Obesity Assessment in the Era of Precision Cardiometabolic Medicine

Dr. Kamal Kishor, Interventional Cardiologist, HOD, Dept. of Cardiology, Rama Heart Centre, Karnal, Haryana, India

BMI alone inadequately captures cardiometabolic risk. Integrating fat distribution measures, imaging-based adiposity markers, and molecular phenotyping enables more accurate cardiovascular risk stratification and personalized obesity care.

Obesity remains a leading driver of cardiovascular disease, yet it is still mostly classified using body mass index (BMI), a classification that does not reflect where fat is stored or how it affects metabolic and cardiovascular risk. Measures such as waist-to-hip ratio (WHR) offer a straightforward way to assess central obesity and have been shown to predict heart attacks and cardiovascular events more reliably than BMI, especially in women and Asian populations.

Imaging techniques provide even greater precision. Visceral adipose tissue (VAT), measured by computed tomography or magnetic resonance imaging, is strongly linked to coronary heart disease regardless of BMI or waist size, highlighting the harmful role of fat stored around internal organs. Epicardial adipose tissue (EAT), which surrounds the heart, is a marker of cardiovascular risk and is associated with heart failure progression, atrial fibrillation, and major adverse cardiovascular events.

BMI also fails to distinguish between different obesity phenotypes. Some individuals with obesity remain metabolically healthy, while others with normal body weight carry significant metabolic risk. Advanced tools such as metabolomic profiling and polygenic risk scores help uncover inflammation, insulin resistance, and genetic risk that traditional measurements miss.

Although challenges remain, including cost, access to advanced testing, and limited inclusion in clinical guidelines, current evidence supports moving toward a more personalized, phenotype-based approach to obesity assessment.

(Source: Tanasescu MD, Rosu AM, Minca A, Rosu AL, Grigorie MM, Timofte D, Ionescu D. Beyond BMI: Rethinking Obesity Metrics and Cardiovascular Risk in the Era of Precision Medicine. Diagnostics. 2025 Nov 27;15(23):3025..)