Pooja Singhal, MD, is a gastroenterologist, hepatologist, and obesity medicine specialist at Oklahoma Gastro Health and Wellness.

Pooja Singhal, MD

Pooja Singhal, MD | Image Credit: Oklahoma Gastro Health and Wellness

 published a Commission establishing an official definition and diagnostic criteria for 

, aiming to alter the way the condition is approached in 

The central conceit of the Commission was the difference between clinical and preclinical obesity, which is described as the presence or absence of objective clinical manifestations. These primarily include altered organ function or the impairment of a patient’s ability to conduct daily activities. A lens this specific allows clinicians to account for patients who are technically obese but exhibit no comorbidities, outwardly appearing to be in good health.

Additionally, the Commission provided suggestions for altering the diagnostic process for obesity, encouraging the abandonment of the body mass index (BMI) as the sole indicator. Instead, the commissioners suggest the utilization of ≥2 individual anthropometric criteria, such as waist circumference, or direct fat measurement when possible. This should prevent the rampant overdiagnosis of obesity that was predicted by the Commission.

To address how the Commission’s decision has influenced endocrinology since its publication, the editorial team at 

 spoke with Pooja Singhal, MD, a gastroenterologist, hepatologist, and obesity medicine specialist at Oklahoma Gastro Health and Wellness, in the following Q&A:

: How has the move toward formally defining obesity as a disease shaped the landscape of obesity care?

: I think defining obesity as a disease was truly transformational. It helped establish a scientific and moral basis for treating obesity directly. You know, in the past, we used to treat the complications – sleep apnea, diabetes, hypertension, cardiovascular disease, MASLD. Now it has helped us to have a newer approach, which is that obesity itself is a disease, and we need to treat that and prevent complications. I think this reframing has been revolutionary and has really redefined how we approach obesity in general. It’s validated that obesity should be treated. It is a disease, and it should be treated before complications arise. It also helped reduce this kind of moral blame on patients by defining it as a true disease that exists on its own, in its own right. It has promoted earlier intervention proactiveness to seek help, and I also think it’s going to help and already has helped early intervention in pediatric obesity, because that’s what we have seen more and more of. I think the whole Commission’s work is helping us in all these ways.

: To what extent has defining obesity as a disease opened the door to broader acceptance of pharmacologic treatment, especially GLP-1s?

: I think GLP-1s have fit perfectly into this new narrative of biological disease. Because it’s really when people see results, when they see that a medication that works neurohormonally can lead to appetite curbing and lead to the weight loss that people were absolutely not able to achieve, no matter what they tried. It has changed that narrative and acceptance as a community, as a society, even globally, that obesity is truly a disease and regulation of appetite signaling has a big role in it. So, I think the timing of the GLP-1s and the results have also been very much a boon to this biologic narrative of obesity as a disease without that disease framing, where GLP-1s would not have been culturally accepted.

: What other details can you provide around clinicians’ views of obesity following the Commission?

: It’s also led to the clinician’s view of obesity has changed too. Before, it was kind of episodic treatment, if you will. Now there’s more willingness to view pharmacotherapy as a first-line option of obesity for many patients. In the past, it was all about diet and exercise and lifestyle changes. Now, more and more clinicians understand that obesity is a disease, and early prevention and treatment could lead to preventing some very serious complications. So I do also love the fact that it has informed clinician behavior as well and promoted chronic management approach rather than episodic weight loss attempts.

Rubino F, Cummings DE, Eckel RH, et al. Definition and diagnostic criteria of clinical obesity. 

Livingston R. The Lancet Commission on Obesity: Redefining Endocrinology’s Most Notorious Condition. 

