Definition and diagnostic criteria of clinical obesity

Probably not a substantial claim: may not pass S2 (checkable).

Disease states are fundamentally defined by their ability to cause illness, intended as both an objective and subjective human experience of ill health, secondary to ongoing alterations in the functioning of organs and tissues.

“Disease states are fundamentally defined by their ability to cause illness, intended as both an objective and subjective human experience of ill health, secondary to ongoing alterations in the functioning of organs and tissues.”

• cites [19] Scully, 2004, What is a disease?, EMBO Rep sourceNot checked — no full text of the source
• cites [20] Boyd, 2000, Disease, illness, sickness, health, healing and wholeness: exploring some elusive concepts, Med Humanit sourcePartly supported

  The Dictionary definitions section describes disease as a disorder of structure or function that can produce or threaten illness. But A medical definition distinguishes objective disease from illness as an entirely personal experience; it also says disease can occur without felt illness. The copy does not specifically define disease through ongoing changes in organs and tissues. (LLM, conf=0.88)

  Experimental — accuracy not yet measured
• cites [21]Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites [22] Farre, 2017, The new old (and old new) medical model: four decades navigating the biomedical and psychosocial understandings of health and illness, Healthcare sourceDisputed

  The Introduction distinguishes disease from illness rather than defining disease by its ability to cause illness. It explicitly says a person can have disease without illness, or experience illness without objectively verifiable disease; illness is therefore not necessarily secondary to changes in organs and tissues. (LLM, conf=0.90)

  Checked by a reasoning model — may be wrong.

  Experimental — accuracy not yet measured
• cites [23]Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

The association between BMI-based obesity and mortality is U-shaped, with factors such as smoking history, occult disease, recent unintentional weight loss, weight variability, and body fat distribution pattern influencing the shape of the BMI versus mortality curve.

“The association between BMI-based obesity and mortality is actually U-shaped, with factors such as smoking history, occult disease, recent unintentional weight loss, weight variability, and body fat distribution pattern influencing the shape of the BMI versus mortality curve.43”

• cites [43] Flegal, 2013, Association of all-cause mortality with overweight and obesity using standard body mass index categories: a systematic review and meta-analysis, JAMA sourceDisputed

  Split into 2 atoms — 0 confirmed, 1 partially supported, 1 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

  Checked by a reasoning model — may be wrong.

  Experimental — accuracy not yet measured

May combine two claims.

Several studies have shown that BMI does not reflect body fat distribution or metabolic health, and alternative measures such as waist circumference or body fat percentage could be more appropriate.

“However, several studies have shown that BMI does not reflect body fat distribution or metabolic health, and alternative measures such as waist circumference or body fat percentage could be more appropriate.36”

• cites [36] Ross, 2020, Waist circumference as a vital sign in clinical practice: a consensus statement from the IAS and ICCR Working Group on Visceral Obesity, Nat Rev Endocrinol sourcePartly supported

  The Abstract (page unavailable) says BMI alone does not fully capture abdominal adiposity or cardiometabolic risk and recommends waist circumference to refine risk assessment. The section on waist circumference, BMI and health outcomes (page unavailable) favors using the two measures together, rather than replacing BMI. The cited passages do not support body fat percentage as a more appropriate measure. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

May combine two claims.

BMI can underestimate fat mass in the elderly, in individuals who have lost bone or muscle mass, and in people of certain ethnicities, leading to underdiagnosis of obesity.

“For example, BMI can underestimate fat mass in the elderly, in individuals who have lost bone or muscle mass, and in people of certain ethnicities (eg, Asian populations), leading to underdiagnosis of obesity.35,40”

• cites [35] Romero-Corral, 2008, Accuracy of body mass index in diagnosing obesity in the adult general population, Int J Obes (Lond) sourcePartly supported

  The Discussion (page unavailable) reports that BMI misses more than half of people classified as obese by body-fat percentage, particularly among the elderly, and explains that BMI cannot distinguish fat from lean mass. Its example of a person with limited lean mass supports the muscle-mass portion. Our copy does not specifically establish underdiagnosis in people who have lost bone mass or in Asian populations. (LLM, conf=0.88)

  Experimental — accuracy not yet measured
• cites [40] Sperrin, 2016, Body mass index relates weight to height differently in women and older adults: serial cross-sectional surveys in England (1992–2011), J Public Health sourcePartly supported

  The Introduction (page unavailable) says BMI is not a measure of body fat amount, and the Discussion, ‘What this study adds’ (page unavailable), cautions that BMI’s meaning varies across adults and age groups. The paper does not establish that BMI specifically underestimates fat mass in older adults, people who have lost bone or muscle, or particular ethnic groups, or that it leads to underdiagnosis of obesity. (LLM, conf=0.82)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing).

Some research studies have called into question the role of sedentary lifestyle as a cause of obesity in modern societies.

“However, some research studies have called into question the role of sedentary lifestyle as a cause of obesity in modern societies.59”

• cites [59] Rimbach, 2022, Total energy expenditure is repeatable in adults but not associated with short-term changes in body composition, Nat Commun sourcePartly supported

  The Discussion reports no evidence that adults with lower adjusted total energy expenditure were more likely to gain body fat, which lends some support to questioning an expenditure-based explanation of weight gain. But it also says the study lacked objective physical-activity measures. It therefore does not directly test whether a sedentary lifestyle causes obesity in modern societies. (LLM, conf=0.86)

  Experimental — accuracy not yet measured

May combine two claims.

The causes of obesity are multifactorial and incompletely understood.

“The causes of obesity are multifactorial and incompletely understood.2,5,80”

• cites [2] 2000Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites [5] Bray, 2017, Obesity: a chronic relapsing progressive disease process. A position statement of the World Obesity Federation, Obes Rev sourcePartly supported

  The agent and Genetic factors sections describe multiple environmental and genetic contributors to obesity, supporting ‘multifactorial.’ Our copy does not say that obesity’s causes are incompletely understood, so that part of the claim is not supported. (LLM, conf=0.82)

  Experimental — accuracy not yet measured
• cites [80] Purnell, 2000, Definitions, classification, and epidemiology of obesityNot checked — no full text of the source

Classified as probably not a substantial claim.

Another multidisciplinary group of international experts found that people living with obesity are frequently confronted with biases or stigma that extend from social interactions to the workplace and health-care settings, causing psychological and physical harm.

“Another multidisciplinary group of international experts found that people living with obesity are frequently confronted with biases or stigma that extend from their social interactions to the workplace and to health-care settings, causing psychological and physical harm.11”

• cites [11] Rubino, 2020, Joint international consensus statement for ending stigma of obesity, Nat Med sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing).

Environmental pollutants might also contribute to obesity, although those mechanisms are largely undefined.

