, mental health conditions, or overall quality of life. To overcome these shortcomings, alternative and complementary metrics—such as waist circumference (WC), waist-to-height ratio (WHtR), dual-energy X-ray absorptiometry (DXA), and bioelectrical impedance analysis (BIA)—have been proposed. Moreover, several comprehensive obesity assessment frameworks have emerged, including the Edmonton Obesity Staging System (EOSS), the 2020 Canadian Adult Obesity Clinical Practice Guidelines, the 2024 European Association for the Study of Obesity diagnostic framework, and the 2025 Lancet Commission’s clinical obesity diagnostic criteria. These systems emphasize multidimensional evaluation, integrating medical, functional, and psychosocial factors, enabling personalized treatment strategies based on a patient’s actual health risks rather than simply focusing on weight reduction. This comprehensive approach has significant clinical implications, as it enhances patient-centered care, optimizes resource allocation in healthcare, reduces obesity-related stigma, and improves treatment adherence and outcomes. This review highlights the need to shift the obesity paradigm from weight-centered to health-centered assessments and underscores the clinical and policy implications of adopting a comprehensive obesity evaluation framework.