Nat Med
Obesity score finds high-risk patients BMI may miss
Clinical takeaway: This risk score could eventually help clinicians prioritize obesity treatment by complication risk, rather than BMI alone.
Body mass index (BMI) still the main indicator that serves as a gateway to obesity treatment, but it can miss the patients most likely to develop weight-related conditions. A new 20-factor risk score, known as OBSCORE, was designed to identify people with overweight or obesity whose clinical profile puts them at higher ten-year risk for diabetes, cardiovascular disease, kidney disease, sleep apnea, and other obesity-related outcomes.
OBSCORE stratified risk across 18 weight-related outcomes and outperformed age, sex, and BMI alone. For 12 of these 18 outcomes, people in the highest risk group had more than 10 times the event rate of those in the lowest risk group, with the largest differences seen for chronic kidney disease, type 2 diabetes, gout, and cardiovascular death.
The model also showed why BMI alone may be too blunt for treatment decisions. Among those in the highest OBSCORE risk group, many had overweight rather than obesity; across outcomes, 19% to 45% of the highest-risk decile had a BMI of 27 to 30. Predicted risks also varied widely within the same BMI category.
The 20-factor model uses mostly routine clinical data, including age, hemoglobin A1c, cholesterol, urate, creatinine, waist-to-height ratio, hypertension, smoking, overall health rating, and selected symptom or history variables.
The tool is meant to complement, not replace, existing BMI-based frameworks. In SURMOUNT-1 trial data, tirzepatide produced broadly similar 72-week reductions in body weight and waist-to-height ratio across OBSCORE baseline risk groups, suggesting treatment effects were not limited to lower-risk patients. OBSCORE-predicted risks were similar across treatment and placebo groups at baseline but fell significantly across all outcomes after tirzepatide treatment.
Researchers developed OBSCORE using UK Biobank data from 197,264 adults with BMI of at least 27 kg/m², including 97,421 with overweight and 99,843 with obesity. The model was designed to predict incident cardiovascular, metabolic, mechanical, and mortality outcomes over ten years and was externally validated in EPIC-Norfolk and Genes & Health.
The 18 weight-related outcomes studied spanned cardiovascular, metabolic, kidney, liver, respiratory, joint, and gastrointestinal complications, including type 2 diabetes, myocardial infarction, stroke, cardiovascular mortality, chronic kidney disease, gout, sleep apnea, arthropathy, gastroesophageal reflux disease, and metabolic dysfunction-associated steatotic liver disease.
“Two people with similar body weight can have very different risks of developing diseases such as diabetes or heart conditions,” summed up Kamil Demircan, PhD, DFG Walter Benjamin Fellow at Queen Mary University of London’s Precision Healthcare University Research Institute and the Berlin Institute of Health.
Next steps include validating and calibrating OBSCORE in larger, more diverse clinical populations, testing whether it improves treatment prioritization and outcomes, and evaluating cost-effectiveness before routine use.
Source: Demircan K. Nat Med. 2026 Apr 30. Data-driven prioritization of high-risk individuals for weight loss interventions