“Environmental pollutants might also contribute to obesity, although those mechanisms are largely undefined.82,83”

• cites [82] Lobstein, 2021, Endocrine-disrupting chemicals and obesity risk: a review of recommendations for obesity prevention policies, Obes Rev sourceNot checked — no full text of the source
• cites [83] Mohajer, 2021, Obesogens: how they are identified and molecular mechanisms underlying their action, Front Endocrinol sourceSupported

May combine two claims.

Biased views toward patients living with obesity are common among clinicians and other health-care professionals, often resulting in detrimental effects on patient care.

“Biased views toward patients living with obesity are common among clinicians and other health-care professionals, often resulting in detrimental effects on patient care.11,63”

• cites [11] Rubino, 2020, Joint international consensus statement for ending stigma of obesity, Nat Med sourceSupported
• cites [63] Nadolsky, 2023, Endocr Pract sourceNot checked — no full text of the source

Classified as probably not a substantial claim.

The traditional narrative about the health effect of obesity emphasises associations between excess adiposity and numerous diseases and conditions.

“The traditional narrative about the health effect of obesity emphasises associations between excess adiposity and numerous diseases and conditions.53,54”

• cites [53] Powell-Wiley, 2021, Obesity and cardiovascular disease: a scientific statement from the American Heart Association, Circulation sourceNot checked — no full text of the source
• cites [54] Sarwer, 2016, The psychosocial burden of obesity, Endocrinol Metab Clin North Am sourceSupported

May combine two claims.

The hypertriglyceridaemic waist approach might increase accuracy in identifying individuals with greater risk of developing cardiovascular diseases in the future, but concerns remain for its validity as a measure of ongoing disease.

“Again, this approach might increase accuracy in identifying individuals with greater risk of developing cardiovascular diseases in the future, but concerns remain for its validity as a measure of ongoing disease.52”

• cites [52] Sinaga, 2018, Optimal cut-off for obesity and markers of metabolic syndrome for Ethiopian adults, Nutr J sourceCould not verify

  The Results section reports waist-circumference cut-offs for high triglyceride levels in Ethiopian adults, but does not evaluate a combined hypertriglyceridaemic-waist approach. Searches for future cardiovascular risk and validity as a measure of ongoing disease found no passage addressing either claim; page numbers are unavailable in our copy. (LLM, conf=0.76)

  Experimental — accuracy not yet measured

May combine two claims.

The pathophysiology of obesity not only involves an increase in total body fat, with preferential distribution to the intra-abdominal compartment in the presence of insulin resistance, but also ectopic lipid accrual into non-adipose tissues, especially in the liver, skeletal muscle, and the pancreas.

“Hence, the pathophysiology of obesity not only involves an increase in total body fat, with preferential distribution to the intra-abdominal compartment in the presence of insulin resistance, but also ectopic lipid accrual into non-adipose tissues, especially in the liver, skeletal muscle, and the pancreas.95”

• cites [95] Chait, 2020, Adipose tissue distribution, inflammation and its metabolic consequences, including diabetes and cardiovascular disease, Front Cardiovasc Med sourceSupported

May combine two claims.

Lean individuals can be insulin-resistant and, conversely, people with obesity can be insulin-sensitive without an increased risk of future diabetes or cardiovascular disease.

“Lean individuals can be insulin-resistant and, conversely, people with obesity can be insulin-sensitive without an increased risk of future diabetes or cardiovascular disease.96”

• cites [96] Gonzalez-Cantero, 2018, Insulin resistance in lean and overweight non-diabetic Caucasian adults: study of its relationship with liver triglyceride content, waist circumference and BMI, PLoS One sourcePartly supported

  The Introduction states that insulin resistance occurs in non-obese individuals, supporting the first part of the claim. The paper does not establish that people with obesity can be insulin-sensitive without increased future diabetes or cardiovascular risk; the Discussion says its cross-sectional design could not assess the natural progression of insulin resistance, and the Introduction reports increased cardiovascular risk with higher BMI. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

May combine two claims.

Obesity is causally associated with atrial fibrillation, with preliminary evidence of reduced incident atrial fibrillation from large weight loss.

“Obesity is also causally associated with atrial fibrillation, with preliminary evidence of reduced incident atrial fibrillation from large weight loss (eg, >10% of total body mass).114”

• cites [114] Pontiroli, 2023, Effect of prolonged and substantial weight loss on incident atrial fibrillation: a systematic review and meta-analysis, Nutrients sourcePartly supported

  The Discussion and Conclusions (pages unavailable in our copy) report that bariatric surgery is associated with reduced incident atrial fibrillation, possibly through sustained weight loss. The Introduction describes an association between obesity and atrial fibrillation, not an established causal link; the Discussion says a causal relationship between weight loss and prevention of atrial fibrillation still needs confirmation. The paper also says more studies are needed to determine how much weight loss is required, so it does not establish the cited >10% threshold. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

May combine two claims.

Lymphoedema can also lead to severe infections, ulcer formation, psychosocial morbidity, and malignant transformation.

“Lymphoedema can also lead to severe infections, ulcer formation, psychosocial morbidity, and malignant transformation.104,105”

• cites [104] Mehrara, 2014, Lymphedema and obesity: is there a link?, Plast Reconstr Surg sourcePartly supported

  The opening section (page not available) associates adipose deposition in late-stage lymphedema with severe infections, psychosocial morbidity, and malignant transformation. It mentions skin changes, but does not specifically identify ulcer formation; it also frames these outcomes as associations with late-stage disease rather than effects of lymphedema generally. (LLM, conf=0.88)

  Experimental — accuracy not yet measured
• cites [105] Gasparis, 2020, Diagnostic approach to lower limb edema, Phlebology sourcePartly supported

  The Introduction (page unavailable) says chronic edema negatively affects psychological health and quality of life, which supports the psychosocial part at a broader level than lymphoedema specifically. The Physical examination section associates ulcerations with advanced venous disease, while the paper does not say lymphoedema leads to severe infections or malignant transformation. (LLM, conf=0.84)

  Experimental — accuracy not yet measured

May combine two claims.

Although the case for physical inactivity as a cause of obesity is weak, there is clear evidence that it contributes to adverse metabolic effects associated with obesity.

“Although the case for physical inactivity as a cause of obesity is weak,84 there is clear evidence that it contributes to adverse metabolic effects associated with obesity.”

• cites [84] Pontzer, 2012, Hunter-gatherer energetics and human obesity, PLoS One sourceSupported

May combine two claims.

Obesity increases risk of thromboembolism, which has also been confirmed genetically.

“Obesity increases risk of thromboembolism, which has also been confirmed genetically.107”

• cites [107] Larsson, 2020, Body mass index and body composition in relation to 14 cardiovascular conditions in UK Biobank: a Mendelian randomization study, Eur Heart J sourceSupported

May combine two claims.

Obesity increases cancer risk by stimulating anabolic signalling pathways, altering hormone regulation, increasing inflammation, inducing DNA damage, and impairing DNA repair mechanisms, although specific mechanisms of action remain somewhat unclear.

