Key result
Lancet 2025 obesity framework reveals BMI alone misses ~23% of clinical obesity cases in Mexican adults.
Why the study?
The 2025 Lancet Commission proposed a framework distinguishing preclinical from clinical obesity, but its prevalence, clinical characteristics, and discordance with conventional BMI categories in Mexican adults had not been evaluated.
Cross-Sectional (n=5,014)
Applying the Lancet 2025 Obesity Framework reveals that conventional BMI thresholds miss nearly a quarter of adults with obesity-related organ dysfunction, primarily cardiovascular.
Identifies substantial preclinical obesity in Mexican adults; leaves open whether framework improves outcome prediction over BMI.
Background/Objectives: The 2025 Lancet Diabetes & Endocrinology Commission proposed a framework that distinguishes preclinical from clinical obesity based on confirmed excess adiposity and evidence of obesity-related organ dysfunction. We estimated the prevalence and clinical characteristics of preclinical and clinical obesity in Mexican adults and quantified their discordance with conventional body mass index (BMI) categories. Methods: Cross-sectional analysis of 5014 adults aged ≥20 years (weighted population 77,915,402) from the 2023 Mexican National Health and Nutrition Survey (ENSANUT). Excess adiposity was confirmed by a BMI ≥ 30 kg/m2 plus one altered measure of central adiposity, by two altered measures irrespective of BMI, or by a BMI ≥ 40 kg/m2 alone. Obesity-related dysfunction was ascertained from available cardiovascular, metabolic, and functional indicators. All analyses accounted for the complex sampling design. Results: Preclinical obesity affected 30.9% of adults and clinical obesity 19.6%. Among adults with clinical obesity, 4.9% had a normal BMI and 18.3% were overweight so that 23.2% fell below the conventional 30 kg/m2 threshold. Cardiovascular dysfunction was the most frequent qualifying domain (78.1%), followed by limitations in activities of daily living (27.6%) and metabolic dysfunction (6.7%). Conclusions: BMI alone underestimates obesity-related clinical severity and misses a substantial share of adults with organ dysfunction, supporting the integration of central adiposity measures and assessment of obesity-related dysfunction into routine obesity surveillance.
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Lara et al. (2026) conducted a cross-sectional in Obesity (n=5,014). Lancet 2025 Obesity Framework criteria vs. Conventional BMI categories was evaluated on Prevalence of preclinical and clinical obesity. The Lancet 2025 Obesity Framework identified preclinical obesity in 30.9% and clinical obesity in 19.6% of Mexican adults, with 23.2% of clinical cases falling below the conventional BMI threshold.
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