{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T04:55:34Z","timestamp":1790571334493,"version":"4.1.0"},"reference-count":18,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T00:00:00Z","timestamp":1788739200000},"content-version":"vor","delay-in-days":6,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Diabetes Metabolism Res"],"published-print":{"date-parts":[[2026,9]]},"abstract":"ABSTRACT<\/jats:title>\n \n Background<\/jats:title>\n Conventional BMI\u2010based obesity classification fails to capture the metabolic heterogeneity underlying obesity\u2010related heart failure (HF) risk. We evaluated the 2024 European Association for the Study of Obesity (EASO) framework\u2014which integrates central adiposity with medical, functional, and psychological morbidity\u2014to refine HF risk stratification.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n Among 449,550 UK Biobank participants (median follow\u2010up 15.5\u00a0years), we applied three obesity definitions: (1) BMI \u2265\u00a030\u00a0kg\/m\n 2<\/jats:sup>\n ; (2) the EASO framework, which retains the normal\u2010weight category (BMI 18.5\u2013<\u00a025\u00a0kg\/m\n 2<\/jats:sup>\n ) and reclassifies individuals with BMI 25\u2013<\u00a030\u00a0kg\/m\n 2<\/jats:sup>\n into \u2018EASO overweight\u2019 (WHtR\u00a0<\u00a00.5 and\/or absence of morbidity) or \u2018EASO new obesity\u2019 (WHtR\u00a0\u2265\u00a00.5 plus \u2265\u00a01 morbidity), while those with BMI\u00a0\u2265\u00a030\u00a0kg\/m\n 2<\/jats:sup>\n are classified as BMI obesity regardless of morbidity status; and (3) an extended EASO framework that additionally stratifies individuals with BMI\u00a0\u2265\u00a030\u00a0kg\/m\n 2<\/jats:sup>\n by morbidity status. Morbidity was defined per the 2024 EASO consensus criteria as the presence of \u2265\u00a01 medical, functional, or psychological conditions associated with excess adiposity. Cox proportional hazard models estimated hazard ratios (HRs) for incident HF.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n The EASO framework reclassified 15.6% of conventionally overweight individuals as obese, increasing the obesity prevalence from 24.5% to 40.1%. Compared with normal\u2010weight individuals, the EASO overweight group (BMI 25\u2013<\u00a030\u00a0kg\/m\n 2<\/jats:sup>\n without central adiposity or morbidity) exhibited the lowest HF risk (HR 0.84, 95% CI 0.80\u20130.89), confirming that overweight per se confers no excess risk in the absence of morbidity. By contrast, EASO new obesity (BMI 25\u2013<\u00a030\u00a0kg\/m\n 2<\/jats:sup>\n with central adiposity and \u2265\u00a01 morbidity; HR 1.32, 95% CI 1.25\u20131.39) demonstrated that morbidity presence\u2014not BMI threshold\u2014drives elevated HF risk within the overweight range. BMI obesity (BMI\u00a0\u2265\u00a030\u00a0kg\/m\n 2<\/jats:sup>\n ) yielded the highest summary HR (1.62, 95% CI 1.53\u20131.71), reflecting its compositional enrichment with high\u2010morbidity individuals rather than superior risk discrimination. In the extended framework, morbidity status produced a consistent vertical upward shift in HF risk across all adiposity categories, establishing phenotypic characterisation beyond anthropometric thresholds as the key determinant of HF vulnerability.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n The EASO framework refines HF risk stratification by uncovering morbidity\u2010driven vulnerability within the overweight range that BMI alone obscures. The extended framework further demonstrates that morbidity status\u2014rather than anthropometric thresholds\u2014is a primary modifier of HF risk across all adiposity categories, supporting a shift from purely anthropometric toward phenotype\u2010based obesity classification in cardiovascular risk assessment.<\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/dmrr.70227","type":"journal-article","created":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T15:14:25Z","timestamp":1788794065000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Redefining Obesity Risk for Heart Failure: Incorporating Morbidity Into the 2024 EASO Framework Definition of Obesity"],"prefix":"10.1002","volume":"42","author":[{"given":"Liang","family":"Tang","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Medicine Second Xiangya Hospital Central South University Changsha Hunan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xianming","family":"Tang","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Second Xiangya Hospital Central South University Changsha Hunan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0036-0420","authenticated-orcid":false,"given":"Zhenhua","family":"Xing","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Second Xiangya Hospital Central South University Changsha Hunan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-5188-1090","authenticated-orcid":false,"given":"Chenkai","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Second Xiangya Hospital Central South University Changsha Hunan 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