Obesity: the (in)visible entity

By Eduardo André

Exercise Physiologist and Hi Well Technical Director

Beyond weight: understanding obesity

For decades, obesity has been in plain sight, yet it has not been fully understood. Addressing obesity seriously means going beyond body weight, overcoming stigma, reaching people, their life context and an environment that, for various reasons, has favoured this systemic dysfunction with profound metabolic changes - the invisible entity of obesity. It is in this duality, the visible and the hidden, that the condition continues to be neglected, normalised, impacting the individual and society, depriving them of health and conscious longevity.

For many years, the main criterion for diagnosing excess weight has been the body mass index (BMI). However, this parameter, which is incomplete and biased, only considers weight and not other body composition variables, such as muscle tissue. Furthermore, we now know that, in the context of obesity, weight is not synonymous with health, but rather the impact it has on the functioning of the body.

The committee of the journal The Lancet Diabetes & Endocrinology (2025) proposed an urgent redefinition of the term, namely: ‘obesity should be understood as a chronic and systemic disease, when excess fat directly affects a person's organs, tissues or autonomy’. This is a significant step, since obesity is no longer just a risk factor for other diseases - such as diabetes, cancer or cardiovascular disorders - but is now largely considered to be their cause.

Two stages, two realities: clinical and pre-clinical

Also in this article, the experts point out that there are two distinct stages of obesity:

• Clinical obesity: when there are already clear signs that excess fat is impairing the body's functioning - for example, severe joint pain, breathing difficulties, hypertension, metabolic changes or limitations in everyday tasks;

• Pre-clinical obesity: when there is excess body fat but no visible manifestations of disease. Despite perceived well-being, there are systemic changes that increase the risk of disease progression.

Perhaps the most surprising thing about this article, which involved 58 experts from different countries, was the proposal to assess obesity by function and not just by shape. Specifically, instead of just considering weight or BMI, it is essential to assess organ function: the heart, lungs, liver, kidneys, pancreas and the real impact on functionality and quality of life.

This view observes the duality between the visible and the invisible and brings clarity to the subject. It is possible to be apparently ‘underweight’ and have health problems related to body fat - and conversely, it is possible to have a high BMI without disease or high risk.

Prevention: a window of opportunity

Pre-clinical obesity is an opportunity for preventive and multidisciplinary intervention. Monitoring by various professionals will help not only to regulate weight, but also to improve the function of the various organs, reducing inflammation and favouring neurohormonal balance and functional autonomy.

In this process, the role of the exercise professional is to sensitise and educate the student to the relevance that movement (i.e. physical activity and exercise) can have, either directly, through its protective and health-promoting benefits, or indirectly, by facilitating behavioural change and a healthy lifestyle.

Beyond weight, let's promote health

To rethink the way we look at obesity is to have another perspective on the society we design. A physically active society promotes its health capital. Obesity tends to diminish it. So let's look at the condition for what it is: a disease that takes hold in the lethargy of silent acceptance, both individual and collective. Let's value movement as its disruptive element, rescuing health and longevity with every step taken.

Bibliografia

Rubino, F., Cummings, D. E., Eckel, R. H., Cohen, R. V., Wilding, J. P. H., Brown, W. A., Stanford, F. C., Batterham, R. L., Farooqi, I. S., Farpour-Lambert, N. J., le Roux, C. W., Sattar, N., Baur, L. A., Morrison, K. M., Misra, A., Kadowaki, T., Tham, K. W., Sumithran, P., Garvey, W. T., ... Mingrone, G. (2025). The Lancet Commission on the Definition, Diagnosis, and Management of Obesity. The Lancet Diabetes & Endocrinology. Advance online publication. https://doi.org/10.1016/S2213-8587(24)00316-4