“Obesity increases cancer risk by stimulating anabolic signalling pathways, altering hormone regulation, increasing inflammation, inducing DNA damage, and impairing DNA repair mechanisms, although specific mechanisms of action remain somewhat unclear.133”

• cites [133] Pati, 2023, Obesity and cancer: a current overview of epidemiology, pathogenesis, outcomes, and management, Cancers sourcePartly supported

  Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

  Experimental — accuracy not yet measured

May combine two claims.

Men with obesity have elevated rates of erectile dysfunction and lower urinary tract symptoms.

“Men with obesity have elevated rates of erectile dysfunction and lower urinary tract symptoms.123”

• cites [123] Palmer, 2012, Impact of obesity on male fertility, sperm function and molecular composition, Spermatogenesis sourceCould not verify

  The ‘Male Obesity and Altered Hormone Profiles’ and ‘Obesity, Metabolic Syndrome and Fertility’ sections discuss testosterone, sperm counts, and fertility, not rates of erectile dysfunction or lower urinary tract symptoms. Searches for both symptoms and related terms found no passage in our copy addressing the claimed rates. (LLM, conf=0.76)

  Experimental — accuracy not yet measured

May combine two claims.

Weight discrimination can cause people to have higher levels of weight gain, cardiometabolic risk, obesity-related complications, and increased mortality.

“Weight discrimination can cause people to have higher levels of weight gain, cardiometabolic risk, obesity-related complications, and increased mortality.11”

• cites [11] Rubino, 2020, Joint international consensus statement for ending stigma of obesity, Nat Med sourcePartly supported

  The Summary of evidence, under “Physical and mental health consequences of weight stigma” (page unavailable), links weight stigma to weight gain and reports higher cardiometabolic risk and mortality among people experiencing weight discrimination. It describes these outcomes chiefly as associations, not established effects caused by discrimination; it also does not directly establish the broader claim about obesity-related complications. (LLM, conf=0.86)

  Experimental — accuracy not yet measured

May combine two claims.

Peripheral neuropathy and chronic pain are related to clinical obesity and can contribute to functional impairment.

“Peripheral neuropathy and chronic pain are related to clinical obesity and can contribute to functional impairment.132”

• cites [132] Fjeldstad, 2008, The influence of obesity on falls and quality of life, Dyn Med sourcePartly supported

  The Results (page unavailable) show that the obese group had worse bodily-pain and physical-function scores than the non-obese group. They do not establish that the pain was chronic or that pain contributed to functional impairment. Peripheral neuropathy appears only in a reference about falls; our copy does not link it to obesity. (LLM, conf=0.86)

  Experimental — accuracy not yet measured

May combine two claims.

A major contributor to obesity is psychological stress, which can lead to uncontrolled eating.

“A major contributor to obesity is psychological stress, which can lead to uncontrolled eating.134”

• cites [134] Petrelli, 2021, Association of obesity with survival outcomes in patients with cancer: a systematic review and meta-analysis, JAMA Netw Open sourceCould not verify

  The Introduction and Discussion address obesity in relation to cancer risk and survival, not causes of obesity. Searches for psychological stress, uncontrolled eating, and emotional eating found no passage in our copy supporting the claimed link. (LLM, conf=0.75)

  Experimental — accuracy not yet measured

May combine two claims.

In men, obesity is a cause of hypogonadotropic hypogonadism resulting in spermatogenesis disturbances and erectile dysfunction.

“In men, obesity is a cause of hypogonadotropic hypogonadism resulting in spermatogenesis disturbances and erectile dysfunction.121–123”

• cites [121] Fernandez, 2019, Male obesity-related secondary hypogonadism—pathophysiology, clinical implications and management, Eur Endocrinol sourcePartly supported

  The Abstract and the ‘Obesity and hypogonadism – bidirectional relationship’ section describe obesity as a cause of functional hypogonadotrophic hypogonadism. The ‘Exercise alone’ section discusses recovery of erectile function in patients with MOSH. However, the paper attributes suppression of spermatogenesis to testosterone replacement therapy, not to obesity-induced hypogonadism; no page numbers are available in our copy. (LLM, conf=0.87)

  Experimental — accuracy not yet measured
• cites [122] Sultan, 2020, Male obesity associated gonadal dysfunction and the role of bariatric surgery, Front Endocrinol sourcePartly supported

  The Testosterone Deficiency section says obesity is a strong risk factor for male secondary hypogonadism and that its effects include erectile dysfunction and changes in sperm and semen parameters. The Erectile Dysfunction section also describes obesity-related central hypogonadism. But the Sperm and Semen Parameters section says obesity’s effect on those parameters remains ambiguous, so the claim’s unqualified assertion of resulting spermatogenesis disturbances is stronger than the paper supports. (LLM, conf=0.83)

  Experimental — accuracy not yet measured
• cites [123] Palmer, 2012, Impact of obesity on male fertility, sperm function and molecular composition, Spermatogenesis sourcePartly supported

  The 'Male Obesity and Altered Hormone Profiles' section links higher BMI with altered reproductive hormones and reduced sperm counts, but describes obesity-related disruption of the hypothalamic–pituitary–gonadal axis as a hypothesis rather than establishing hypogonadotropic hypogonadism as its consequence. 'Obesity, Metabolic Syndrome and Fertility' also cautions that obesity may not directly cause reduced sperm counts. The paper passages found do not support the erectile-dysfunction part of the claim (searched: erectile dysfunction, sexual dysfunction). (LLM, conf=0.88)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Obesity is associated with increased risk for 13 types of cancer that account for more than 40% of cancer diagnoses annually.

“Obesity is associated with increased risk for 13 types of cancer that account for more than 40% of cancer diagnoses annually.99,133,134”

• cites [99] Gallagher, 2020, Hyperinsulinaemia in cancer, Nat Rev Cancer sourceNot checked — no full text of the source
• cites [133] Pati, 2023, Obesity and cancer: a current overview of epidemiology, pathogenesis, outcomes, and management, Cancers sourcePartly supported

  Section 6 (Obesity and Cancer Risk; page not provided) reports strong evidence linking obesity to increased risk of 13 cancers. The paper does not state that those 13 cancer types account for more than 40% of annual cancer diagnoses; its 4–8% figure in Section 4 measures the proportion of cancers attributed to obesity, which is a different quantity. (LLM, conf=0.88)

  Experimental — accuracy not yet measured
• cites [134] Petrelli, 2021, Association of obesity with survival outcomes in patients with cancer: a systematic review and meta-analysis, JAMA Netw Open sourcePartly supported

  The Introduction says increased BMI is associated with increased risk of multiple cancer types. It does not specify 13 types or say that they account for more than 40% of annual cancer diagnoses; searches for those figures found no supporting passage in our copy. (LLM, conf=0.86)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The iteration characteristics of the Delphi technique have intrinsic limitations and might lead to groupthink, where participants might conform to dominant opinions of the group, which could affect objectivity.

