Definition and diagnostic criteria of clinical obesity

Francesco Rubino¹, David E Cummings², Robert H Eckel³, Ricardo V Cohen⁴, John P H Wilding⁵, Wendy A Brown⁶, Fatima Cody Stanford⁷, Rachel L Batterham⁸, I Sadaf Farooqi⁹, Nathalie J Farpour-Lambert¹⁰, Carel W le Roux¹¹, Naveed Sattar¹², Louise A Baur¹³, Katherine M Morrison¹⁴, Anoop Misra¹⁵, Takashi Kadowaki¹⁶, Kwang Wei Tham¹⁷, Priya Sumithran¹⁸, W Timothy Garvey¹⁹, John P Kirwan²⁰, José-Manuel Fernández-Real²¹, Barbara E Corkey²², Hermann Toplak²³, Alexander Kokkinos²⁴, Robert F Kushner²⁵, Francesco Branca²⁶, Jonathan Valabhji²⁷, Matthias Blüher²⁸, Stefan R Bornstein²⁹, Harvey J Grill³⁰, Eric Ravussin²⁰, Edward Gregg³¹, Noor B Al Busaidi³², Nasreen F Alfaris³³, Ebaa Al Ozairi³⁴, Lena M S Carlsson³⁵, Karine Clément³⁶, Jean-Pierre Després³⁷, John B Dixon³⁸, Gauden Galea³⁹, Lee M Kaplan⁴⁰, Blandine Laferrère⁴¹, Martine Laville⁴², Soo Lim⁴³, Jesús R Luna Fuentes⁴⁴, Vicki M Mooney⁴⁵, Joseph Nadglowski Jr⁴⁶, Agbo Urudinachi⁴⁷, Magdalena Olszanecka-Glinianowicz⁴⁸, An Pan⁴⁹, Francois Pattou⁵⁰, Philip R Schauer²⁰, Matthias H Tschöp⁵¹, Maria T van der Merwe⁵², Roberto Vettor⁵³, Geltrude Mingrone⁵⁴

