Abstract
<title>Abstract</title> <p> Background: The EASO and Lancet Commission (LDEC) recently proposed modern anthropometric frameworks for the diagnosis of obesity. Objective: To <bold/> evaluate the efficacy of the novel EASO and LDEC anthropometric criteria against standard WHO BMI criteria for identifying individuals with prevalent cardiometabolic impairment, and to establish DEXA-derived reference values for fat mass index (FMI) and visceral adipose tissue index (VATI). Subjects/Methods: We analyzed 10,296 Austrian LEAD study participants. Obesity was classified using WHO (BMI ≥30 kg/m²), EASO, and LDEC criteria. Body composition was assessed via DEXA. Associations with cardiometabolic outcomes were evaluated using logistic regression and ROC analyses. Results: Obesity prevalence was 16.3% (WHO), 44.1% (LDEC), and 50.4% (EASO). EASO and LDEC criteria identified younger individuals and more females than WHO criteria, demonstrating stronger associations with metabolic syndrome (EASO OR: 6.61, 95% CI: 5.81-7.45; LDEC OR: 6.49, 95% CI: 5.78-7.26) compared to WHO (OR: 4.89, 95% CI: 4.31-5.53). FMI showed the highest discriminatory power across all definitions (AUC ≥ 0.92). Conclusion: The anthropometric EASO and LDEC criteria outperform BMI in identifying individuals with prevalent cardiometabolic dysfunction. The established FMI and VATI thresholds provide actionable clinical reference values, supporting a shift toward body composition-focused obesity diagnosis and management. </p>