"Beyond BMI"... Seoul National University Bundang Hospital Proposes New Obesity Diagnostic Criteria for Asians

Comprehensive Assessment of Body Fat and Comorbidity
Distinguishing 'Pre-Obesity' and 'Clinical Obesity Disease'

A study has found that it is difficult to accurately diagnose obesity in Asians using only the Body Mass Index (BMI). A personalized obesity diagnostic system for Asians, which evaluates body fat quantity and distribution as well as comorbidity status, has been proposed.

Characteristics of Obesity in Asians. Bundang Seoul National University Hospital

On July 28, Seoul National University Bundang Hospital announced that the research team led by Professor Soo Lim of the Department of Endocrinology and Metabolism, in collaboration with researchers from Japan, China, and India, has published a review paper proposing new diagnostic criteria for obesity that reflect the unique characteristics of Asians.

Currently, obesity is mainly diagnosed based on BMI, but this measure has limitations as it fails to reflect the amount and location of body fat, as well as associated health risks. In particular, Asians may have a normal BMI but still accumulate fat in the abdomen, liver, or pancreas, which increases the risk of diabetes, fatty liver disease, and cardiovascular disease—but relying on BMI alone can easily miss these risks. The research team also highlighted that 32% of Korean adults with a normal BMI (18.5–22.9) are at risk of metabolic diseases.

Based on the 'clinical obesity disease' concept featured in the Lancet Commission in 2025, the research team proposed an Asian-specific diagnostic system. The core idea is to classify cases with excessive body fat but no comorbidities as 'pre-obesity,' and those with organ dysfunction or comorbidities caused by excess body fat as 'clinical obesity disease.'

Three-Step Approach to Diagnosing 'Clinical Obesity Disease.' Seoul National University Bundang Hospital

Diagnosis of clinical obesity disease involves first confirming the presence of excess body fat and then evaluating organ dysfunction. This comprehensive assessment includes waist circumference, body fat percentage, blood glucose, blood pressure, cholesterol, kidney function, and may utilize tools such as DXA (dual-energy X-ray absorptiometry) or bioelectrical impedance analysis devices.

The research team suggested that treatment strategies should also differ according to the diagnostic stage. In the pre-obesity stage, efforts such as improving diet and increasing physical activity can prevent the development of complications, while clinical obesity disease requires more aggressive treatments, such as GLP-1–based anti-obesity medications or bariatric-metabolic surgery.

Professor Lim stated, "Even if Asians do not weigh much, the accumulation of visceral fat and fat in the liver and pancreas can increase the risk of diabetes and fatty liver disease. The focus of obesity care should shift from weight alone to the amount and location of body fat, organ function, and actual health problems." The research findings were recently published in the international journal Nature Reviews Endocrinology.

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