Affiliations

¹ Metabolic and Bariatric Surgery, School of Cardiovascular and Metabolic Medicine & Sciences, King's College London, London, UK; King's College Hospital, London, UK. Electronic address: francesco.rubino@kcl.ac.uk.
² University of Washington, Seattle, WA, USA; Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA.
³ University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
⁴ Center for the Treatment of Obesity and Diabetes, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil.
⁵ Department of Cardiovascular and Metabolic Medicine, University of Liverpool, Liverpool, UK.
⁶ Monash University Department of Surgery, Central Clinical School, Alfred Health, Melbourne, VIC, Australia.
⁷ Neuroendocrine Unit, Division of Endocrinology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Division of Endocrinology, Department of Pediatrics, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
⁸ International Medical Affairs, Eli Lilly, Basingstoke, UK; Diabetes and Endocrinology, University College London, London, UK.
⁹ Institute of Metabolic Science and National Institute for Health and Care Research, Cambridge Biomedical Research Centre at Addenbrookes Hospital, Cambridge, UK.
¹⁰ Obesity Prevention and Care Program, Department of Medicine, University Hospitals of Geneva, Geneva, Switzerland.
¹¹ Diabetes Complications Research Centre, University College Dublin, Dublin, Ireland.
¹² School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK.
¹³ Sydney Medical School, The University of Sydney, Sydney, NSW, Australia; Weight Management Services, The Children's Hospital at Westmead, Sydney, NSW, Australia.
¹⁴ Centre for Metabolism, Obesity and Diabetes Research, Department of Pediatrics, McMaster University, Hamilton, ON, Canada; McMaster Children's Hospital, Hamilton, ON, Canada.
¹⁵ Fortis C-DOC Center of Excellence for Diabetes, Metabolic Diseases and Endocrinology, New Delhi, India; National Diabetes Obesity and Cholesterol Foundation, New Delhi, India; Diabetes Foundation New Delhi, India.
¹⁶ Toranomon Hospital, Tokyo, Japan.
¹⁷ Department of Endocrinology, Woodlands Health, National Healthcare Group, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
¹⁸ Department of Surgery, School of Translational Medicine, Monash University, Melbourne, VIC, Australia; Department of Endocrinology and Diabetes, Alfred Health, Melbourne, VIC, Australia.
¹⁹ Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL, USA.
²⁰ Pennington Biomedical Research Center, Baton Rouge, LA, USA.
²¹ CIBER Pathophysiology of Obesity and Nutrition, Girona, Spain; Department of Medical Sciences, School of Medicine, University of Girona, Girona, Spain; Hospital Trueta of Girona and Institut d'Investigació Biomèdica de Girona, Girona, Spain.
²² Chobanian & Avedisian School of Medicine, Boston University, Boston, MA, USA.
²³ Division of Endocrinology and Diabetology, Department of Medicine, University of Graz, Graz, Austria.
²⁴ First Department of Propaedeutic Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
²⁵ Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
²⁶ Department of Nutrition and Food Safety, World Health Organization, Geneva, Switzerland.
²⁷ Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK; Department of Diabetes and Endocrinology, Chelsea and Westminster Hospital National Health Service Foundation Trust, London, UK.
²⁸ Helmholtz Institute for Metabolic, Obesity and Vascular Research of Helmholtz Munich, University of Leipzig and University Hospital Leipzig, Leipzig, Germany.
²⁹ Department of Internal Medicine III, Carl Gustav Carus University Hospital Dresden, Technical University Dresden, Dresden, Germany; School of Cardiovascular and Metabolic Medicine & Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK.
³⁰ Institute of Diabetes, Obesity and Metabolism, University of Pennsylvania, Philadelphia, PA, USA.
³¹ School of Population Health, Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland; School of Public Health, Imperial College London, London, UK.
³² National Diabetes and Endocrine Center, Royal Hospital, Muscat, Oman; Oman Diabetes Association, Muscat, Oman.
³³ Obesity Endocrine and Metabolism Center, King Fahad Medical City, Riyadh, Saudi Arabia.
³⁴ Clinical Research Unit, Dasman Diabetes Institute, Dasman, Kuwait.
³⁵ Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
³⁶ Nutrition and Obesities: Systemic Approaches, NutriOmics Research Group, INSERM, Sorbonne Université, Paris, France; Department of Nutrition, Pitié-Salpêtrière Hospital, Assistance Publique-Hospital of Paris, Paris, France.
³⁷ VITAM-Research Center on Sustainable Health, Québec, QC, Canada.
³⁸ Iverson Health Innovation Research institute, Swinburne University of Technology, Melbourne, VIC, Australia.
³⁹ Regional Office for Europe, World Health Organization, Geneva, Switzerland.
⁴⁰ Section on Obesity Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
⁴¹ Division of Endocrinology, Columbia University Irving Medical Center, New York, NY, USA.
⁴² Claude Bernard Lyon 1 University, Lyon, France.
⁴³ Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seoul, South Korea.
⁴⁴ Mexican Society of Obesity, Monterrey, NL, Mexico.
⁴⁵ European Coalition for people Living with Obesity, Dublin, Ireland.
⁴⁶ Obesity Action Coalition, Tampa, FL, USA.
⁴⁷ Department of Community Health, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Abakaliki, Nigeria.
⁴⁸ Health Promotion and Obesity Management Unit, Department of Pathophysiology, Faculty of Medical Science, Medical University of Silesia, Katowice, Poland.
⁴⁹ School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
⁵⁰ Translational Research for Diabetes, Lille University, Lille University Hospital, Inserm, Institut Pasteur Lille, Lille, France; Department of General and Endocrine Surgery, Lille University Hospital, Lille, France.
⁵¹ Helmholtz Munich, Munich, Germany; Technical University of Munich, Munich, Germany.
⁵² University of Pretoria, Pretoria, South Africa; Nectare Waterfall City Hospital, Midrand, South Africa.
⁵³ Internal Medicine, Center for the Study and the Integrated Treatment of Obesity, Department of Medicine, University of Padova, Padua, Italy; Center for Metabolic and Nutrition Related Diseases,Humanitas Research Hospital, Milan, Italy.
⁵⁴ Division of Diabetes & Nutritional Sciences, School of Cardiovascular and Metabolic Medicine & Sciences, King's College London, London, UK; Catholic University of the Sacred Heart, Rome, Italy; University Polyclinic Foundation Agostino Gemelli IRCCS, Rome, Italy.

PMID: 39824205
PMCID: PMC11870235 (available on 2026-03-01)
DOI: 10.1016/S2213-8587(24)00316-4

Review

Definition and diagnostic criteria of clinical obesity

Francesco Rubino et al. Lancet Diabetes Endocrinol. 2025 Mar.

. 2025 Mar;13(3):221-262.

doi: 10.1016/S2213-8587(24)00316-4. Epub 2025 Jan 14.

