Clinical obesity and Himan-sho (obesity disease) - Lessons from Japan’s 25 years of experience toward a new era of obesity care

Sep 28, 2026

Uploaded by Adam

Clinical obesity and Himan-sho (obesity disease) outlines how obesity care can move beyond BMI-only definitions through a refined, function-centered approach. It reviews an international “clinical obesity” framework dividing excess adiposity into preclinical versus clinical categories based on organ/tissue dysfunction and limitations in daily living. It contrasts this with Japan’s long-standing obesity disease (Himan-sho) construct, including BMI and disorder criteria and visceral fat thresholds, and highlights implications for global harmonization, regional adaptation, and prioritizing patients for medical intervention amid modern pharmacotherapy and bariatric/metabolic surgery.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages4

Reading Time10 min

AccessFree to download

Introduction

A New Framework: The Concept of "Clinical Obesity"

The Japanese Concept of "Obesity Disease" (Himan-sho)

Obesity Disease Diagnostic Criteria

Implications for Future Obesity Care

COMMENTARY Clinical obesity and Himan-sho (obesity disease): Lessons from Japan’s 25 years of experience toward a new era of obesity care INTRODUCTION Obesity has become one of the most pressing global health challenges of the 21st century, contributing to a broad spectrum of noncommunicable diseases, including type 2 diabetes, cardiovascular disorders, steatotic liver disease, certain cancers, and musculoskeletal complications. Its prevalence continues to rise worldwide, imposing substantial burdenson health systems and societies. At the same time, remarkable advances have been made in recent years, with the development of highly effective pharmacotherapies acting on receptors related to glucagon-like peptide-1 (GLP-1) and with the reﬁnement of bariatric and metabolic surgery. These breakthroughshave transformed the therapeutic landscape and highlighted the importance of precise disease deﬁnitions to identify patients most likely to beneﬁt from intervention. A NEW FRAMEWORK: THE CONCEPT OF “CLINICAL OBESITY”In light of these developments and broader challenges, an international commission convened by The Lancet Diabetes & Endocrinology recently proposed the concept of “clinical obesity” as a means of reﬁning how obesity should be deﬁned and addressed1. They argued that deﬁning obesity solely by body mass index (BMI) is inadequate, as BMI fails to capture the heterogeneous health risks associated with excess adiposity. Instead, the Correspondence Wataru Ogawa Tel.: +81-78-304-6046 Fax: +81-78-382-2080 E-mail address: [ogawa@med.kobe-u.ac.jp](ogawa@med.kobe-u.ac.jp) Received 24 September 2025; revised 30 September 2025; accepted 1 October 2025 report emphasized the need to consider both fat distribution and the functional consequences of adiposity. Within this framework, excess adiposity is divided into two categories: preclinical obesity, where there is excess adiposity without demonstrable impairment, and clinical obesity, where adiposity has already produced organ or tissue dysfunction and/or limitations in ageadjusted daily living activities. By introducing these categories, the authors sought to clearly distinguish between individuals at risk and those already experiencing disease due to obesity (Figure 1). The commission also stressed that this new framework should lay the foundation for a future international consensus. Implementation, they suggested, will require global harmonization of deﬁnitions and approaches, while also allowing regional adaptation to account for country-speciﬁc epidemiology, health systems, and resources. Thus, the proposal represents an aspirational step intended to guide future clinical practice and policy. At this stage, however, it remains primarily a conceptual framework, and its translation into tangible outcomes will depend on subsequent international and regional efforts. THE JAPANESE CONCEPT OF“OBESITY DISEASE (HIMAN-SHO)”In contrast, Japan has already demonstrated how such a conceptual framework can be transformed into practice. Nearly 25 years ago, the Japan Society for the Study of Obesity (JASSO) introduced the construct of “obesity disease” (Himan-sho in Japanese, where Himan means obesity and sho indicates disease/disorder), which closely parallels the concept of clinical obesity proposed by the commission2. This diagnosis was designed to differentiate individuals requiring medical intervention from those with excess body weight but without immediate health consequences. The diagnosis requires BMI ≥25 kg/m2—reﬂecting the elevated metabolic risk of East Asian populations at relatively lower BMI thresholds—together with either3: 1. One or more of 11 deﬁned obesityrelated health disorders (glucose intolerance [including type 2 diabetes and impaired glucose tolerance], dyslipidemia, hypertension, hyperuricemia orgout, coronary artery disease, cerebral infarction or transient ischemic attack, nonalcoholic fatty liver disease [recently proposed to be redeﬁned as

FAQs

Why is BMI alone considered insufficient for defining obesity in the proposed framework?

BMI does not capture the heterogeneous health risks linked to excess adiposity. The framework emphasizes fat distribution and functional consequences instead.

How does the “clinical obesity” concept distinguish preclinical obesity from clinical obesity?

Excess adiposity without demonstrable impairment is classified as preclinical obesity, while clinical obesity requires organ or tissue dysfunction and/or limitations in age-adjusted daily living activities.

What diagnostic criteria underpin Japan’s obesity disease (Himan-sho) concept?

It requires BMI ≥25 kg/m² plus either one or more defined obesity-related health disorders, or visceral fat obesity defined as visceral fat area ≥100 cm².

Sep 28, 2026

Uploaded by Adam