The recent publication ‘A new framework for the diagnosis, staging and management of obesity in adults’ by authors from the European Association for the Study of Obesity¹ illustrates a practical context for the diagnosis and treatment of obesity in adults. The document paves the way for more tailored assessment and treatment of obesity in adults. Although the authors deliberately focused on obesity in adults in this work, the framework they propose fits well with what is observed in the pediatric population and provides a basis for some considerations.

As described in that article¹, body mass index does not reflect the severity of fat accumulation and dysfunction in adults. In children, it does so even less even if it is normalized for age and sex^2,3. In the pediatric setting, the concept of age- and sex-specific references for visceral fat measured as abdominal circumference, waist-to-height ratio and other indices is firmly grounded in the need to reflect continuous body growth. Few of these indices are well referenced to reflect visceral fat in children. This is a critical oversight, as without a doubt, obesity is an adiposity-based chronic disease in children⁴. Accurate quantification of excess adiposity and how it affects the health and function of the child or adolescent is crucial.

欧洲肥胖研究协会¹ 的作者最近出版的“成人肥胖诊断、分期和管理的新框架”说明了成人肥胖诊断和治疗的实际背景。该文件为更有针对性的成人肥胖评估和治疗铺平了道路。尽管作者在这项工作中特意关注成人肥胖，但他们提出的框架与在儿科人群中观察到的情况非常吻合，并为一些考虑提供了基础。

如第¹ 条所述，体重指数并不能反映成人脂肪堆积和功能障碍的严重程度。在儿童中，即使年龄和性别正常化，它的影响甚至更小^2,3。在儿科环境中，以腹围、腰高比和其他指标衡量的内脏脂肪的年龄和性别特异性参考概念牢固地建立在反映身体持续生长的需要之上。这些指数中很少有很好的参考来反映儿童的内脏脂肪。这是一个严重的疏忽，因为毫无疑问，肥胖是儿童基于肥胖的慢性疾病⁴。准确量化过度肥胖及其如何影响儿童或青少年的健康和功能至关重要。