Authors

Affiliations

¹ Metabolic and Bariatric Surgery, School of Cardiovascular and Metabolic Medicine & Sciences, King's College London, London, UK; King's College Hospital, London, UK. Electronic address: francesco.rubino@kcl.ac.uk.
² University of Washington, Seattle, WA, USA; Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA.
³ University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
⁴ Center for the Treatment of Obesity and Diabetes, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil.
⁵ Department of Cardiovascular and Metabolic Medicine, University of Liverpool, Liverpool, UK.
⁶ Monash University Department of Surgery, Central Clinical School, Alfred Health, Melbourne, VIC, Australia.
⁷ Neuroendocrine Unit, Division of Endocrinology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Division of Endocrinology, Department of Pediatrics, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
⁸ International Medical Affairs, Eli Lilly, Basingstoke, UK; Diabetes and Endocrinology, University College London, London, UK.
⁹ Institute of Metabolic Science and National Institute for Health and Care Research, Cambridge Biomedical Research Centre at Addenbrookes Hospital, Cambridge, UK.
¹⁰ Obesity Prevention and Care Program, Department of Medicine, University Hospitals of Geneva, Geneva, Switzerland.
¹¹ Diabetes Complications Research Centre, University College Dublin, Dublin, Ireland.
¹² School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK.
¹³ Sydney Medical School, The University of Sydney, Sydney, NSW, Australia; Weight Management Services, The Children's Hospital at Westmead, Sydney, NSW, Australia.
¹⁴ Centre for Metabolism, Obesity and Diabetes Research, Department of Pediatrics, McMaster University, Hamilton, ON, Canada; McMaster Children's Hospital, Hamilton, ON, Canada.
¹⁵ Fortis C-DOC Center of Excellence for Diabetes, Metabolic Diseases and Endocrinology, New Delhi, India; National Diabetes Obesity and Cholesterol Foundation, New Delhi, India; Diabetes Foundation New Delhi, India.
¹⁶ Toranomon Hospital, Tokyo, Japan.
¹⁷ Department of Endocrinology, Woodlands Health, National Healthcare Group, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
¹⁸ Department of Surgery, School of Translational Medicine, Monash University, Melbourne, VIC, Australia; Department of Endocrinology and Diabetes, Alfred Health, Melbourne, VIC, Australia.
¹⁹ Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL, USA.
²⁰ Pennington Biomedical Research Center, Baton Rouge, LA, USA.
²¹ CIBER Pathophysiology of Obesity and Nutrition, Girona, Spain; Department of Medical Sciences, School of Medicine, University of Girona, Girona, Spain; Hospital Trueta of Girona and Institut d'Investigació Biomèdica de Girona, Girona, Spain.
²² Chobanian & Avedisian School of Medicine, Boston University, Boston, MA, USA.
²³ Division of Endocrinology and Diabetology, Department of Medicine, University of Graz, Graz, Austria.
²⁴ First Department of Propaedeutic Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
²⁵ Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
²⁶ Department of Nutrition and Food Safety, World Health Organization, Geneva, Switzerland.
²⁷ Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK; Department of Diabetes and Endocrinology, Chelsea and Westminster Hospital National Health Service Foundation Trust, London, UK.
²⁸ Helmholtz Institute for Metabolic, Obesity and Vascular Research of Helmholtz Munich, University of Leipzig and University Hospital Leipzig, Leipzig, Germany.
²⁹ Department of Internal Medicine III, Carl Gustav Carus University Hospital Dresden, Technical University Dresden, Dresden, Germany; School of Cardiovascular and Metabolic Medicine & Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK.
³⁰ Institute of Diabetes, Obesity and Metabolism, University of Pennsylvania, Philadelphia, PA, USA.
³¹ School of Population Health, Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland; School of Public Health, Imperial College London, London, UK.
³² National Diabetes and Endocrine Center, Royal Hospital, Muscat, Oman; Oman Diabetes Association, Muscat, Oman.
³³ Obesity Endocrine and Metabolism Center, King Fahad Medical City, Riyadh, Saudi Arabia.
³⁴ Clinical Research Unit, Dasman Diabetes Institute, Dasman, Kuwait.
³⁵ Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
³⁶ Nutrition and Obesities: Systemic Approaches, NutriOmics Research Group, INSERM, Sorbonne Université, Paris, France; Department of Nutrition, Pitié-Salpêtrière Hospital, Assistance Publique-Hospital of Paris, Paris, France.
³⁷ VITAM-Research Center on Sustainable Health, Québec, QC, Canada.
³⁸ Iverson Health Innovation Research institute, Swinburne University of Technology, Melbourne, VIC, Australia.
³⁹ Regional Office for Europe, World Health Organization, Geneva, Switzerland.
⁴⁰ Section on Obesity Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
⁴¹ Division of Endocrinology, Columbia University Irving Medical Center, New York, NY, USA.
⁴² Claude Bernard Lyon 1 University, Lyon, France.
⁴³ Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seoul, South Korea.
⁴⁴ Mexican Society of Obesity, Monterrey, NL, Mexico.
⁴⁵ European Coalition for people Living with Obesity, Dublin, Ireland.
⁴⁶ Obesity Action Coalition, Tampa, FL, USA.
⁴⁷ Department of Community Health, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Abakaliki, Nigeria.
⁴⁸ Health Promotion and Obesity Management Unit, Department of Pathophysiology, Faculty of Medical Science, Medical University of Silesia, Katowice, Poland.
⁴⁹ School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
⁵⁰ Translational Research for Diabetes, Lille University, Lille University Hospital, Inserm, Institut Pasteur Lille, Lille, France; Department of General and Endocrine Surgery, Lille University Hospital, Lille, France.
⁵¹ Helmholtz Munich, Munich, Germany; Technical University of Munich, Munich, Germany.
⁵² University of Pretoria, Pretoria, South Africa; Nectare Waterfall City Hospital, Midrand, South Africa.
⁵³ Internal Medicine, Center for the Study and the Integrated Treatment of Obesity, Department of Medicine, University of Padova, Padua, Italy; Center for Metabolic and Nutrition Related Diseases,Humanitas Research Hospital, Milan, Italy.
⁵⁴ Division of Diabetes & Nutritional Sciences, School of Cardiovascular and Metabolic Medicine & Sciences, King's College London, London, UK; Catholic University of the Sacred Heart, Rome, Italy; University Polyclinic Foundation Agostino Gemelli IRCCS, Rome, Italy.

