Did actor Jake Gyllenhaal carry extra weight while filming Road House? Is Kansas City Chiefs’ tight end Travis Kelce on the verge of obesity?

Based on the traditional metrics for “overweight” and “obesity,” which rely on height and weight ratios, both men qualify.

However, this method, known as body mass index (BMI), doesn’t accurately reflect a person’s health status, according to a team of global medical experts highlighted in a recent publication in The Lancet Diabetes & Endocrinology.

The evaluation of obesity should also take into account body size indicators, like waist circumference, along with BMI. Another method suggested is assessing body fat percentage, the panel argued.

This issue is not merely about appearances; it could significantly impact access to treatment options such as weight-loss medications, various experts on obesity informed YSL News.

Can you be fit and fat?

Not all extra weight poses the same health risks, as acknowledged by The Lancet commission.

The Centers for Disease Control and Prevention (CDC) defines obesity as having a BMI of 30 or above. As of March 2020, nearly 42% of adults in the U.S. fell into this category, per CDC data.

Athletes and highly fit individuals like Kelce and Gyllenhaal may register higher BMIs due to muscle mass weighing more than fat. Nevertheless, this does not imply they are unhealthy.

For example, during the filming of Road House, Gyllenhaal stood 6 feet tall and weighed 184 pounds, which placed him at the threshold of being “overweight” with a reported body fat of 5%, but he was certainly not unhealthy. Kelce, measuring 6 feet 5 inches and weighing 250 pounds, has a BMI of 29.6, just under the 30 BMI limit that defines “obese,” as per the CDC’s calculator.

“Clinical obesity,” according to The Lancet commission, is a chronic condition that affects organ function or restricts daily activities such as bathing or eating. Individuals diagnosed with this should seek medical care and may require treatments like weight-loss medications.

A secondary group identified as “pre-clinical obesity” includes individuals with elevated BMI and excess body fat who are otherwise in good health. However, these individuals could face risks for obesity-related conditions like type 2 diabetes, heart disease, and certain cancers in the future.

Researchers emphasized that relying solely on BMI to define obesity is inadequate since it fails to account for how body fat is distributed.

Those with excess abdominal fat or fat around vital organs may be at a higher health risk compared to individuals with extra fat in other areas, explained Robert Eckel, a professor at the University of Colorado Anschutz and a member of the expert panel.

Impact of the new criteria on medication coverage

The commission’s guidance comes as physicians and consumers increasingly turn to a new category of weight-loss medications known as glucagon-like peptide 1 (GLP-1), used for treating obesity and related conditions such as type 2 diabetes and heart disease. However, these medications can have side effects and can be costly for patients, insurers, and employers providing health benefits.

Due to the effectiveness but high cost of these weight-loss drugs, medical professionals are working to determine the criteria for who should have access, stated Justin Ryder, a pediatric obesity researcher and professor at Northwestern Feinberg School of Medicine, who was not part of the commission.

“There has been much discussion about who should receive obesity medications and the criteria for identifying patients needing more aggressive intervention,” Ryder commented. “Where do we delineate those with obesity who require close monitoring from those who may not need as much attention?”

Ryder believes the commission’s findings will provide clarity for healthcare providers and patients, potentially influencing insurance coverage for obesity treatments.

At present, doctors prescribe Novo Nordisk’s Wegovy to patients with a BMI of 30 or more, while those with a BMI of at least 27 may also qualify if they have weight-related health issues like high blood pressure or elevated cholesterol.

Based on the commission’s guidelines, health insurers might impose additional conditions for coverage, requiring a minimum BMI alongside measures like waist circumference or body fat percentage.

The commission outlined 18 factors that could confirm a diagnosis of obesity. These may include symptoms like shortness of breath, high blood pressure, joint pain, limited mobility due to excess fat, or issues with heart or other organs. For children and teenagers, obesity could lead to restricted movement or increase the likelihood of falls due to misaligned bones.

While the commission aimed to broaden the criteria for weight-loss drug coverage by refining the definition of obesity, Ryder expressed doubt about whether it would achieve its goal.

Views from obesity specialists on the recommendations

Medical professionals and organizations focused on obesity have long argued for a more detailed approach, emphasizing factors beyond just BMI, said Dr. Angela Fitch, a former president of the Obesity Medicine Association.

Obesity should be assessed holistically, emphasized Fitch, co-founder and Chief Medical Officer at Knownwell, a provider focused on obesity and primary care in Boston and Dallas. Health implications should also play a role in this assessment.

The significant expense and limited insurance coverage for obesity treatments are pushing many individuals to seek alternative methods, some of which may be unsafe, Fitch noted.

“There are numerous dubious options available,” she stated. “People are being exploited.”

Opinions from fat advocacy groups on the new classification

Defining obesity as a disease could negatively affect individuals who are overweight and perpetuate societal stigma, warned Tigress Osborn, executive director of the National Association to Advance Fat Acceptance.

The introduction of a new “pre-clinical obesity” category still labels many individuals as being on the brink of disease, Osborn argued.

Her organization champions personalized treatment approaches instead of classifying obesity strictly as a disease.

“Efforts to diminish stigma by classifying fatness as a disease have not proven effective,” stated Osborn.