Clinical obesity was associated with higher odds of 90-day post-treatment complications compared to pre-clinical obesity for both antiobesity medications (aOR 1.10) and bariatric surgery (aOR 1.39).
Observational (n=261,408)
Yes
Does clinical obesity compared to pre-clinical obesity increase the odds of treatment-related complications in adults receiving medical or surgical obesity treatment?
A significant proportion of patients receiving obesity treatments have pre-clinical obesity, and restricting treatment eligibility to clinical obesity could delay intervention and shift care to older, sicker populations with higher complication risks.
Effect estimate: aOR 1.10 (AOM), aOR 1.39 (BS)
p-value: p=<0.001
OBJECTIVE: We sought to determine how the proportion of adults historically receiving obesity interventions would be classified under the recently proposed "pre-clinical" and "clinical" obesity classifications and the impact of this change on safety and outcomes. METHODS: A retrospective analysis of adults with BMI ≥ 35 who received bariatric surgery (BS) or antiobesity medications (AOMs) between 2017 and 2023 was conducted using the Merative MarketScan database. Patients had ≥ 6-month continuous enrollment before treatment. Clinical obesity was defined as presence of ≥ 1 obesity-related condition and pre-clinical obesity defined as absence of such. Treatment-related complications were identified within 90 days of treatment initiation. Multivariable logistic regression was used to compare the odds of treatment-related complications by obesity classification. RESULTS: A total of 120,499 individuals (46.1%) underwent BS and 140,909 (53.9%) received AOMs. Among BS patients, 12.7% (n = 15,334) had pre-clinical obesity. Of AOM users, 38.1% (n = 53,633) had pre-clinical obesity. Clinical obesity patients were older with a higher comorbidity burden compared to pre-clinical obesity. Clinical obesity was associated with higher odds of post-treatment complications (AOM: aOR 1.10, BS: aOR 1.39, both p < 0.001). CONCLUSIONS: This novel framework would reclassify a significant proportion of patients as having pre-clinical obesity. Use of these definitions to determine treatment eligibility could potentially delay intervention and shift care to older, sicker populations.
Samuels et al. (2026) conducted an observational in Obesity (BMI ≥ 35) (n=261,408). Clinical obesity vs. Pre-clinical obesity was evaluated on Treatment-related complications within 90 days of treatment initiation (aOR 1.10 (AOM), aOR 1.39 (BS), p=<0.001). Clinical obesity was associated with higher odds of 90-day post-treatment complications compared to pre-clinical obesity for both antiobesity medications (aOR 1.10) and bariatric surgery (aOR 1.39).