PMID: 39824205
PMCID: PMC11870235 (available on 2026-03-01)
DOI: 10.1016/S2213-8587(24)00316-4

Erratum in

Correction to Lancet Diabetes Endocrinol 2025; 13: 221-62.
[No authors listed] [No authors listed] Lancet Diabetes Endocrinol. 2025 Mar;13(3):e6. doi: 10.1016/S2213-8587(25)00006-3. Lancet Diabetes Endocrinol. 2025. PMID: 40015811 No abstract available.

Abstract

Current BMI-based measures of obesity can both underestimate and overestimate adiposity and provide inadequate information about health at the individual level, which undermines medically-sound approaches to health care and policy. This Commission sought to define clinical obesity as a condition of illness that, akin to the notion of chronic disease in other medical specialties, directly results from the effect of excess adiposity on the function of organs and tissues. The specific aim of the Commission was to establish objective criteria for disease diagnosis, aiding clinical decision making and prioritisation of therapeutic interventions and public health strategies. To this end, a group of 58 experts—representing multiple medical specialties and countries—discussed available evidence and participated in a consensus development process. Among these commissioners were people with lived experience of obesity to ensure consideration of patients’ perspectives. The Commission defines obesity as a condition characterised by excess adiposity, with or without abnormal distribution or function of adipose tissue, and with causes that are multifactorial and still incompletely understood. We define clinical obesity as a chronic, systemic illness characterised by alterations in the function of tissues, organs, the entire individual, or a combination thereof, due to excess adiposity. Clinical obesity can lead to severe end-organ damage, causing life-altering and potentially life-threatening complications (eg, heart attack, stroke, and renal failure). We define preclinical obesity as a state of excess adiposity with preserved function of other tissues and organs and a varying, but generally increased, risk of developing clinical obesity and several other non-communicable diseases (eg, type 2 diabetes, cardiovascular disease, certain types of cancer, and mental disorders). Although the risk of mortality and obesity-associated diseases can rise as a continuum across increasing levels of fat mass, we differentiate between preclinical and clinical obesity (ie, health vs illness) for clinical and policy-related purposes. We recommend that BMI should be used only as a surrogate measure of health risk at a population level, for epidemiological studies, or for screening purposes, rather than as an individual measure of health. Excess adiposity should be confirmed by either direct measurement of body fat, where available, or at least one anthropometric criterion (eg, waist circumference, waist-to-hip ratio, or waist-to-height ratio) in addition to BMI, using validated methods and cutoff points appropriate to age, gender, and ethnicity. In people with very high BMI (ie, >40 kg/m²), however, excess adiposity can pragmatically be assumed, and no further confirmation is required. We also recommend that people with confirmed obesity status (ie, excess adiposity with or without abnormal organ or tissue function) should be assessed for clinical obesity. The diagnosis of clinical obesity requires one or both of the following main criteria: evidence of reduced organ or tissue function due to obesity (ie, signs, symptoms, or diagnostic tests showing abnormalities in the function of one or more tissue or organ system); or substantial, age-adjusted limitations of daily activities reflecting the specific effect of obesity on mobility, other basic activities of daily living (eg, bathing, dressing, toileting, continence, and eating), or both. People with clinical obesity should receive timely, evidence-based treatment, with the aim to induce improvement (or remission, when possible) of clinical manifestations of obesity and prevent progression to end-organ damage. People with preclinical obesity should undergo evidence-based health counselling, monitoring of their health status over time, and, when applicable, appropriate intervention to reduce risk of developing clinical obesity and other obesity-related diseases, as appropriate for the level of individual health risk. Policy makers and health authorities should ensure adequate and equitable access to available evidence-based treatments for individuals with clinical obesity, as appropriate for people with a chronic and potentially life-threatening illness. Public health strategies to reduce the incidence and prevalence of obesity at population levels must be based on current scientific evidence, rather than unproven assumptions that blame individual responsibility for the development of obesity. Weight-based bias and stigma are major obstacles in efforts to effectively prevent and treat obesity; health-care professionals and policy makers should receive proper training to address this important issue of obesity. All recommendations presented in this Commission have been agreed with the highest level of consensus among the commissioners (grade of agreement 90–100%) and have been endorsed by 76 organisations worldwide, including scientific societies and patient advocacy groups.

