A Proposal of the European Association for the Study of Obesity to Improve the ICD-11 Diagnostic Criteria for Obesity Based on the Three Dimensions Etiology, Degree of Adiposity and Health Risk

Abstract

Diagnostic criteria for complex medical conditions caused by a multitude of both genetic and environmental factors should be descriptive and avoid any attribution of causality. Furthermore, the wording used to describe a disorder should be evidence-based and avoid stigmatization of the affected individuals. Both terminology and categorizations should be readily comprehensible for healthcare professionals and guide clinical decision making. Uncertainties with respect to diagnostic issues and their implications may be addressed to direct future clinical research. In this context, the European Association of the Study of Obesity (EASO) considers it an important endeavor to review the current ICD-11 Beta Draft for the definition of overweight and obesity and to propose a substantial revision. We aim to provide an overview of the key issues that we deem relevant for the discussion of the diagnostic criteria. We first discuss the current ICD-10 criteria and those proposed in the ICD 11 Beta Draft. We conclude with our own proposal for diagnostic criteria, which we believe will improve the assessment of patients with obesity in a clinically meaningful way.

The ABCD of Obesity: An EASO Position Statement on a Diagnostic Term with Clinical and Scientific Implications

“…Similar efforts have been undertaken by our colleagues in North America [13-15]. Among their diverse activities, the coining of obesity as an adiposity-based chronic disease (ABCD) is of particular interest [16] and is in line with the EASO’s proposal to improve the ICD-11 diagnostic criteria for obesity based on three dimensions, namely etiology, degree of adiposity, and health risks [6]. The relevance and timeliness of these proposals is further accentuated by the current global health paradigm where the burden has moved from acute communicable diseases towards chronic noncommunicable diseases (NCDs) [17], even in low- and middle-income countries.…”

“…During the last decade, the European Association for the Study of Obesity (EASO) has been extraordinarily active in promoting actions through collaboration in advocacy, communication, education, and research to reduce the global burden associated with unhealthy body weight. This mission has been accomplished, among others, by highlighting the rising public health, clinical, scientific, economical, and societal challenges caused by obesity [5], as well as by reviewing the current International Classification of Diseases ICD-10 and revising the ICD-11 Beta Draft (July 27, 2018) for the definition of overweight and obesity to propose a substantial revision [6]. Further efforts to improve the assessment and management of children and adults with obesity in a clinically meaningful way include identification of paradigm shifts, calls for action, clinical guidelines, position statements, and education of health care workers [7-12].…”

Proposal for a Scientifically Correct and Medically Actionable Disease Classification System (ICD) for Obesity

“…The current International Classification of Diseases, Tenth Revision (ICD‐10) code for obesity lies within the block of “endocrine, nutritional and metabolic diseases” (E00‐E99) (specific codes shown in Box 1). The key code, E66.0, which describes “obesity due to excess calories,” does not indicate the cause of excess calories and could be translated as “you’re fat because you eat too much.” The shortcomings of ICD‐10 coding for obesity have previously been delineated by Hebebrand et al and the EASO . Briefly, there is no accurate methodology in clinical practice for quantifying caloric ingestion, and the descriptor ignores the energy expenditure component of energy balance.…”

„Diabesity“ – Adipositas und Typ-2-Diabetes (Update 2019)

“…Es wird häufig darüber diskutiert, ob die Adipositas eine Erkrankung für sich selbst darstellt oder einem krankhaften Zustand entspricht, eine rezente Publikation der European Association for the Study of Obesity (EASO) hat sie zum "Gateway of ill Health", also zu einem zentralen krankheitsbestimmenden Faktor erklärt [6] und später auch eine neue Klassifikation für ICD-11 vorgeschlagen [7]. Die "Milan Declaration 2015" der EASO hat die Adipositas nunmehr selbst als "progressive Erkrankung" genannt und als zentrales "Tor" zu vielen anderen Erkrankungen wie die meisten NCDs ("non communicable diseases"; nicht übertragbare Erkrankungen) erklärt.…”