. December 18, 2025. Accessed December 19, 2025. 

https://www.hcplive.com/view/the-lancet-commission-on-obesity-redefining-endocrinology-s-most-notorious-condition

Articles

The Lancet Diabetes & Endocrinology Commission has redefined obesity by distinguishing between clinical and preclinical obesity, focusing on objective clinical manifestations. This new definition encourages moving beyond BMI as the sole diagnostic tool, advocating for multiple anthropometric criteria. The reclassification of obesity as a disease has transformed its treatment, promoting early intervention and reducing patient stigma. It has also facilitated the acceptance of pharmacologic treatments like GLP-1s, shifting clinician perspectives towards chronic management rather than episodic interventions.

Singhal discusses the multi-pronged impact of the Commission’s definition of obesity and how it effects clinicians, patients, and the treatment structure itself.

Impacts of the Lancet Commission on Obesity Treatment, With Pooja Singhal, MD

Public Perceptions and Clinical Realities of Obesity Care, With Pooja Singhal, MD

 continues to rise across the United States, affecting more than 100 million adults and reshaping how clinicians, policymakers, and the public think about chronic disease. At the same time, breakthroughs in pharmacotherapy and the widespread adoption of GLP-1 receptor agonists have accelerated conversations about how obesity is defined and treated.

Even as therapeutic tools rapidly evolve, public understanding and perceptions remain a powerful force influencing stigma, access to care, and policy priorities. A new survey from the American Gastroenterological Association (AGA) offers insight regarding how Americans view obesity as a condition, as a risk factor, and as a treatable disease, with findings shedding light on both encouraging progress and persistent gaps.

“Perceptions lead to stigma. Perceptions 

 stigma,” Pooja Singhal, MD, a gastroenterologist, hepatologist, and obesity medicine specialist at Oklahoma Gastro Health and Wellness, told 

. "When we talk about obesity, I feel like this is one disease state where stigma has really been deeply entrenched.”

Singhal notes that obesity remains one of the most stigmatized chronic diseases, in part because society has long been taught to see it as a matter of personal responsibility, and explains that understanding public perceptions is essential for addressing barriers to care as well as informing advocacy efforts and driving payer and policy attention toward meaningful coverage.

She describes several findings from the AGA survey she finds particularly striking and encouraging, including the 63% of US adults who recognize obesity as a chronic condition. Singhal also highlights the growing awareness that obesity increases the risk of other chronic diseases, noting that clinicians have spent years managing complications such as hypertension and diabetes rather than addressing obesity itself.

Additionally, Singhal calls attention to the 85% of respondents who reported believing insurance should cover obesity treatment. Despite improved understanding of obesity as a chronic disease, she says cost remains the greatest barrier to care, with more than 80% of respondents citing out-of-pocket expenses and limited insurance coverage as major obstacles.

While public and clinical perspectives are aligning in some areas, such as recognizing obesity as a chronic disease requiring long-term management and increased openness to anti-obesity medications, including GLP-1 receptor agonists, Singhal notes key misalignments remain that must be addressed moving forward.

“I think the public sees it as a medication problem, while the reality is that obesity is very complex. We need proper nutrition, proper exercise, proper sleep, proper mental health. There are so many social determinants that also play into obesity,” she said. “We clinicians see it as a multidisciplinary approach dealing with the long-term management of obesity. I think that's the biggest misalignment we still have.”

Looking ahead, Singhal points to major opportunities, including transformative pharmacotherapy, promising endoscopic interventions, and advances in digital health, while stressing that insurance coverage, stigma reduction, and improved clinician training remain critical to closing the gap between need and access.

Editors’ Note: Singhal reports no relevant disclosures.

American Gastroenterological Association. Most Americans view obesity as a chronic disease deserving insurance coverage. November 19, 2025. Accessed December 11, 2025. 

https://gastro.org/press-releases/most-americans-view-obesity-as-a-chronic-disease-deserving-insurance-coverage/

US Centers for Disease Control and Prevention. Adult Obesity Facts. May 14, 2024. Accessed December 11, 2025. 

https://www.cdc.gov/obesity/adult-obesity-facts/index.html

Videos

Singhal reviews new AGA survey data on public perceptions of obesity as a chronic disease and describes opportunities to improve care.