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Conflict of interest statement

Declaration of interests FR declares research grants from Ethicon (Johnson & Johnson), Novo Nordisk, and Medtronic; consulting fees from Morphic Medical; speaking honoraria from Medtronic, Ethicon, Novo Nordisk, Eli Lilly, and Amgen; has served (unpaid) as a member of the scientific advisory board for Keyron, and a member of data safety and monitoring board for GI Metabolic Solutions; is president of the Metabolic Health Institute (non-profit); and is sole director of Metabolic Health International and London Metabolic and Bariatric Surgery (private practice). JRLF declares personal consulting or speaker fees from Novo Nordisk, IFA Celtics, Eli Lilly, and Merck. PS declares research grants (paid to institution) from the National Health and Medical Research Council; coauthorship of manuscripts with medical writing assistance from Novo Nordisk and Eli Lilly; and an unpaid position in the leadership group of the Obesity Collective. WAB declares research grants from Johnson & Johnson, Medtronic, Gore, Applied Medical, Novo Nordisk, National Health and Medical Research Council, Myerton, and the Australian Commonwealth Government; and personal consulting fees for lectures and advisory boards from Johnson & Johnson, Gore, Novo Nordisk, Pfizer, Medtronic, Eli Lily, and Merck Sharp & Dohme. GM declares consulting fees from Novo Nordisk, Boehringer Ingelheim, Eli Lilly, Medtronic, Fractyl, and Recor; and is a scientific advisor for Keyron, Metadeq, GHP Scientific, and Jemyll. MB declares personal honoraria as a consultant and speaker from Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Daiichi Sankyo, Eli Lilly, Novo Nordisk, Novartis, Pfizer, and Sanofi. ML declares personal consulting fees from, and has served on scientific boards for, Novo Nordisk, Pfizer, and Eli Lilly. LMSC declares consultancy fees from Antaros Medical. MTvdM declares past consulting fees from Netcare PTY and Novo Nordisk. RVC declares research grants from Johnson & Johnson and Medtronic; honoraria for lectures and presentations from Johnson & Johnson, Medtronic, and Novo Nordisk; and serving on scientific advisory boards for Morphic Medical, Johnson & Johnson, and Medtronic. AM declares research grants from USV (India) and AstraZeneca; honoraria for lectures from USV (India), Eli Lilly, Lupin, Boehringer Ingelheim, Janssen, Cipla, AstraZeneca, Glenmark, Zydus, Novo Nordisk, Sanofi, Danone, Abbott, and the Almond Board of California; support for attending meetings or travel from USV (India), Eli Lilly, Boehringer Ingelheim, AstraZeneca, Lupin, and the Almond Board of California. KC is a primary investigator for Rhythm Pharmaceuticals, Bioprojects, and Integrative Phenomic (SME) trials; declares support for attending meetings or travel from Rhythm Pharmaceuticals and Novo Nordisk; and received research grants or support from Rhythm Pharmaceuticals to conduct research or deliver lectures via Institutions (Assistance Publique-Hôpitaux de Paris, Sorbonne Université). RFK declares consulting fees from Novo Nordisk, Weight Watchers, Eli Lilly, Boehringer Ingelheim, Altimmune, Structure, and Regeneron. JN has no personal relationships with industry; is an employee of the Obesity Action Coalition, which receives unrestricted support from a wide variety of companies and organisations interested in obesity care including, from the pharmaceutical industry (NovoNordisk, Eli Lilly, Boehringer Ingelheim, Pfizer, Amgen, Genentech, Regeneron, Wave Life Sciences, Zealand Pharma, KVKTech, Madrigal Pharmaceuticals, Structure Therapeutics, Biohaen Pharmaceuticals, and Currax), surgical industry (Intuitive, Ethicon, Medtronic, and Boston Scientific), behavioural care (WW International and WondrHealth), and not-for-profit medical societies (American Society for Metabolic and Bariatric Surgery, the Obesity Society, and the Obesity Medicine Association); and is president and chief executive officer for the Obesity Action Coalition. NS declares consulting or speaker honoraria