How the New Obesity Definition Could Reshape the Wound Care Industry

New obesity definition impacts wound care risk, assessment, and healing outcomes. Learn how expanded criteria reshape prevention, management, and clinical practice.

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10/27/20256 min read

a doctor measuring the waist of an overweight patient

A recent landmark study published in The Lancet and expounded in JAMA Network Open introduced a new definition of obesity that could have far-reaching implications, including for clinicians and care teams working in wound care. The article, Implications of a New Obesity Definition Among the All of Us Cohort, found that when obesity is defined using not only body mass index (BMI) but also waist circumference, waist-to-hip ratio, and other anthropometric measures, the prevalence of obesity in a large U.S. cohort increased from about 43% to nearly 69%!
In this piece, we explore how this evolving definition of obesity might affect the wound care industry—looking at wound risk stratification, wound healing delays, clinical assessment, treatment planning, and healthcare system implications.

Why the new obesity definition matters

Traditionally, obesity has been defined by BMI alone—weight in kilograms divided by height squared (m²). But the new framework proposed by an international commission (and applied in the study) classifies obesity when BMI is elevated plus at least one abnormal anthropometric measure (like high waist circumference), or when BMI is normal but two or more anthropometric measures are elevated.
According to the study, this broadened definition:

Raised the obesity prevalence in the cohort from ~42.9% (traditional) to ~68.6% (new framework).
Identified individuals with so-called “anthropometric-only obesity” (normal BMI but elevated waist/hip parameters) who showed elevated risks of organ dysfunction, diabetes, cardiovascular events, and mortality.
Highlighted that many individuals previously considered non-obese under BMI alone may, under the new definition, be considered at elevated risk and therefore candidates for more intense monitoring or intervention.

So what does this mean for wound care? Since adiposity, metabolic dysfunction, inflammation, and perfusion deficits are all relevant to wound healing, expanding the population considered “obese” may affect risk stratification, preventive screening, management decisions, and resource planning in wound care.

Obesity and wound healing: the basic connections

Before diving into the effects of the new definition, here’s a quick refresher on how obesity influences wound outcomes:

Poor perfusion and increased risk of ischemia: Excess adipose tissue, especially central or visceral fat, can impair microvascular circulation and oxygen delivery (key for wound healing).
Chronic inflammation: Obesity is associated with a pro-inflammatory state which can impair progression from the inflammatory phase of healing into proliferation and remodeling.
Increased mechanical stress and risk of breakdown: In obesity, there is greater pressure on lower extremities, more shear forces, and increased risk of skin breakdown—especially in the context of diabetic foot ulcers or pressure injuries.
Comorbidities: Obesity is strongly linked with diabetes, peripheral vascular disease, and venous insufficiency—all high-risk factors for non-healing wounds.
Altered wound-healing responses: Studies have shown that patients with obesity may have delayed angiogenesis, impaired fibroblast activity, and higher risk of wound-complications such as infection.

Therefore, when wound care teams see patients with obesity, particularly those with comorbid diabetes or vascular disease, there is a recognized need for earlier, more aggressive assessment (eg. offloading, vascular evaluation, nutrition, infection control) and for closer monitoring of healing trajectories.

How the new definition might impact the wound care industry

Below are some key practical implications of the broadened definition of obesity for wound care specialists, clinicians, and care systems:

1. Broader at-risk population for chronic wounds

With the new definition, a larger number of patients may be categorized as having “clinical obesity” (or at least “pre-clinical obesity”). Many of these patients will carry increased wound-risk factors (eg. central adiposity, metabolic dysfunction) even if their BMI was previously considered “normal” or “overweight.”
For wound care teams, this could mean a shift in referral patterns, pre-wound screening, and preventive care for patients previously not flagged as obese. For example:

More patients may require foot-screening clinics (especially in diabetic populations)
Lower-leg ulcer preventive programs may need to adjust inclusion criteria
Pressure injury prevention programs in larger patients may need to adjust equipment and monitoring

2. Enhanced risk stratification and treatment planning

If a patient is re-classified under the new obesity definition, clinicians may weight their wound-healing risk higher. That can mean:

Initiating wound-bed preparation earlier (eg. debridement, compression, or offloading)
Prioritizing vascular or nutritional assessment earlier in the course of care
Monitoring healing metrics (size reduction, epithelialization) more tightly and being ready to escalate if healing stalls

For example, a patient with a BMI of 29 (below traditional obesity threshold) but elevated waist circumference and waist-to-height ratio might now be considered at higher wound risk, prompting earlier vascular evaluation or closer nutrition consultation.

3. Preventive and multidisciplinary frameworks may shift

Wound care is increasingly moving upstream: screening, prevention, and early intervention matter. With more patients classified as “obese,” wound-prevention programs may need to scale accordingly. This might include:

Wellness/foot-care education programs for a broader patient base
Earlier referral to dietitians, exercise physiologists, and wound-care nurses for patients with central adiposity
More investment in monitoring modalities (thermography, bio-impedance, offloading technology) for at-risk patients

This may require system adjustments: more staff time, more equipment, and potentially new metrics for tracking outcomes in patient populations not traditionally flagged for obesity or wound risk.

