How Will Patients Benefit From Redefining Obesity?Thursday, June 1, 2017
The sixth 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 incremental benefits to patients.
With the current BMI-based definition, this measure is generally used to decide whether or not a given patient receives obesity treatments.
But, as readers are aware, not everyone with a BMI over a certain threshold would have the same degree of health issues (if any) and therefore not everyone currently classified as having obesity would necessarily benefit from treatment.
On the other hand, there are a substantial number of individuals who currently fall below the BMI threshold, but have significant health problems attributable to the presence of abnormal or excess body fat. These individuals, would currently not have access to obesity treatments.
Thus, as the authors of the checklist point out,
“Wherever changes in disease definitions will alter which patients receive treatment, it isessential to assess treatment benefits and harms, focusing on the balance of benefits and harms for those diagnosed by the new definition and not diagnosed by the previous definition. Changes to disease definitions can provide benefits to patients, mostly by providing access to treatments with beneficial effects.”
However, the authors also warn that,
“…evidence from previous treatment trials in patients with later or more severe disease cannot be extrapolated to patients with milder or less severe disease…”
This means that evidence for treatment benefits will require clinical trials to include participants covered by the new definition.
Guideline committees should also consider the possibility that broadening the diagnosis may provide validation of symptoms and access to social and other benefits in individuals not previously qualifying for such benefits.