Defining Clinical Obesity
In January 2025, the Lancet published the conclusions of their Commission on the definition of clinical obesity, to aid clinical decision making and to guide interventions at the individual and population level.
Key Points
- Preclinical obesity is described as a physical phenotype, whereby excess adiposity is present but major signs and symptoms of organ dysfunction caused by obesity are absent. Preclinical obesity is not a pre-disease condition.
- Two main criteria are required to diagnose clinical obesity, which is described as a chronic systemic illness:
- Anthropometry establishing excess adiposity (e.g., waist circumference), in addition to BMI (can be assumed with very high BMI, e.g., > 40 kg/m2), which are appropriate to sex, age, and ethnicity.
- Signs or symptoms of current organ system dysfunction, and/or there are age-adjusted limitations to mobility or other daily living activities.
In the 2024 module on Obesity Management in Adults, the Edmonton Obesity Staging System (EOSS) tool is discussed. Stage 0 on the EOSS would be equivalent to preclinical obesity. Stages 1-4 of clinical obesity depend on BMI, comorbidities, and the degree of physical and psychological symptoms.
Blood Pressure Targets in Older Adults with Hypertension
A Cochrane review was conducted to determine the outcome differences between less aggressive (BP target < 150 to 160/95 to 105 mmHg) and conventional/more aggressive pharmacology treatments (BP target < 140/90 mmHg) for hypertension in adults age ≥ 65 years, over a 2- to 4-year follow-up. Primary outcomes included all-cause mortality, serious cardio-renal vascular adverse events, and stroke, while secondary outcomes included total serious adverse events, and the systolic and diastolic BP achieved, among other measures. Four trials were included in the updated review (n=16,732).
Findings
Treatment targeting the lower BP levels reduced stroke (high-certainty) and probably reduced total serious cardiovascular adverse events (moderate-certainty). Effects on all-cause mortality were unclear. Adverse effects were not higher with the more aggressive treatment (moderate-certainty).
Bottom Line
- For most adults age ≥ 65 years, conventional BP targets may be appropriate treatment.
- Additional research is needed for those aged ≥ 80 years and/or frail, as risks and benefits of treatment may differ.
Further information on managing hypertension can be found in the Hypertension module published in 2021.
Cognitive Functional Therapy and Chronic Low Back Pain
A systematic review with meta-analyses (7 RCTs) was conducted to investigate the effectiveness of cognitive functional therapy (CFT) for treating chronic nonspecific low back pain. CFT involves 3 components: making sense of pain, gradual exposure to valued activity with pain control, and healthy behavioural change. Long-term outcome (≥ 12 months) was the primary endpoint (short-term = closer to 6 weeks, medium-term = closer to 6 months). Across the 7 trials there was moderate variability in dosage, ranging between 3.6 to 7.7 sessions.
Findings
- When compared to usual care or alternate treatment:
- CFT reduced disability for all time points (low- to moderate-certainty).
- CFT was more effective in reducing pain intensity in the short-term (low-certainty), medium-term (moderate-certainty), and likely in the long-term.
- CFT improved pain self-efficacy in the medium- and long-term (high-certainty).
Bottom Line
- For those with chronic low back pain, CFT is probably more effective than usual care or alternate intervention (e.g., exercise and education), with improvements in disability, self-efficacy, and likely pain, sustained in the long-term.
Cognitive functional therapy is described in the 2024 module on Chronic Musculoskeletal Pain in Adults as a potential therapy option.
Exercise for Parkinson Disease
- A 2025 Tools for Practice article on exercise for Parkinson disease (11 systematic reviews included) reported that when compared to control, exercise produced clinically significant improvements in motor symptoms which were similar to those achieved with medications over 1 to 6 months.
- Depressive symptoms scores improved when compared to those not active, though quality of life did not show clinically meaningful change. Over a 6 to 12 month period, out of 100 patients who exercise, 6 more will avoid ≥ 1 fall when compared to control.
- Reported limitations of the reviewed studies included short study durations, non-blinded interventions, small sample sizes, and few severe patients.
Promoting exercise is in alignment with the recommendation on exercise included in the 2025 module on Parkinson Disease.