Balancing Benefits And Harms From Redefining Obesity

The final and eight item on the disease definition modification checklist developed by the Guidelines International Network (G-I-N) Preventing Overdiagnosis Working Group published in JAMA Internal Medicine,  deals with issue of determining the benefit/harm ratio of the proposed new definition.

With terms to redefining obesity as the presence of abnormal or excess body fat that impairs health, I have discussed the potential benefits and harms in previous posts.

The question is, whether or not the overall balance comes down on the benefit or harm side of the equation.

Here, the authors of the checklist have the following to offer,

“Modifying a disease definition should be guided by a balanced assessment of the anticipated benefits and harms, using the best evidence available. The definition should reflect the values and preferences of patients and the wider community and include the impact on resource usage….In general, we recommend that panels consider both an individual and societal approach to assessing the overall benefits and harms of changing disease definitions. We recommend introducing a new disease definition where there is an expected positive balance of harms and benefit for individuals, and in aggregate at the societal level.”

In addition, the authors note,

“Different definitions may be required for research purposes, for example more stringent standardization, than for clinical purposes where more stringent definitions may deny access to care for patients who would benefit.”

Thus, as we have seen, changing disease definitions is not just a matter of opinion but rather, the pros and cons must be considered both at an individual and societal (resource) level.

That said, disease definitions are in constant flux as new knowledge and treatments emerge – obesity, should be no exception.

Indeed, guidelines would be amiss in not reconsidering the validity of current definitions and exploring potential changes as part of the guidelines process. The published checklist can certainly serve as a guide for this process.

@DrSharma
Edmonton, AB