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  • Perspective
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Clinical obesity in Asian people: bridging the gap between adiposity and disease

Nature Reviews Endocrinology (2026) Cite this article

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Abstract

This Perspective argues for a reconceptualization of clinical obesity in Asian populations, moving beyond BMI-centric definitions towards an adiposity-based and function-based framework. Asian populations exhibit a distinctive obesity phenotype, characterized by excess visceral and ectopic adipose tissue accumulation, reduced β-cell reserve, sarcopenic obesity and heightened cardiometabolic risk at lower BMI thresholds than for white European and North American populations, leading to systematic under-recognition of obesity-related disease when conventional criteria are applied. Building on the Lancet Commission’s framework for defining and diagnosing clinical obesity, we propose an integrated approach that combines anthropometric measures, body composition assessment, metabolic and organ-specific markers and emerging biomarkers to distinguish preclinical obesity from clinical obesity on the basis of organ dysfunction and functional impairment. This approach improves risk stratification, supports earlier and more precise diagnosis and informs stage-specific management, including lifestyle intervention, pharmacotherapy and metabolic surgery, particularly in Asian populations. We discuss implications for clinical practice, prevention strategies and public health policy, emphasizing the need to align clinical guidelines, reimbursement systems and education with a function-based definition of obesity. Finally, we highlight key research priorities, including validation of biomarker-driven classifications, assessment of long-term clinical and economic outcomes and development of scalable diagnostic tools, to advance precision care and metabolic health equity across diverse Asian populations.

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Fig. 1: Clinical features of Asian people with obesity.
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Authors and Affiliations

  1. Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea

    Soo Lim

  2. Department of Endocrinology and Metabolism, Peking University People’s Hospital, Beijing, China

    Linong Ji

  3. Department of Endocrinology, Woodlands Health, National Healthcare Group, Singapore, Singapore

    Kwang Wei Tham

  4. Fortis-C-DOC Centre of Excellence for Diabetes, Metabolic Diseases and Endocrinology, New Delhi, India

    Anoop Misra

  5. National Diabetes Obesity and Cholesterol Foundation (N-DOC), New Delhi, India

    Anoop Misra

  6. Diabetes Foundation (India), New Delhi, India

    Anoop Misra

  7. Department of Internal Medicine, Toranomon Hospital, Tokyo, Japan

    Takashi Kadowaki

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  1. Soo Lim
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  2. Linong Ji
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  3. Kwang Wei Tham
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  4. Anoop Misra
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The authors contributed equally to all aspects of the article.

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Correspondence to Soo Lim or Takashi Kadowaki.

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Competing interests

S.L. received research grants from Merck Sharp & Dohme, Novo Nordisk and LG Chem and honoraria as a consultant or speaker for AstraZeneca, Boehringer Ingelheim, Abbott, LG Chem, Daewoong Pharmaceutical, Chong Kun Dang Pharmaceutical and Novo Nordisk. L.J. received consulting fees from Eli Lilly, Novo Nordisk, Sanofi Aventis, Bayer, AstraZeneca, Boehringer Ingelheim, Fosun Pharma, Abbott and Innovent Biologics; received speaking fees from Eli Lilly, Boehringer Ingelheim, Novo Nordisk, Bayer, Sanofi, AstraZeneca, Abbott, Gan & Lee Pharmaceuticals, Sinocare, Sibionics, Innovent Biologics, Merck and MSD; participated on a Data Safety Monitoring Board or Advisory Board for Eli Lilly, Novo Nordisk, Fosun Pharma, AstraZeneca and Innovent Biologics. K.W.T. received speaking fees from DKSH, Eurodrug Laboratories, iNova Pharmaceuticals and Novo Nordisk and participated in scientific advisory boards for DKSH, Novo Nordisk, Abbott Nutrition and Boehringer Ingelheim. A.M. received a research grant from USV Private Limited and AstraZeneca; honoraria for lectures from USV Private Limited, AstraZeneca and Mannkind Pharma; and honoraria for lectures and travel support as a speaker from Eli Lilly, Lupin, Boehringer Ingelheim, Janssen, Cipla, AstraZeneca, Glenmark, Novo Nordisk and Sanofi. T.K. received research funds from Daiichi Sankyo, Sumitomo Pharma and Nippon Boehringer Ingelheim and speaking fees from MSD, Taisho Pharmaceutical, Sumitomo Pharma, Takeda Pharmaceutical, Mitsubishi Tanabe Pharma Corporation, Teijin Pharma, Eli Lilly Japan, Nippon Boehringer Ingelheim and Novo Nordisk.

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Nature Reviews Endocrinology thanks Nitin Kapoor, who co-reviewed with Khushboo Agarwal; and Liyong Zhu for their contribution to the peer review of this work.

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Lim, S., Ji, L., Tham, K.W. et al. Clinical obesity in Asian people: bridging the gap between adiposity and disease. Nat Rev Endocrinol (2026). https://doi.org/10.1038/s41574-026-01239-8

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