A Checklist For Modifying Disease DefnitionsTuesday, May 23, 2017
At the recent European Congress on Obesity in Porto, Portugal, there was much support for calling obesity a chronic progressive relapsing disease.
However, there was also much agreement that the current criteria for diagnosing this disease, based on BMI criteria alone, has important limitations in that it may over-diagnose a significant number of individuals at no or very little imminent risk from their body fat and (even more importantly) under-diagnose a substantial number of individuals, who may well stand to benefit from anti-obesity treatments.
Thus, as my readers are well aware, I have long called for a redefinition of obesity based on the actual presence of health impairments attributable to abnormal or excess body fat.
It is thus timely that JAMA Internal Medicine has just published a seminal article by Jenny Doust and colleagues on behalf of the Guidelines International Network (G-I-N) Preventing Overdiagnosis Working Group, that provides a framework for anyone proposing changes to disease definitions.
Using a 5-step process that included (1) a literature review of issues, (2) a draft outline document, (3) a Delphi process of feedback on the list of issues, (4) a 1-day face-to-face meeting, and (5) further refinement, the group developed an 8-item checklist of items to consider when changing disease definitions.
The checklist specifically deals with the issues of definition changes, number of people affected, trigger, prognostic ability, disease definition precision and accuracy, potential benefits, potential harms, and the balance between potential harms and benefits.
The authors propose that,
“…the checklist be piloted and validated by groups developing new guidelines. We anticipate that the use of the checklist will be a first step to guidance and better documentation of definition changes prior to introducing modified disease definitions.”
No doubt it would be prudent to consider all of the identified aspects in the checklist, when considering changing the definition of obesity from one based simply on BMI to a more clinical definition, based on actual impairments in health.
In coming posts, I will consider each of the proposed checklist items and how they may apply to such a change in the definition of obesity.
Hat tip to Dr. Marcela Flores for drawing my attention to this paper