Researchers from Harvard and Mass General Brigham analyzed data from more than 300,000 adults in the NIH’s All of Us cohort to see how the new classification plays out in practice.

The shift was dramatic. Obesity prevalence jumped from about 40 to 70 percent, driven largely by people who had a normal BMI but unhealthy fat distribution based on their waist measurements. Older adults were especially affected: nearly 80 percent of Americans over age 70 met criteria for obesity under the new definition.

The health risks were just as striking. People with both a high BMI and an elevated waist measure had 231 percent higher odds of organ dysfunction compared with those without obesity. Even more telling, people with “anthropometric-only obesity,” those who would not have been classified as obese under BMI alone still had 76 percent higher odds of organ dysfunction.

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BMI is a simple calculation based on height and weight, but it can’t distinguish between fat and muscle, and it overlooks where fat accumulates. The updated definition, released by the Lancet Diabetes & Endocrinology Commission, adds waist circumference, waist-to-height ratio, and waist-to-hip ratio to provide a clearer picture of metabolic risk.

Traditionally, obesity has been defined as:

Under the new framework, a person is classified as having obesity if they have any of the following:

The definition also introduces two stages:

In the study, people with clinical obesity faced substantially higher risks of diabetes, cardiovascular events, and death. Those with preclinical obesity also faced elevated risks, though to a lesser degree.

BMI has been criticized for decades because it oversimplifies body composition. Created nearly 200 years ago using data from white European men, it doesn’t adjust for age, sex, race, frame size, or muscle mass.

Its biggest blind spot: it doesn’t show where fat is stored. An athlete may score as “obese” on BMI despite having low body fat, while someone with a normal BMI may carry dangerous levels of visceral fat that BMI completely misses.

This is one reason the American Medical Association urged clinicians in 2023 not to use BMI as the sole measure of weight-related health.

The body measures used in the new study, waist circumference, waist-to-hip ratio, and waist-to-height ratio, are all proxies for abdominal fat, particularly visceral fat. 

This deep, organ-surrounding fat is far more predictive of metabolic disease: higher levels are linked to inflammation, insulin resistance, heart disease, fatty liver disease, type 2 diabetes, and increased mortality.

If you already use BMI, you don’t need to stop. But the new definition highlights the value of pairing BMI with simple, at-home checks for a fuller, more accurate picture of your health.

Ultimately, this shift reflects a broader truth: obesity isn’t just about weight. It’s about fat distribution and how it affects your organs. A tape measure, used alongside BMI, may offer a more reliable window into your long-term health than BMI alone.