Abstract
Obesity is a chronic, adiposity-based disease with increasing global prevalence and multiple, competing definitions. Traditionally, body mass index (BMI) has been the primary tool for diagnosis, although it does not completely reflect adipose tissue mass, distribution or associated organ dysfunction. In the past 2 years, major professional societies (including the European Association for the Study of Obesity (EASO), the Lancet Diabetes & Endocrinology Commission, the American College of Cardiology (ACC) and the American Association of Clinical Endocrinologists (AACE)) have advanced new diagnostic frameworks that move beyond BMI to incorporate multimodal assessment of adiposity and its clinical consequences. By integrating anthropometric precision with standardized complication assessment, these frameworks support earlier identification of risk, improved prognostication and more equitable, patient-centred obesity care. However, the way in which the new guidelines should be integrated into routine clinical care remains unclear. Here we synthesize current evidence across anthropometric measures of obesity and body composition imaging. We clarify the diagnostic performance, limitations and relevance of these measures across diverse populations. We compare areas of convergence and divergence among the new guidelines, particularly the shift towards defining clinical obesity on the basis of both excess adiposity and evidence of organ dysfunction or functional impairment.
Key points
The diagnosis of obesity is shifting from body mass index-based definitions to multimodal assessments integrating adiposity, adipose tissue distribution and obesity-related complications
Waist-based measures improve the detection of central adiposity across diverse populations
Emerging frameworks and guidelines from major international professional societies and organizations redefine clinical obesity as a heterogeneous, chronic disease that extends beyond body size alone
Implementation of emerging frameworks introduces challenges in standardization, re
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F.C.S. served on the Lancet Diabetes & Endocrinology Commission on the definition and diagnostic criteria of clinical obesity
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Warren Alpert Medical School, Brown University, Providence, RI, USA
Clara E. Tandar
Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
John C. Lin
Neuroendocrine Unit, Boston Area Nutrition Obesity Research Center, MGH Weight Center, Massachusetts General Hospital, Boston, MA, USA
Fatima C. Stanford
Department of Medicine, Harvard Medical School, Harvard University, Boston, MA, USA
Fatima C. Stanford
Department of Pediatrics, Harvard Medical School, Harvard University, Boston, MA, USA
Fatima C. Stanford
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Tandar, C.E., Lin, J.C. & Stanford, F.C. Diagnosis, staging and management of obesity: a synthesis of contemporary guidelines.
Nat Rev Endocrinol (2026). https://doi.org/10.1038/s41574-026-01279-0
Accepted:26 June 2026
Published:21 July 2026
Version of record:21 July 2026
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:https://doi.org/10.1038/s41574-026-01279-0