4. Implications for wound healing outcomes and resource utilization

Because obesity is linked to slower wound healing, higher complication rates (eg. infection, re-hospitalization, amputation), expanding the definition could lead to larger populations requiring more intensive wound care. As a result:

Wound clinics may see higher volumes of high-risk patients
Treatment algorithms may need to stratify by “obesity phenotype” (eg. anthropometric-only vs BMI-plus-anthropometric)
Payers and healthcare systems may need to revise quality measures, risk adjustment, and resource allocation

For example, a wound-care centre may decide that all patients meeting the new obesity definition automatically receive a “wound-risk bundle” (vascular screen + nutrition consult + offloading device) even before a wound forms.

5. Research, guideline development, and coding/documentation

With new definitions, coding, guideline criteria, and clinical trial populations may shift. For wound care industry stakeholders:

New guidelines may require obesity status to be documented using anthropometric measures (waist circumference, waist-to-hip ratio) rather than BMI alone
Research into wound healing may begin to stratify by newly defined obesity phenotypes and examine how these affect healing trajectories
Insurance and reimbursement frameworks may adapt to include anthropometric-only obesity as a risk factor for wound-care interventions

Wound-care clinicians will need to stay aware of evolving definitions and ensure their assessment tools (eg intake forms) capture waist circumference or other anthropometric data when indicated.

Practical steps for wound-care clinicians and teams

Given the above implications, wound-care professionals may consider the following practical strategies:

Update patient intake and risk-screening protocols to capture waist circumference, waist-to-hip ratio or waist-to-height ratio in addition to BMI when feasible.
Flag patients who meet the expanded obesity criteria (even if BMI <30) for earlier vascular, nutritional, or wound preventive interventions.
Identify and document “obesity phenotype” when relevant: for example, a patient with central adiposity but normal BMI might warrant closer monitoring for wound-risk.
Strengthen multidisciplinary collaboration: ensure dietitians, physiotherapists, vascular specialists, and wound nurses are integrated early for patients classified under the expanded definition.
Adjust wound prevention programmes: broaden patient educational materials, off-loading strategies, pressure-relief equipment for higher-weight patients or those with central adiposity.
Collect and monitor data: track whether patients meeting the new obesity criteria have higher wound incidence or slower healing in your practice; this may drive local quality improvement and resource planning.
Advocate for better documentation and coding: ensure waist/hip measures are recorded, and that obesity status is clearly documented when relevant to wound-care billing or risk adjustment.

Cautions and open questions

The new obesity definition is relatively recent and requires further validation in wound-care specific cohorts. How strongly the newly identified “anthropometric-only” group drives wound risk remains to be seen.
Not every patient meeting the new obesity criteria will develop wounds, and obesity alone does not guarantee delayed healing; other factors (perfusion, infection, off-loading, nutrition) remain critical.
Resource constraints may limit how quickly wound clinics can scale preventive programmes for a larger at-risk population.
Implementation of new measurement protocols (waist circumference, hip ratio) may require training and workflow adjustments.
Clinical trials of wound therapies may need re-tooling to stratify patients by these new obesity phenotypes to generate specific evidence on healing outcomes.

Final thoughts

The expanded definition of obesity marks a shift in how we classify and understand adiposity and its health-effects. For the wound care industry, this re-definition has the potential to broaden the at-risk population, enhance risk stratification, influence preventive and treatment pathways, and reshape resource planning. Wound-care clinicians, teams, and systems that adapt early (by updating screening, refining multidisciplinary workflows, and tracking patient outcomes) may improve both prevention and healing outcomes in a landscape where obesity and metabolic dysfunction remain major wound-risk drivers.

More Information

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Sources

Fourman LT, Awwad A, Gutiérrez-Sacristán A, et al. “Implications of a New Obesity Definition Among the All of Us Cohort.” JAMA Network Open. 2025;8(10):e2537619. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2840138
Rubino, Francesco, et al. Definition and diagnostic criteria of clinical obesity.
The Lancet Diabetes & Endocrinology, 2025, Volume 13, Issue 3, 221 - 262. https://doi.org/10.1016/S2213-8587(24)00316-4
https://www.thelancet.com/journals/landia/article/PIIS2213-8587(24)00316-4/abstract
Alma A, Marconi GD, Rossi E, Magnoni C, Paganelli A. Obesity and Wound Healing: Focus on Mesenchymal Stem Cells. Life. 2023; 13(3):717. https://doi.org/10.3390/life13030717
https://www.mdpi.com/2075-1729/13/3/717
Cotterell A, Griffin M, Downer MA, Parker JB, Wan D, Longaker MT. Understanding wound healing in obesity. World J Exp Med. 2024 Mar 20;14(1):86898. doi: 10.5493/wjem.v14.i1.86898. PMID: 38590299; PMCID: PMC10999071. https://www.wjgnet.com/2220-315X/full/v14/i1/86898.htm
https://pmc.ncbi.nlm.nih.gov/articles/PMC10999071/

* This blog is for informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment.