Preclinical and clinical obesity: prevalence, associations to cardiometabolic risk and response to lifestyle intervention in NHANES and the EPIC-Potsdam and TULIP studies

An expert commission (The Lancet Diabetes & Endocrinology Commission on Clinical Obesity) proposed novel diagnostic criteria distinguishing between preclinical and clinical obesity and suggesting treatment indications for the latter. However, the proportional assignment to preclinical and clinical obesity in adults with BMI-defined obesity, the associated disease risks, as well as the response to lifestyle interventions are not well known. Here we show that among those with BMI-based obesity, 100% are confirmed to have obesity by at least one other anthropometric measure in NHANES 2017-2018 and the prospective EPIC-Potsdam cohort. More than 80% of adults with confirmed obesity meet the criteria for clinical obesity and have 2.8-fold increased risk of incident cardiovascular disease and 7.9-fold increased risk for type 2 diabetes compared to adults without obesity and not fulfilling clinical criteria. Adults with preclinical obesity have no elevated cardiovascular disease risk, but type 2 diabetes risk is markedly increased. A 9-months lifestyle intervention (Tübingen Lifestyle Intervention Programme) decreases the proportion of clinical obesity from 71% to 57%, and that of prediabetes from 52% to 29%.