from Abbott, Amgen, AstraZeneca, Boehringer Ingelheim, Eli Lilly, Hanmi Pharmaceuticals, Janssen, Merck Sharp & Dohme, Novartis, Novo Nordisk, Pfizer, Roche Diagnostics, and Sanofi; and grants (paid to institution) from AstraZeneca, Boehringer Ingelheim, Novartis, and Roche Diagnostics. WTG declares consulting fees as a member of advisory boards for Boehringer Ingelheim, Eli Lilly, Novo Nordisk, Pfizer, Fractyl Health, Alnylam Pharmaceuticals, Inogen, Zealand Pharma, Allurion, Carmot Therapeutics (Roche), Regeneron, and Merck; research grants as a site principal investigator for multicentre clinical trials sponsored by his university and funded by Novo Nordisk, Eli Lilly, Epitomee, Neurovalens, and Pfizer; has served as a consultant on an advisory board for the non-profit Milken Foundation; and is a member of the data monitoring committee for phase 3 clinical trials conducted by Boehringer Ingelheim and Eli Lilly. BL declares research grants from US National Institutes of Health (not related to this Commission); and personal consulting fees from UpToDate. RHE declares consulting fees from Novo Nordisk, The Healthy Aging Co, and WW International. AK declares research grants from Novo Nordisk, ELPEN Pharma, and Pharmaserve–Lilly; serving on scientific advisory boards for Novo Nordisk, Pharmaserve–Lilly, Sanofi, and Boehringher Ingelheim; and honoraria for lectures by Novo Nordisk, Pharmaserve–Lilly, AstraZeneca, MSD, Sanofi, Bausch Health, Ethicon, Galenica Pharma, Epsilon Health, and Winmedica. J-PD declares grants from the Canadian Institutes of Health Research; and personal consulting fees from INVERSAGO Pharma as a member of the advisory board. KWT declares speaker honoraria or consulting fees from Novo Nordisk, Eurodrug Laboratories, iNova Pharmaceuticals, and DKSH; travel support from Novo Nordisk; and serving on advisory boards of Novo Nordisk, DKSH (representing Eli Lilly), Abbott Nutrition, and Boehringer Ingelheim. ER declares research grants from Eli Lilly and Novo Nordisk; and consulting fees from Energesis Pharmaceuticals, Eli Lilly, Amway, Kintai Therapeutics, YSOPIA Bioscience (previously LNC Therapeutics), CINFINA Pharmaceuticals, and Boehringer Ingelheim. JBD declares personal consulting fees from Reshape Lifescience, and Nestle Health Science Australia; serving on advisory boards and speaker panels for Reshape Lifescience, Nestle Health Science Australia, Novo Nordisk, Eli Lilly, and I-nova; and speaker fees from HealthED and Eurodrug Laboratories. FP declares personal consulting fees from Medtronic, Ethicon, Novo Nordisk, and Eli Lilly. DEC declares serving on scientific advisory boards for GI Dynamics, Gila Therapeutics, and Endogenex. TK declares research grants from Nippon Boehringer Ingelheim and Sumitomo Pharma; consulting fees from Taisho Pharmaceutical, Eli Lilly Japan, and Novo Nordisk; and honoraria for lectures from Nippon Boehringer Ingelheim, Sumitomo Pharma, Teijin Pharma, MSD, Eli Lilly Japan, Mitsubishi Tanabe Pharma Corporation, Taisho Pharmaceutical, and Novo Nordisk. NBAB declares research grants from NovoNordisk and AstraZeneca; and honoraria for lectures and presentations from Novo Nordisk, Boehringer Ingelheim, AstraZeneca, Merck, MSD, Sanofi, and Servier. JV was national clinical director for diabetes and obesity at NHS England from April, 2013, to September, 2023; declares funding support from the North West London National Institute for Health and Care Research Applied Research Collaboration, CW+ (the official charity of Chelsea and Westminster Hospital NHS Foundation Trust), European Commission Horizon Europe 2022, and UK Research and Innovation Horizon Europe. CWlR declares grants from the Irish Research Council, Science Foundation Ireland, Anabio, and the Health Research Board; serving on advisory boards and speakers panels for Novo Nordisk, Herbalife, GI Dynamics, Eli Lilly, Johnson & Johnson, Glia, Irish Life Health, Boehringer Ingelheim, Currax, Zealand Pharma, Keyron, and Rhythm Pharmaceuticals; was the chief medical officer and director (unpaid) of