New medicines help people lose weight. These medicines are now in the UK and Australia. But doctors do not have one clear rule to define obesity.

新藥物能幫助人們減重。這些藥物目前已在英國和澳洲上市。但醫生們對於定義肥胖尚未有統一的明確標準。

In the past, doctors used BMI to check weight. BMI is a simple number. It does not show if a person is truly sick. Some people had high BMI but felt fine. Other people were very sick but did not get help.

過去，醫生使用 BMI 來檢查體重。BMI 僅是一個簡單的數字，無法顯示一個人是否真正患病。有些人 BMI 很高但感覺良好，而有些人則病得很重卻無法獲得幫助。

Now, some doctors think obesity is a long disease. Other doctors think it is just a risk for future problems. This creates a problem for hospitals and money.

現在，有些醫生認為肥胖是一種長期疾病。其他醫生則認為這僅僅是未來問題的風險。這給醫院和資金帶來了問題。

A group of experts has a new idea. They want two groups. Group one is 'clinical obesity'. These people have organ problems. Group two is 'pre-clinical obesity'. These people have a high risk but their organs work well.

一組專家提出了一個新想法。他們希望將其分為兩組。第一組是「臨床肥胖」，這些人的器官有問題。第二組是「臨床前肥胖」，這些人的風險較高，但其器官運作良好。

Doctors want to stop using only BMI. They want this new two-group system to give the right medicine to the right people.

醫生希望停止僅使用 BMI，他們希望透過這個新的兩組系統，將正確的藥物提供給正確的人。

Recent improvements in GLP-1 medications, such as the arrival of oral versions of Wegovy in the UK and Australia, have made it easier for people to lose a significant amount of weight. However, these medical advances have revealed a major problem: there is no globally accepted clinical definition of obesity.

近期 GLP-1 藥物的進步，例如 Wegovy 口服版本的在英國與澳洲上市，讓人們更容易減掉大量體重。然而，這些醫療進展也揭露了一個重大問題：全球缺乏一個公認的肥胖臨床定義。

In the past, the way doctors viewed obesity changed from a general health perspective to a risk-based model created by the insurance industry. This change replaced detailed medical exams with the Body Mass Index (BMI), which was designed for studying large groups of people rather than diagnosing individuals. Consequently, many patients only received treatment if they already had other health problems, meaning those whose main issue was simply excess weight were often ignored.

過去，醫生看待肥胖的角度從一般的健康視角，轉變為由保險業建立的風險模型。這種改變以身體質量指數 (BMI) 取代了詳細的醫療檢查，而 BMI 的設計初衷是用於研究大群體而非診斷個人。因此，許多患者直到出現其他健康問題後才獲得治療，這意味著那些主要問題僅為體重過重的人往往被忽略了。

Currently, there is a debate over whether obesity should be seen as a chronic disease for everyone or as a risk factor. If it is treated as a universal disease, more people can get help; however, this might lead to over-treating people who have no symptoms. On the other hand, treating it only as a risk factor might mean that people with serious organ damage do not get the care they need.

目前，關於肥胖應被視為所有人的慢性疾病還是風險因素，仍存在爭論。如果將其視為普遍疾病，更多人能獲得幫助；然而，這可能會導致沒有症狀的人被過度治療。另一方面，若僅將其視為風險因素，可能意味著器官受損嚴重的患者無法獲得所需的照顧。

To solve this problem, a Lancet commission has suggested a new system. They propose dividing the condition into 'clinical obesity,' where the patient has clear organ damage, and 'pre-clinical obesity,' where the organs function well but the risk is high. This approach aims to make obesity treatment similar to heart disease or cancer care, ensuring that the strength of the medication or surgery matches the patient's actual physical needs.

為了p解決這個問題，《柳葉刀》(Lancet) 委員會建議了一套新系統。他們提議將此情況分為「臨床肥胖」（患者有明顯器官損壞）以及「臨床前肥胖」（器官功能良好但風險較高）。此方法旨在使肥胖治療與心臟病或癌症治療相似，確保藥物強度或手術方案符合患者實際的身體需求。

The medical community is now considering a move away from relying solely on BMI. Instead, they are looking at a two-category model to make treatments more effective and affordable for healthcare systems.

醫學界目前正考慮不再單純依賴 BMI。相反地，他們正在研究一種雙類別模型，以使治療對醫療體系而言更有效且更經濟實惠。

Recent advancements in GLP-1 receptor agonists, including the introduction of oral formulations of Wegovy in the United Kingdom and Australia, have expanded the capacity for significant weight reduction. However, this technological progress has highlighted a systemic lack of a standardized clinical definition for obesity.

近期 GLP-1 受體激動劑取得顯著進展，包括在英國與澳洲推出口服劑型的 Wegovy，擴大了大幅減重的可能性。然而，這項技術進步也突顯了系統性地缺乏標準化的肥胖臨床定義。

The historical conceptualization of obesity has transitioned from a Hippocratic spectrum of health to a risk-based model established by the 20th-century insurance industry. This shift substituted clinical pathology with the Body Mass Index (BMI), a metric designed for population statistics rather than individual diagnosis. Consequently, medical intervention was frequently contingent upon the presence of comorbidities, effectively ignoring patients whose primary pathology was the excess weight itself.

肥胖的歷史概念已從希波克拉底的健康光譜，轉向由 20 世紀保險業建立的風險模型。這一轉變以身體質量指數 (BMI) 取代了臨床病理學，而 BMI 是為人口統計而非個人診斷而設計的指標。因此，醫療干預往往取決於共病的有無，實際上忽略了那些主要病理即為體重過高的患者。

Currently, a tension exists between viewing obesity as a universal chronic disease and maintaining it as a risk state. While the former ensures broader access to care, it risks the over-medicalization of asymptomatic individuals and the inefficient allocation of healthcare resources. Conversely, the latter may lead to the neglect of those with active organ dysfunction.

目前，將肥胖視為一種普遍的慢性疾病與將其視為一種風險狀態之間存在張力。前者雖能確保更廣泛的醫療接及，但可能導致無症狀個體的過度醫療化以及醫療資源的低效分配。相反，後者則可能導致具有活性器官功能障礙的患者被忽視。

To resolve this dichotomy, a Lancet commission has proposed a diagnostic framework that distinguishes 'clinical obesity'—characterized by demonstrable organ impairment or functional limitation—from 'pre-clinical obesity,' which is defined as a state of preserved organ function but elevated risk. This stratification aims to align obesity management with other medical disciplines, such as oncology or cardiology, ensuring that the intensity of pharmacological or surgical intervention is proportionate to the patient's actual physiological state.

為了消除這種對立，一份《柳葉刀》委員會報告提出了一套診斷框架，將「臨床肥胖」（特徵為可證明的器官損害或功能限制）與「臨床前肥胖」（定義為器官功能尚在維持但風險較高）區分開來。此分層旨在將肥胖管理與腫瘤學或心臟學等其他醫學學科接軌，確保藥物或手術干預的強度與患者實際的生理狀態相稱。

The medical community is currently evaluating a transition from BMI-centric risk assessment toward a dual-category diagnostic model to optimize treatment efficacy and economic sustainability.

醫療社群目前正在評估從以 BMI 為中心的風險評估，轉向雙類別診斷模型，以優化治療成效與經濟永續性。