“The iteration characteristics of the Delphi technique have intrinsic limitations and might lead to groupthink, where participants might conform to dominant opinions of the group, which could affect objectivity.197”

• cites [197] Hsu, 2007, The Delphi technique: making sense of consensus, Pract Assess Res Eval sourceSupported

May combine two claims.

Type 2 diabetes is a highly heterogeneous disease (some studies suggest multiple subtypes might exist).

“type 2 diabetes is a highly heterogeneous disease (some studies suggest multiple subtypes might exist),195”

• cites [195] Ahlqvist, 2018, Novel subgroups of adult-onset diabetes and their association with outcomes: a data-driven cluster analysis of six variables, Lancet Diabetes Endocrinol sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing).

In a survey of commissioners' initial opinions, about 70% agreed that the current definition of obesity is not consistent with the notion of a standalone disease state.

“In a survey of commissioners’ initial opinions, a large majority of the group (~70%) agreed that the current definition of obesity (“abnormal or excessive fat accumulation that presents a risk to health”)34 is not consistent with the notion of a standalone disease state.”

• cites [34]Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Classified as probably not a substantial claim.

The Commission identified a limitation in the current definition of obesity: lack of clarity on whether abnormal function of adipose tissue and excess adipose tissue mass should both be present to define obesity.

“One important limitation is the lack of clarity on whether abnormal function (metabolic, endocrine, or both) of adipose tissue and excess adipose tissue mass should both be present to define obesity.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

In a pre-Delphi survey, more than half of commissioners rejected the all-or-nothing scenario of whether obesity is a disease, supporting the view that obesity is a risk factor for other diseases and sometimes a disease itself.

“A specific pre-Delphi survey on the question of whether obesity is a disease showed that more than half of the commissioners rejected the all-or-nothing scenario implied in the question, but supported the view that obesity is a risk factor for other diseases and sometimes a disease itself.”

Probably not a substantial claim: may not pass S3 (load-bearing).

There was general agreement among commissioners that abnormal function of adipose tissue results in several perturbances of physiology, such as insulin resistance, thereby crucially contributing to metabolic consequences of obesity.

“There was general agreement among commissioners that abnormal function of adipose tissue results in several perturbances of physiology, such as insulin resistance, thereby crucially contributing to metabolic consequences of obesity.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

In the same survey, only about a third of commissioners supported the idea of obesity as a disease, and the rest did not consider obesity to be a disease.

“Only about a third supported the idea of obesity as a disease, and the rest of the commissioners did not consider obesity to be a disease.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Initial opinions among commissioners diverged substantially, and consensus would not be reached on a blanket definition of obesity as a disease, at least as currently defined.

“Initial opinions diverged substantially, clearly indicating that a consensus would not be reached on a blanket definition of obesity as a disease, at least as currently defined.”

Classified as probably not a substantial claim. May combine two claims.

There was strong agreement among commissioners (98%) that the use of BMI should be restricted to screening patients with potential obesity, whereas additional measures of adiposity are essential to confirm obesity status at the clinical level.

“There was strong agreement among commissioners (98%) that the use of BMI should be restricted to the screening of patients with potential obesity (table 1), whereas additional measures of adiposity are essential to confirm obesity status (ie, excess adiposity) at the clinical level.”

Probably not a substantial claim: may not pass S3 (load-bearing).

In that survey, respondents stated that the treatment of obesity was less effective than for nine of ten other chronic conditions.

“Moreover, those who responded stated that the treatment of obesity was less effective than for nine of ten other chronic conditions.”

• cites [64] Foster, 2003, Primary care physicians' attitudes about obesity and its treatment, Obes Res sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

In that survey, the majority (75%) of physicians felt that a 10% weight reduction was sufficient to improve obesity-related health complications, but claimed that insufficient reimbursement limited their ability to treat obesity adequately.

“The majority (75%) of physicians felt that a 10% weight reduction was sufficient to improve obesity-related health complications, but claimed that insufficient reimbursement limited their ability to treat obesity adequately.”

• cites [64] Foster, 2003, Primary care physicians' attitudes about obesity and its treatment, Obes Res sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

In Foster and colleagues' 2003 survey, physical inactivity was listed by responders as the most salient cause for obesity, although overeating and a high-fat diet were considered important.

“Although overeating and a high-fat diet were considered important, physical inactivity was listed by responders as the most salient cause for obesity.”

• cites [64] Foster, 2003, Primary care physicians' attitudes about obesity and its treatment, Obes Res sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

When ascertaining perceived treatment effectiveness, lifestyle interventions are considered more useful than medical management among people with obesity.

“When ascertaining perceived treatment effectiveness, lifestyle interventions (eg, healthy eating and physical activity) are considered more useful than medical management among people with obesity.57”

• cites [57] Kaplan, 2018, Perceptions of barriers to effective obesity care: results from the national ACTION study, Obesity sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

In that survey, patients living with obesity were described as unattractive, awkward, and non-compliant.

“Patients living with obesity were described as unattractive, awkward, and non-compliant.”

• cites [64] Foster, 2003, Primary care physicians' attitudes about obesity and its treatment, Obes Res sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

The most cited perceived barriers to successful management of obesity are lack of exercise and motivation.

“The most cited perceived barriers to successful management of obesity are lack of exercise and motivation.”

May combine two claims.

Skin-on-skin rubbing and excessive moisture damage skin, causing inflammation and rash (eg, intertrigo), which predispose skin to fungal and bacterial infections.

“Skin-on-skin rubbing and excessive moisture damage skin, causing inflammation and rash (eg, intertrigo), which predispose skin to fungal and bacterial infections.”

May combine two claims.

Weight stigma can exacerbate disordered eating, binge eating, emotional overeating, the choice of unhealthy diets, avoidance of physical activity, and encouragement of sedentary behaviour.

“Paradoxically, weight stigma can exacerbate disordered eating, binge eating, emotional overeating, the choice of unhealthy diets, avoidance of physical activity, and encouragement of sedentary behaviour.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The presence and severity of obesity-related organ dysfunction vary among children and adolescents, and not all people are susceptible to the same complications.

“The presence and severity of obesity-related organ dysfunction vary among children and adolescents, and not all people are susceptible to the same complications.”

May combine two claims.

Not every person with excess adiposity has ongoing illness; some people with obesity might be able to maintain normal function of organs and substantially preserved health, long term.

“Not every person with excess adiposity has ongoing illness; some people with obesity might be able to maintain normal function of organs and substantially preserved health, long term.”

May combine two claims.

About half of children with obesity will have obesity throughout their lives, with considerable effects on adult morbidity.

“About half of children with obesity will have obesity throughout their lives, with considerable effects on adult morbidity.”