the Medical Device Division of Keyron in 2021; was a previous investor in Keyron, which develops endoscopically implantable medical devices intended to mimic the surgical procedures of sleeve gastrectomy and gastric bypass (no patients have been included in any of Keyron's studies and they are not listed on the stock market); was gifted stock holdings in September, 2021, and divested all stock holdings in Keyron in September, 2021; continues to provide scientific advice (unpaid) to Keyron; and provides (unpaid) obesity clinical care in the Beyond BMI clinic (Dublin, Ireland), and is a shareholder in the clinic. NJF-L declares personal consulting fees from WHO and the European Commission (Best Re-MaP joint action [a project aimed to develop and implement policy proposals in nutrition for children]). NFA declares personal consulting fees from Ethicon and Eli Lilly; and serving on scientific advisory boards for Novo Nordisk and Eli Lilly. ISF declares personal consulting fees from Rhythm Pharmaceuticals, Eli Lilly, Novo Nordisk, SV Health, Nodthera Therapeutics, and Goldman Sachs. VMM declares personal consulting fees from Boehringer Ingelheim and Novo Nordisk. JPK declares research grants from the US National Institutes of Health (grants U54, U01, and U54 GM104940 that could be indirectly linked to the work of this Commission); and honoraria for serving on scientific advisory boards of Novo Nordisk and the Annual Reviews of Nutrition. KMM reports serving on scientific advisory boards for Novo Nordisk and Rhythm Pharmaceuticals; and is a member of a drug safety and monitoring board for Novartis. PRS declares research grants from Ethicon and Medtronic; personal consulting fees or honoraria from GI Dynamics, Keyron, Persona, Mediflix, Metabolic Health International, Eli Lilly, Heron, Novo Nordisk, and Klens; serving on scientific advisory boards for SE Healthcare Board of Directors, GI Dynamics, Keyron, Persona, and Mediflix; and has ownership interest in SE Healthcare, Mediflix, and Metabolic Health International. HT declares research grants from Amgen, Boehringer Ingelheim, Daiichi Sankyo, Novartis, and Novo Nordisk; serving on advisory boards for Novo Nordisk, Daiichi Sankyo, and Novartis; and speakers fees from Daiichi Sankyo, Novartis, and Novo Nordisk. MHT declares participation in a scientific advisory board meeting of ERX Pharmaceuticals (Cambridge, MA, USA) in 2019; was a member of the Research Cluster Advisory Panel of the Novo Nordisk Foundation between 2017 and 2019; funding for research projects from Novo Nordisk (2016–20) and Sanofi-Aventis (2012–19); consulted twice for Boehringer Ingelheim (2020 and 2021); delivered scientific lectures for Sanofi-Aventis (2020), Boehringer Ingelheim (2024), and AstraZeneca (2024); is cofounder of the biotech startups Ghrelco and Bluewater Biotech (2024); is chief executive officer and chief scientific officer of Helmholtz Munich, and is co-responsible for countless collaborations of the employees with a multitude of companies and institutions worldwide (in this capacity, discusses potential projects with and signs contracts for the centres institutes related to research collaborations worldwide, including, but not limited to, pharmaceutical corporations such as Boehringer Ingelheim, Novo Nordisk, Roche Diagnostics, Arbormed, Eli Lilly, and SCG Cell Therapy, and as chief scientific officer is responsible for commercial technology transfer activities); and is a former member of the scientific advisory board of ERX, which is developing the drug celastrol, but has no current competing interests. JPHW declares consultancy or advisory board work for the pharmaceutical industry contracted via the University of Liverpool (no personal payment) for Altimmune, Amgen, AstraZeneca, Boehringer Ingelheim, Eli Lilly, Napp, Novo Nordisk, Menarini, Pfizer, Regeneron, Rhythm Pharmaceuticals, Sanofi, Saniona, Tern, Shionogi, and YSOPIA Bioscience; research grants for clinical trials from AstraZeneca and Novo Nordisk; personal honoraria or lecture fees from AstraZeneca, Boehringer