Convergent recommendations with other position statements
Classification and staging of SMD
Systemic metabolic disorder (SMD) is a progressive condition linked to obesity and metabolic complications. The EAS consensus proposes a clinically actionable three-stage system based on the underlying pathophysiology and organ involvement. This framework emphasizes the importance of early detection, treating multiple pathologies simultaneously, and tailoring interventions according to disease stage. Using this system, the prevalence of SMD Stages 1 and 2 was calculated in European participants of the UK Biobank.
Alignment with other Guidelines
Other recent position statements, including those from EASO, the Lancet Commission, and the American Heart Association, also use staging approaches to guide clinical management. The EASO framework focuses on obesity diagnosis and management, the Lancet Commission distinguishes between clinical and pre-clinical obesity, and the American Heart Association introduces a cardiovascular–kidney–metabolic syndrome concept with four stages. These systems converge on the idea that identifying early stages is crucial to prevent progression and organ damage.
Redefining diagnosis of obesity
BMI alone is insufficient to determine an individual’s health status. Accurate assessment should combine BMI with at least one additional anthropometric measure, such as waist circumference, and thresholds should be adjusted for ethnicity. This approach allows a more precise evaluation of metabolic risk.
Comprehensive evaluation of metabolic risk factors
Obesity-related metabolic complications are driven by dysfunctional subcutaneous fat, which releases free fatty acids leading to visceral fat accumulation and fat deposition in ectopic tissues. Central to these processes is insulin resistance, accompanied by atherogenic dyslipidaemia, elevated blood pressure, and low-grade chronic inflammation. Early and thorough assessment of all these interrelated risk factors is essential to enable a whole-body, preventive approach and guide tailored interventions.
Management principles
Lifestyle interventions remain the cornerstone of SMD management at all stages. This includes improving diet quality, reducing caloric intake, and increasing physical activity. Management strategies should address all identified risk factors, and treatment should be escalated as disease progresses or as more organs become affected. Early intervention is critical to prevent organ damage and reduce long-term cardiovascular and metabolic risk.