Probably not a substantial claim: may not pass S2 (checkable).

The inability to recognise obesity as a direct cause of ill health could undermine effective treatment and medically sound policies from regulatory agencies and health insurers.

“However, the inability to recognise obesity as a direct cause of ill health could undermine effective treatment and medically sound policies from regulatory agencies and health insurers.”

Probably not a substantial claim: may not pass S4 (based).

The idea of obesity as a standalone disease entity remains controversial, both within and beyond the medical community.

“The idea of obesity as a standalone disease entity, however, remains controversial, both within and beyond the medical community.”

Probably not a substantial claim: may not pass S2 (checkable).

With no explicit characterisation of the illness intrinsically induced by obesity, independent of comorbidities, the question of whether obesity is a disease is objectively unanswerable.

“With no explicit characterisation of the illness intrinsically induced by obesity, independent of comorbidities—in other words, without a clear subject for disease diagnosis—the question of whether obesity is a disease is objectively unanswerable.”

• AssumptionRests on an assumption: The illness directly caused by obesity is yet to be defined.

Classified as probably not a substantial claim. May combine two claims.

A blanket attribution of disease status to obesity (as currently defined and measured) poses an objective risk of overdiagnosis, resulting in unwarranted use of drugs, technologies, and surgical procedures, with staggering costs for society, and negative ramifications at clinical, economic, and political levels.

“In this context, a blanket attribution of disease status to obesity (as currently defined and measured [ie, BMI >30 kg/m2, or 27·5 kg/m2 for Asian populations]) poses an objective risk of overdiagnosis, resulting in unwarranted use of drugs, technologies, and surgical procedures, with staggering costs for society, and negative ramifications at clinical, economic, and political levels.”

• cites [13] Rosen, 2014, Is obesity a disease or a behaviour abnormality? Did the AMA get it right?, Mo MedNot checked — no full text of the source
• cites [14] Katz, 2014, Perspective: obesity is not a disease, Nature sourceNot checked — no full text of the source
• cites [15] Luli, 2023, The implications of defining obesity as a disease: a report from the Association for the Study of Obesity 2021 annual conference, EClinicalMedicine sourceNot checked — no full text of the source

Classified as probably not a substantial claim. May combine two claims.

We defined 18 criteria for the diagnosis of clinical obesity in adults (range of consensus 90-100%; table 2), plus 13 criteria in children and adolescents (range of consensus 96-100%; table 2).

“We defined 18 criteria for the diagnosis of clinical obesity in adults (range of consensus 90–100%; table 2), plus 13 criteria in children and adolescents (range of consensus 96–100%; table 2).”

Probably not a substantial claim: may not pass S2 (checkable).

If obesity were only a condition of risk to health, it would be difficult to understand why it should be considered a disease.

“Thus, if obesity were only a condition of risk to health (as per its current definition) it would be difficult to understand why it should be considered a disease.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

A total of 82 statements (including definitions and diagnostic criteria) had consensus, of which 49 (60%) were unanimous consensus and 33 (40%) near-unanimous.

“A total of 82 statements (including definitions and diagnostic criteria) had consensus, of which 49 (60%) were unanimous consensus and 33 (40%) near-unanimous.”

Probably not a substantial claim: may not pass S3 (load-bearing).

All three rounds of Delphi were accomplished with 100% response rate (58 of 58 commissioners).

“All three rounds of Delphi were accomplished with 100% response rate (58 of 58 commissioners).”

Classified as probably not a substantial claim.

Obesity has been framed and extensively studied as a harbinger of other diseases.

“Consistent with its original definition as a condition that poses a risk to health,1,4 obesity has been framed and extensively studied as a harbinger of other diseases.”

• Also stated in: § Conclusion · plain

  “obesity has been framed and extensively studied as a harbinger of other diseases.”

• cites [1] 2004, Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies, Lancet sourceNot checked — no full text of the source
• cites [4]Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

BMI provides no information about the functional status of tissues and organs or the ability of an individual to conduct normal daily activities.

“In addition to potentially misclassifying excess adiposity itself, BMI provides no information about the functional status of tissues and organs, or the ability of an individual to conduct normal daily activities, which are two fundamental criteria for assessment of a person’s health.”

May combine two claims.

BMI does not differentiate between fat and lean mass or account for differences in body fat distribution.

“BMI does not differentiate between fat and lean mass or account for differences in body fat distribution.”

Classified as probably not a substantial claim.

Several professional organisations, including the American Association of Clinical Endocrinology and the European Association for the Study of Obesity, have recommended consideration of pathophysiological abnormalities in the mass, distribution, and function of adipose tissue as more appropriate than BMI-centric criteria to assess the effect of excess adiposity on health.

“Several professional organisations, including the American Association of Clinical Endocrinology and the European Association for the Study of Obesity have recommended consideration of pathophysiological abnormalities in the mass, distribution, and function of adipose tissue as more appropriate than BMI-centric criteria to assess the effect of excess adiposity on health.48,49”

• cites [48] Mechanick, 2017, Adiposity-based chronic disease as a new diagnostic term: the American Association of Clinical Endocrinologists and American College of Endocrinology position statement, Endocr Pract sourceNot checked — no full text of the source
• cites [49] Frühbeck, 2019, The ABCD of obesity: an EASO position statement on a diagnostic term with clinical and scientific implications, Obes Facts sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

This dispute reveals a crucial missing piece in the way obesity is conceptualised: because the illness directly caused by obesity is yet to be defined, obesity lacks a precise clinical identity.

“This dispute, however, reveals a crucial missing piece in the way obesity is conceptualised: because the illness directly caused by obesity is yet to be defined, obesity lacks a precise clinical identity.”

• AssumptionRests on an assumption: The illness directly caused by obesity is yet to be defined.

May combine two claims.

These obesity-associated conditions are diseases in their own right and cannot be configured as expressions of a single disease process.

“Regardless of the causality of such associations, these conditions are diseases in their own right and cannot be configured as expressions of a single disease process.”

Probably not a substantial claim: may not pass S3 (load-bearing).

According to WHO, an adult with a BMI of 30 kg/m2 or higher is considered to have obesity.

“According to WHO, an adult with a BMI of 30 kg/m2 or higher is considered to have obesity.”

Probably not a substantial claim: may not pass S3 (load-bearing).

All commissioners reviewed the results and signed a statement to confirm their agreement with the final recommendations.

“All commissioners reviewed the results and signed a statement to confirm their agreement with the final recommendations.”

Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

An accurate definition of obesity should make clear that excess fat mass is the fundamental characteristic of obesity, whereas abnormal function of adipose tissue might or might not be part of obesity.

“Accordingly, an accurate definition of obesity should make it clear that excess fat mass is the fundamental characteristic of obesity, whereas abnormal function of adipose tissue might or might not be part of obesity (ie, obesity should be defined by excess fat mass, with or without abnormal function).”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

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.

