As the EU celebrates Diversity Month 2025 and honours the Capitals of Inclusion and Diversity, we’re reminded that inclusion isn’t just a social value. It’s a scientific necessity. In health, as in society, one-size-fits-all approaches no longer serve us.

This is especially true in how we approach the chronic disease of obesity. For too long, diagnosis and care have been anchored in weight and BMI,; tools that are not only outdated, but also structurally biased. They miss the biology. They miss the nuance. And they miss people.

“Obesity is a chronic disease of biology, not a number on a scale. True progress starts when we move beyond one-size-fits-all metrics.”

BMI: A Blunt Tool in a Precision Era

Let’s be honest: BMI was never designed to diagnose individual health. It was developed in the 19th century by a Belgian astronomer and statistician, not a doctor, and based on measurements of European men. It doesn’t account for ethnicity, body composition, or metabolic function. Yet it still shapes clinical decisions across Europe.

And it does so poorly.

• Black women may have higher BMI but healthier metabolic profiles than White women at the same level—yet are more likely to be flagged as high-risk.
• South Asian adults face elevated risk of type 2 diabetes and cardiovascular disease at BMI levels as low as 23.9.
• Chinese and Arab adults show similar risk at 26–27, well below the standard obesity threshold.
• Hispanic populations often carry more visceral fat at lower BMIs; risk that BMI doesn’t see.

These aren’t exceptions. They’re evidence that body size is not a reliable proxy for disease.

“Our diagnostic tools must catch up with our science: diversity is the reality, not the outlier.”

Who’s Affected and Who’s Overlooked

Across Europe, millions of people from diverse ethnic backgrounds are living with the disease of obesity; often without accurate diagnosis or access to appropriate care. Yet the tools we use to assess risk still reflect outdated norms.

Consider the scale:

• Black: ~9–10 million, with the largest communities in France and the UK, and growing populations in Germany and Italy.
• South Asian: ~5–6 million people, primarily in the UK, Italy, Germany, and the Netherlands.
• Chinese: ~2–3 million, with significant populations in the UK, France, Italy, and Spain.
• Arab: ~6–8 million, especially in France, Germany, the Netherlands, and Sweden.
• Hispanic/Latino: ~2–3 million, mostly in Spain, Portugal, Italy, and the UK.

These communities are not only underrepresented in clinical trials, they’re also underserved by diagnostic tools like BMI, which fail to reflect their true metabolic risk.

And the stakes are high. According to the WHO, more than 60% of adults in Europe live with pre-obesity (overweight) or obesity, and 1 in 3 children are affected. Yet many are not diagnosed until complications arise; because their risk wasn’t visible on a scale.

“When diagnosis rests on outdated norms, whole communities are left invisible and at risk.”

What the Science Shows

Recent studies have shown that adipose tissue dysfunction, the root of the disease of obesity, can be detected early through:

• Mitochondrial dysfunction in fat cells, which disrupts energy regulation and triggers inflammation
• Extracellular vesicles released by stressed adipose tissue, carrying molecular signals of metabolic imbalance
• Genomic endotyping, which reveals distinct biological pathways driving disease progression

This means we can identify people at risk before disease becomes visible, and intervene with the right tools at the right time.

“Precision in medicine means targeting the root cause; not just what we can see.”

Matching Care to Biology

Phenotyping isn’t just about better diagnosis; it’s about better care.

• Medication strategies should be matched to the biological drivers of disease, whether hormonal, metabolic, or neurobehavioral.
• Psychotherapy should be integrated at every stage. The chronic disease of obesity is never just physical. It’s shaped by stress, trauma, discrimination, and social context.

This is what precision care looks like: tailored, timely, and human.

Shared Value, Shared Responsibility

As lead of Work Package 8 on the IMI-SOPHIA project (Shared Value Analysis), my role is to ensure that innovation delivers shared value—benefits that matter to patients, clinicians, payers, and policymakers alike. Phenotyping supports this by:

• Reducing structural bias in diagnosis and treatment
• Improving access to appropriate therapies for underrepresented groups
• Aligning with EU values of fairness, inclusion, and data solidarity

The medical, social, and economic consequences of not treating obesity as a major chronic disease are severe. Delayed diagnosis and misaligned care increase the burden on health systems and deepen health inequities.

This approach also supports the goals of the European Health Data Space, and complements the EU’s broader equity agenda; from the Anti-Racism Action Plan to the Union of Equality.

“Precision medicine must be inclusive by design, or it risks repeating the disparities it aims to solve.”

From Body Size to Biological Risk

The science is clear: body size is not the story; biology is. If we want to intervene earlier, more equitably, and more effectively, we need to start with phenotyping. This is how we move from reactive to proactive care, and from generalised to truly personalised medicine.

A Blueprint for Change

To build a future-ready model for care, we must:

• Diagnose risk based on biology, not body size
• Design treatments around phenotypes, not averages
• Integrate psychotherapy at every stage of care
• Ensure that data and innovation reflect Europe’s full population
• Assess health system readiness using tools like SOPHIA’s “readiness to act” framework
• Engage stakeholders, from policymakers to people of lived experience , in co-creating resilient, inclusive health ecosystems

“Inclusion is not just a value. It’s the foundation of scientific and medical progress.”

Final Thoughts: Inclusion Is Precision and a Legal Right

The chronic disease of obesity does not affect all people equally; and neither should our response.

For too long, non-white populations across Europe have been misdiagnosed, underdiagnosed, or entirely left out of the obesity care conversation. Their risk factors are different. Their access to care is different. And their lived experiences—shaped by systemic discrimination and exclusion—are different too.

Precision medicine means nothing if it is not inclusive. And inclusion means nothing if it does not translate into better care, earlier diagnosis, and equitable outcomes.

This is not just a scientific imperative. It is a legal one.

Under the European Charter of Fundamental Rights and international human rights law, every person has the right to the highest attainable standard of health. That includes access to timely, appropriate, and effective care regardless of ethnicity, background, or body size.

The SOPHIA project has shown us what’s possible: a future where care is based on biology, not bias. Where data reflects the full diversity of Europe. Where every person is seen, heard, and treated with dignity.

Let’s build systems that deliver on that right. Let’s make inclusion the foundation of precision.