Ingelheim, Medscape, Napp, Novo Nordisk, and Rhythm Pharmaceuticals; is past president of the World Obesity Federation; and was national lead for the Metabolic and Endocrine Speciality Group of the National Institute of Health and Reasearch Clinical Research Network from 2010–24; and is a member of the Rank Prize Funds Nutrition Committee and a past member of the RCP committee on nutrition, weight, and health. FCS declares personal consulting fees from Eli Lilly, Novo Nordisk, Boehringer Ingelheim, Pfizer, Gelesis, Currax, and Rhythm Pharmaceuticals; and has served on scientific advisory boards for Eli Lilly and Novo Nordisk. LAB declares serving on scientific advisory board for Novo Nordisk (for the ACTION Teens study) and Eli Lilly; and speaker fees (paid to institution) from Novo Nordisk. LMK declares participation on advisory boards for Boehringer Ingelheim and Eli Lilly; and consulting fees from Altimmune, Amgen, AstraZeneca, Boehringer Ingelheim, Cytoki, Ethicon, Glyscend, Kallyope, Eli Lilly, Neurogastrx, Novo Nordisk, Optum Health, Perspectum, Pfizer, Sidekick Health, Xeno Biosciences, and Zealand Pharma. RLB declares research grants from the Sir Jules Thorn Trust, National Institutes for Health and Care Research, Rosetrees Trust, and Novo Nordisk; personal consulting fees from Eli Lilly, Novo Nordisk, Gila Therapeutics, Epitomee Medical, Medscape, ViiV, and International Medical Press; serving on scientific advisory boards for Eli Lilly, Novo Nordisk, Pfizer, ViiV, and International Medical Press; leadership or fiduciary roles (unpaid) in other board, society, committee, or advocacy groups for the Royal College of Physicians; is a committee member of the British Obesity and Metabolic Surgery Society and the National Bariatric Surgery Registry; is scientific chair of the International Federation for the Surgery of Obesity, European Chapter; is a trustee for the Association for the Study of Obesity and the Obesity Empowerment Network UK; is a member of the Obesity Guideline Update Committee for the National Institutes for Health and Care Excellence; and, since May 15, 2023, is senior vice president for Eli Lilly and holds shares in Eli Lilly, and as a result has had no active involvement in this Commission since May 1, 2023 (however, to comply with authorship requirements, RLB read and approved the final draft [see Acknowledgements for details]). RV declares research grants from Pfizer; fees for educational purposes from Novo Nordisk, AstraZeneca, and Eli Lilly; and serving on scientific advisory boards for Eli Lilly and Novo Nordisk. MO-G declares research grants from Adamed Poland; personal consulting fees from Baush Health, Novo Nordisk, and Promed Poland; and serving on scientific advisory boards for Baush Health, Novo Nordisk, and Boehringer Ingelheim. HJG declares consulting fees from Gila Pharmaceuticals and Pfizer. SL declares research grants from Merck Sharp & Dohme, Novo Nordisk, and LG Chem; and honoraria as a consultant or speaker for AstraZeneca, Boehringer Ingelheim, Abbott, LG Chem, Daewoong Pharmaceutical, Chong Kun Dang Pharmaceutical, and Novo Nordisk. All other authors have no competing interests.

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1. WHO. Obesity: preventing and managing the global epidemic. Report of a WHO consultation. WHO technical report series 894. World Health Organisation, 2000. - PubMed
1. Carruba MO, Busetto L, Bryant S, et al. The European Association for the Study of Obesity (EASO) endorses the Milan Charter on Urban Obesity. Obes Facts 2021; 14: 163–68. - PMC - PubMed
1. American Society for Metabolic and Bariatric Surgery. Consensus statement on obesity as a disease. https://asmbs.org/resources/consensus-statement-on-obesity-as-a-disease/ (accessed Dec 6, 2023).
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Definition and diagnostic criteria of clinical obesity

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Definition and diagnostic criteria of clinical obesity

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