Abstract

The 2025 Lancet Commission proposed a new framework for diagnosing obesity, defining ‘Clinical Obesity’ as a chronic, systemic disease resulting from excess adiposity leading to detectable changes in the function of tissues, organs, or the whole individual. Conversely, ‘Preclinical Obesity’ is defined as a state of excess adiposity without major signs or symptoms of organ dysfunction, signifying an elevatedrisk of progression to clinical obesity or obesity-related diseases, but not classified as a disease state within their structure. While this framework advances the field significantly, concerns are raised regarding the classifying it merely as a health risk.The visibly corpulent appearance and excessive body weight characteristic of excess adiposity should be recognized as its salient, observable clinical signs and symptoms.Analogous to early stage hypertension or diabetes, preclinical obesity should be recognized as an early stage of the chronic disease where secondary preventive treatment is strongly warranted within a critical therapeutic window, aligning with the contemporary chronic disease care model. Furthermore, the extensive list of organ dysfunctions, which often necessitates high-cost medical investigation, presents challenges for the clinical applicability of the clinical obesity diagnosis. The exclusion of major obesity-related conditions such as diabetes, pre-fibrotic steatotic liver disease, and coronary artery obstructive disease, from the functional dysfunction criteria raises questions about the framework’s logical consistency. In conclusion, excess adiposity should be considered a disease entity in itself, irrespective of the presence of secondary organ dysfunction. Preclinical obesity must be recognized and actively managed as the early stage of a chronic disease.