“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.”

Classified as probably not a substantial claim.

Obesity is currently conceived and defined as a condition of excess adiposity that presents a risk to health.

“Obesity is currently conceived and defined as a condition of excess adiposity that presents a “risk to health”.34”

• cites [34]Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S2 (checkable).

The notion of disease in medicine fundamentally implies an ability of the disease to cause illness, characterised by distinct clinical manifestations secondary to ongoing alterations in organ or tissue functioning.

“The aforementioned examples of other chronic diseases show that the notion of disease in medicine fundamentally implies an ability of the disease to cause illness, intended as a human experience of ill health, characterised by distinct clinical manifestations secondary to ongoing alterations in the functioning of organs, tissues, or both.”

May combine two claims.

BMI remains the most commonly used measure of obesity worldwide and helps identify individuals at risk of obesity-related comorbidities.

“Nonetheless, BMI remains the most commonly used measure of obesity worldwide, and helps identification of individuals at risk of obesity-related comorbidities.”

Probably not a substantial claim: may not pass S4 (based). May combine two claims.

Although not appropriate for use as a clinical parameter, BMI remains a universally accepted measure of obesity at the individual level.

“Although not appropriate for use as a clinical parameter, BMI remains a universally accepted measure of obesity at the individual level.”

Classified as probably not a substantial claim.

The narrative of the clinical effect of obesity focuses on adiposity-related risks of developing other diseases rather than on illness caused by obesity itself.

“The narrative of the clinical effect of obesity focuses instead on adiposity-related risks of developing other diseases—that is, distinct clinical entities with their own pathophysiology, clinical manifestations, evolution, and prognosis.”

Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

The objective evidence and logic behind both perspectives on obesity as a disease suggest fundamental issues in the current framing of obesity and in the methods used for its diagnosis.

“The objective evidence and logic behind both perspectives suggest fundamental issues in the current framing of obesity and in the methods used for its diagnosis.”

May combine two claims.

The current BMI-based definition of obesity can either underestimate or overestimate both adiposity and illness.

“Thus, the current BMI-based definition of obesity can either underestimate or overestimate both adiposity and illness (figure 2).”

May combine two claims.

Some individuals with a BMI in the range currently defining obesity do not have excess fat mass and are not at increased risk of morbidity or mortality.

“Conversely, some individuals with a BMI in the range currently defining obesity (>30 kg/m2 in individuals of European descent) do not have excess fat mass and are not at increased risk of morbidity or mortality.41”

• cites [41] Després, 2023, BMI versus obesity subtypes in the era of precision medicine, Lancet Diabetes Endocrinol sourceNot checked — no full text of the source

Classified as probably not a substantial claim. May combine two claims.

BMI has become an integral part of the current definition of obesity, as most health-care services, medical organisations, and public health agencies recommend use of a BMI threshold to diagnose obesity.

“Most crucially, BMI has become an integral part of the current definition of obesity, as most health-care services, medical organisations, and public health agencies recommend use of a BMI threshold (ie, 30 kg/m2 in individuals of European descent) to diagnose obesity.”

Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

A more accurate definition of obesity is necessary to explain the full effect of obesity on health, consistent with evidence that risk for other diseases and ongoing illness can both be associated with excess adiposity.

“Thus, a more accurate definition of obesity—consistent with evidence that risk for other diseases and ongoing illness can both be associated with excess adiposity—is necessary to explain the full effect of obesity on health.”

May combine two claims.

The exclusive focus on risk in the definition of obesity implies that ill health has not yet materialised and might never materialise.

“First, the exclusive focus on risk in the definition of obesity inherently implies that ill health has not yet materialised (and might, at least theoretically, never materialise).”

May combine two claims.

One practical consequence of defining obesity as a disease under its current BMI-based definition is that approximately 30-40% of people in some countries would be diagnosed as having this disease and would become eligible overnight for claims of disability or expensive treatments.

“One practical consequence of defining obesity as a disease, under its current BMI-based definition, is that approximately 30–40% of people in some countries would be diagnosed as having this disease right now and would be rendered eligible, overnight, for claims of disability or expensive (and potentially unnecessary) treatments.”

May combine two claims.

BMI thresholds are routinely used in clinical practice to rank the severity of obesity, establish indications for therapeutic interventions, or decide insurance coverage of obesity treatments.

“In fact, BMI thresholds are routinely used in clinical practice to rank the severity of obesity (class 1, 2, or 3 [eg, BMI of 30–34·9 kg/m2, 35–39·9 kg/m2, or >40 kg/m2, respectively, for individuals of European descent]), establish indications for therapeutic interventions, or decide insurance coverage of obesity treatments.”

Classified as probably not a substantial claim.

The current diagnosis of obesity worldwide is based on BMI, calculated as weight in kilograms divided by height in metres squared.

“The current diagnosis of obesity worldwide is based on BMI, calculated as weight in kilograms divided by height in metres squared.”

Probably not a substantial claim: may not pass S1 (asserted), S2 (checkable). May combine two claims.

The lack of a clearly identifiable illness caused by obesity provides no subject for accurate disease diagnosis and is a major stumbling block for considering obesity a disease.

“The lack of a clearly identifiable illness caused by obesity provides no subject for accurate disease diagnosis, thus representing a major stumbling block for the consideration of obesity as a disease (panel 4).”

Probably not a substantial claim: may not pass S2 (checkable).

Using BMI for the diagnosis of obesity represents a major barrier for both the understanding and acceptance of obesity as a disease.

“For all these reasons, using BMI for the diagnosis of obesity represents a major barrier for both the understanding and acceptance of obesity as a disease.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Feedback from such groups did not change the conclusions of the Commission but has been used to improve the presentation of our findings in this manuscript.

“Feedback from such groups did not change the conclusions of the Commission but has been used to improve the presentation of our findings in this manuscript.”

Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

A risk factor is not necessarily a disease, and a disease should be diagnosed when it occurs, not before.

“In fact, one can legitimately argue that a risk factor is not necessarily a disease, and that a disease should be diagnosed when it occurs, not before.”

May combine two claims.

Some individuals with a BMI in the normal or overweight range could have excess body fat and be at increased risk of obesity-related morbidity.

“As a result, some individuals with a BMI in the so-called normal or overweight range (eg, 18·5–29·9 kg/m2 in individuals of European descent) could have excess body fat and be at increased risk of obesity-related morbidity.”

Probably not a substantial claim: may not pass S2 (checkable).

The current definition of obesity provides no clear characterisation of the illness induced by obesity itself.

“In contrast with such generally adopted medical principles, the current definition of obesity provides no clear characterisation of the illness induced by obesity itself.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Once developed, excess adiposity can affect the structure and function of multiple organs and predisposes individuals to obesity-related diseases and conditions that contribute to increased risk of morbidity, mortality, and impaired quality of life.

