Severe obesity — BMI ≥40 kg/m² (WHO class III obesity), distinct from the broader RF-LIFE...

Deterministic view of the source YAML entity. Clinical authority remains with the cited source IDs and reviewer sign-off state.

ID	`RF-CHRONIC-SEVERE-OBESITY-BMI40-PREVENTION`
Type	Red flag
Status	reviewed 2026-05-20 \| pending_clinical_signoff
Diseases	`DIS-BREAST` `DIS-CRC` `DIS-ENDOMETRIAL`
Sources	`SRC-NCCN-BCELL-2025` `SRC-WCRF-AICR-CUP-2018`

Red Flag Origin

Definition	Severe obesity — BMI ≥40 kg/m² (WHO class III obesity), distinct from the broader RF-LIFESTYLE-OBESITY-CANCER-PREVENTION (which covers BMI ≥30 class I-III). Severe obesity carries multiplicative cancer-risk effects (linear-then-accelerating dose-response per WCRF/AICR + IARC Working Group on obesity-related cancers) particularly for hormonally- driven cancers: endometrial (RR ~7-10 vs. ~1 baseline), esophageal adenocarcinoma (RR ~4-5), post-menopausal breast cancer (RR ~1.5-2), colorectal (RR ~1.5-2), renal cell carcinoma (RR ~2), hepatocellular carcinoma (RR ~2-4 via NAFLD/MASH), pancreatic adenocarcinoma (RR ~2). Severe obesity also defines the bariatric-surgery-candidate cohort (BMI ≥40 alone, or BMI ≥35 with obesity-related comorbidity), and bariatric surgery has documented cancer-incidence reduction (~30% relative reduction for hormonally-driven cancers in long-term follow-up cohor...
Clinical direction	investigate
Category	other

Trigger Logic

{
  "any_of": [
    {
      "finding": "bmi_ge_40_severe_obesity_bariatric_candidate",
      "value": true
    },
    {
      "finding": "severe_obesity_class_3_diagnosis",
      "value": "positive"
    },
    {
      "finding": "bmi_ge_35_with_obesity_comorbidity_bariatric_candidate",
      "value": true
    }
  ],
  "type": "lab_value"
}

Notes

v0.3 wave-N niche pathway — severe obesity (BMI ≥40) prevention. Fires on documented BMI ≥40 kg/m² OR BMI ≥35 with documented obesity-related comorbidity (T2DM, sleep apnea, NAFLD, hypertension, hyperlipidemia) — the bariatric-surgery-candidate cohort definition. Distinct finding name from the broader-obesity RF (which fires on bmi_ge_40 alone) so that the engine can present BOTH tracks when applicable but they are not redundant (severe obesity opens bariatric-surgery pathway + intensified screening discussion that the general obesity RF does not specifically cover). Engine routes to PreventionPlan recommending: (a) IND-SEVERE-OBESITY-CANCER-PREVENTION-INTENSIFIED (standard) — structured weight-loss intervention with multidisciplinary bariatric program (medical weight loss including GLP-1 agonists / semaglutide / tirzepatide, behavioral, surgical referral when BMI ≥40 alone or BMI ≥35 with comorbidity); intensified cancer screening per affected-organ guideline (mammography from age 40, colonoscopy from age 45 with no upward-deferral, endometrial-symptom awareness with low- threshold ultrasound for postmenopausal bleeding); NAFLD screening + management; comorbidity management. (b)...

Used By

Indications

IND-SEVERE-OBESITY-CANCER-PREVENTION-INTENSIFIED - IND-SEVERE-OBESITY-CANCER-PREVENTION-INTENSIFIED
IND-SEVERE-OBESITY-CANCER-PREVENTION-OBSERVATION - IND-SEVERE-OBESITY-CANCER-PREVENTION-OBSERVATION