“Once developed, excess adiposity can affect the structure and function of multiple organs (ie, cause illness) and also predisposes individuals to obesity-related diseases and conditions that contribute to an increased risk of morbidity, mortality, and impaired quality of life.”

May combine two claims.

Anthropometric measures have been extensively studied as predictors of metabolic risk, but much less so as a sign of ongoing organ dysfunction caused by obesity.

“Anthropometric measures have been extensively studied as predictors of metabolic risk, but much less so as a sign of ongoing organ dysfunction caused by obesity.”

Probably not a substantial claim: may not pass S2 (checkable).

Describing the health effect of obesity through other diseases inherently implies that the onset of other diseases is necessary for obesity to cause ill health.

“Describing the health effect of obesity through other diseases inherently implies that the onset of other diseases is necessary for obesity to cause ill health.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Many chronic diseases are substantially influenced by lifestyle choices, yet their disease status is not under discussion.

“In fact, many chronic diseases are substantially influenced by lifestyle choices (eg, type 2 diabetes, cancer, and chronic obstructive pulmonary disease [COPD]), yet their disease status is not under discussion.”

Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

The debate around the idea of obesity as a disease elicits polarising and often emotional reactions, often based on non-medical considerations.

“The debate around the idea of obesity as a disease elicits polarising and often emotional reactions, often based on non-medical considerations.”

Probably not a substantial claim: may not pass S2 (checkable).

Without a clear definition of the illness caused by obesity, it is not possible to establish which biomarkers, and with what specific thresholds, have objective clinical validity as measures of disease in obesity.

“Without a clear definition of the illness caused by obesity, it is not possible to establish which biomarkers, and with what specific thresholds, have objective clinical validity as measures of disease in obesity.”

Classified as probably not a substantial claim.

The conventional narrative about the health effects of obesity might contribute to controversy about the idea of obesity as a disease.

“The conventional narrative about the health effects of obesity might also contribute to controversy about the idea of obesity as a disease.”

May combine two claims.

Although using anthropometric measures as alternatives or in addition to BMI could improve detection of excess adiposity and prediction of cardiometabolic risk, they are not a robust measure of ongoing illness.

“Although using anthropometric measures as alternatives or in addition to BMI could improve detection of excess adiposity and prediction of cardiometabolic risk, akin to BMI they are not a robust measure of ongoing illness.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Adding biochemical markers such as plasma triglyceride levels to waist circumference (hypertriglyceridaemic waist) has been suggested as a useful method for identifying individuals with excess visceral adipose tissue and ectopic fat.

“Adding biochemical markers, such as plasma triglyceride levels, to the measurement of waist circumference—a phenotype described as hypertriglyceridaemic waist—has been suggested as a useful method for identification of individuals with excess visceral adipose tissue and ectopic fat.51”

• cites [51] Lemieux, 2000, Hypertriglyceridemic waist: a marker of the atherogenic metabolic triad (hyperinsulinemia; hyperapolipoprotein B; small, dense LDL) in men?, Circulation sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

The availability and cost of biochemical tests can limit their widespread implementation in clinical practice, especially in the context of variable reliability.

“Additionally, the availability and cost of biochemical tests can limit their widespread implementation in clinical practice, especially in the context of variable reliability.”

Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

Although the traditional narrative has merit to alert clinicians, policy makers, patients, and the public about the need to take obesity seriously, it could contribute to misconceptions in the way obesity is approached clinically compared with other chronic diseases.

“Although such a narrative has merit to alert clinicians, policy makers, patients, and the public about the need to take obesity seriously, it could contribute to misconceptions in the way obesity is approached clinically, compared with other chronic diseases.”

Probably not a substantial claim: may not pass S2 (checkable), S4 (based). May combine two claims.

These seemingly irreconcilable arguments result from a narrative that highlights only partial, indirect evidence of the negative effects of excess adiposity on health and fails to recognise direct consequences of obesity itself on tissues and organs, with resulting illness.

“These seemingly irreconcilable arguments result from a narrative that highlights only partial, indirect evidence of the negative effects of excess adiposity on health, and fails to recognise direct consequences of obesity itself on tissues and organs, with resulting illness (figure 1).”

May combine two claims.

Alternative anthropometric measures and biomarkers have not been used as a measure of health in individual patients and would have insufficient diagnostic accuracy as a measure of ongoing illness.

“Although alternative anthropometric measures and biomarkers have been suggested as possible replacements for BMI as diagnostic tools or to inform decisions about treatment, they have not been used as a measure of health in individual patients and would have insufficient diagnostic accuracy as a measure of ongoing illness.”

May combine two claims.

Higher levels of adiposity worsen insulin resistance, increasing β-cell demand, particularly when fat is deposited ectopically in the liver and muscle.

“Higher levels of adiposity worsen insulin resistance, increasing β-cell demand, particularly when fat is deposited ectopically in the liver and muscle.”

May combine two claims.

Obesity can directly cause organ dysfunction via several pathophysiological mechanisms, including the physical effect of increased adipose tissue mass, the presence of ectopic fat within tissues and organs, metabolic effects, inflammatory mechanisms, and psychological consequences.

“Obesity can directly cause organ dysfunction via several pathophysiological mechanisms, including the physical effect of increased adipose tissue mass, the presence of ectopic fat within tissues and organs, metabolic effects, inflammatory mechanisms, and psychological consequences (figure 3).”

May combine two claims.

If a patient has obesity, this can change the hippocampus, affecting food-related memory and cognitive processes, potentially influencing eating behaviours.

“If a patient has obesity, this can change the hippocampus, affecting food-related memory and cognitive processes, potentially influencing eating behaviours.93”

• cites [93] Farooqi, 2015, Genetic, molecular and physiological mechanisms involved in human obesity: Society for Endocrinology medal lecture 2012, Clin Endocrinol sourceNot checked — no full text of the source

May combine two claims.

Obesity functions as a chronically inflamed state that originates from adipose tissue but also occurs systemically.

“Consequently, obesity functions as a chronically inflamed state that originates from adipose tissue but also occurs systemically.”

May combine two claims.

NTS neurons express receptors for multiple satiety peptides such as leptin, melanocortin, and GLP-1, and are key contributors to satiety control.

“NTS neurons express receptors for multiple satiety peptides such as leptin, melanocortin, and GLP-1, and are key contributors to satiety control.93”

• cites [93] Farooqi, 2015, Genetic, molecular and physiological mechanisms involved in human obesity: Society for Endocrinology medal lecture 2012, Clin Endocrinol sourceNot checked — no full text of the source

May combine two claims.

Eating is both an innate (hard-wired) and learned behaviour.

“These findings show that eating is both an innate (hard-wired) and learned behaviour.93”

• cites [93] Farooqi, 2015, Genetic, molecular and physiological mechanisms involved in human obesity: Society for Endocrinology medal lecture 2012, Clin Endocrinol sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

These clinical manifestations are responsible for conferring morbidity, mortality, and impaired quality of life in people with obesity.

“These clinical manifestations are responsible for conferring morbidity, mortality, and impaired quality of life in people with obesity.”

May combine two claims.

Disruption of genes in the leptin-melanocortin pathway alters eating behaviour by increasing hunger, decreasing satiety, activating food reward cues, and increasing the preference for dietary fat.

“In particular, disruption of genes in the leptin-melanocortin pathway alters eating behaviour by increasing hunger, decreasing satiety, activating food reward cues, and increasing the preference for dietary fat.”

• cites [93] Farooqi, 2015, Genetic, molecular and physiological mechanisms involved in human obesity: Society for Endocrinology medal lecture 2012, Clin Endocrinol sourceNot checked — no full text of the source

May combine two claims.

The severity of symptoms and complications vary among individuals at any given BMI, and not all people are susceptible to the same symptoms and complications.

“Moreover, the severity of symptoms and complications vary among individuals at any given BMI, and not all people are susceptible to the same symptoms and complications.”

May combine two claims.

Lymphoedema of the lower limbs is strongly associated with severe obesity, particularly in women, which develops due to mechanical compression of lymphatic vessels and reduced drainage.

“Lymphoedema of the lower limbs is strongly associated with severe obesity, particularly in women, which develops due to mechanical compression of lymphatic vessels and reduced drainage, with feelings of pain, tightness, or both, resulting in decreased range of motion.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

There is a strong association of disordered eating with lack of exercise, which can exacerbate stress levels, additionally causing increased food intake.

“There is a strong association of disordered eating with lack of exercise, which can exacerbate stress levels, additionally causing increased food intake.”

May combine two claims.

Urinary incontinence is common in women with obesity and develops due to high intra-abdominal pressure combined with pelvic floor dysfunction.

“Urinary incontinence is common in women with obesity and develops due to high intra-abdominal pressure combined with pelvic floor dysfunction.127”

• cites [127] Doumouchtsis, 2022, The role of obesity on urinary incontinence and anal incontinence in women: a review, BJOG sourceNot checked — no full text of the source

May combine two claims.

The presence of MASLD is associated with a higher risk of type 2 diabetes and cardiovascular disease.

“The presence of MASLD is also associated with a higher risk of type 2 diabetes (and is present in ~70% of people with type 2 diabetes) and cardiovascular disease.125”

• cites [125] Hydes, 2020, Mechanisms, screening modalities and treatment options for individuals with non-alcoholic fatty liver disease and type 2 diabetes, Diabet Med sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

Eating disorders are common among people living with obesity, especially binge eating disorder and night eating syndrome.

“Eating disorders are common among people living with obesity, especially binge eating disorder and night eating syndrome.140”

• cites [140] Shillito, 2018, Why I eat at night: a qualitative exploration of the development, maintenance and consequences of night eating syndrome, Appetite sourceNot checked — no full text of the source

May combine two claims.

Many people with obesity present with raised triglycerides, surrogate evidence of excess liver fat, and often with reduced HDL cholesterol and elevated blood glucose and HbA1c concentrations.

“In line with such interactions, many people with obesity present with raised triglycerides, surrogate evidence of excess liver fat, and often with reduced HDL cholesterol and elevated blood glucose and HbA1c concentrations.120”

• cites [120] Sattar, 2022, High circulating triglycerides are most commonly a marker of ectopic fat accumulation: connecting the clues to advance lifestyle interventions, Circulation sourceNot checked — no full text of the source

May combine two claims.

The development of obesity-related glomerulopathy is well recognised and can lead to end-stage kidney disease.

“The development of obesity-related glomerulopathy is well recognised and can lead to end-stage kidney disease.”

May combine two claims.

Psychological stress changes not only the amount of the food ingested but also shifts eating patterns away from recommended diets to sweeter and fattier foods.

“Psychological stress changes not only the amount of the food ingested but also shifts eating patterns away from recommended diets to sweeter and fattier foods.”

Classified as probably not a substantial claim. May combine two claims.

The appraisal of evidence included a broad range of topics related to obesity, but relied on narrative reviews and experts' assessment of evidence, rather than on systematic reviews and meta-analyses.

“Our appraisal of evidence included a broad range of topics related to obesity, but relied on narrative reviews and experts’ assessment of evidence, rather than on systematic reviews and meta-analyses.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The extensive use of live and offline pre-Delphi surveys, and discussions within smaller subgroups (subcommittees), provided ample opportunities for dissenting opinions to be heard and considered before developing a Delphi questionnaire.

“the extensive use of live and offline pre-Delphi surveys, and discussions within smaller subgroups (subcommittees), provided ample opportunities for dissenting opinions to be heard and considered before developing a Delphi questionnaire.”

Classified as probably not a substantial claim.

The meaning of preclinical obesity does not coincide with the terms overweight or preobesity (defined as a BMI of 25·0-29·9 kg/m2).

“Importantly, the meaning of preclinical obesity does not coincide with the terms overweight or preobesity (defined as a BMI of 25·0–29·9 kg/m2).”

Classified as probably not a substantial claim.

The diagnosis of clinical obesity requires confirmation of obesity status through fulfilment of anthropometric criteria plus signs or symptoms of abnormalities in the function of one or more tissue or organ systems, substantial (age-adjusted) limitations of daily activities, or both.

“Accordingly, the diagnosis of clinical obesity requires confirmation of obesity status through fulfilment of anthropometric criteria (an anthropometric component) plus signs or symptoms of abnormalities in the function of one or more tissue or organ systems, substantial (age-adjusted) limitations of daily activities, or both (a clinical component).”

Probably not a substantial claim: may not pass S2 (checkable).

This approach could plausibly reduce risks of inequality or discrimination pertaining to access to care for obesity.

“This approach could plausibly reduce risks of inequality or discrimination pertaining to access to care for obesity.”

Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

Using a disease state as a diagnostic criterion for another disease would be contradictory on logical grounds, and would also undermine differential diagnosis, as it would make diseases indistinguishable from one another.

“using a disease state as a diagnostic criterion for another disease would be contradictory on logical grounds, and would also undermine differential diagnosis, as it would make diseases indistinguishable from one another.”

Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

There is an inevitable risk of bias in the Commission group, as in any selection of experts.

“there is an inevitable risk of bias in this group, as in any selection of experts.”

Classified as probably not a substantial claim.

The criteria for the diagnosis of clinical obesity are only met when one can plausibly exclude other causes.

“the criteria for the diagnosis of clinical obesity are only met when one can plausibly exclude other causes.”

Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

Our definition of clinical obesity emphasises illness, which is objective, rather than risk, which is highly variable among individuals of different age, gender, and ethnicity.

“Our definition of clinical obesity actually emphasises illness, which is objective, rather than risk, which is highly variable among individuals of different age, gender, and ethnicity.”

Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.