New Diagnostic Term for Obesity

Author(s):

The new term is not meant merely to “re-brand” obesity, but to frame it as a chronic disease with distinct complications.

The American Association of Clinical Endocrinologists (AACE) and American College of Endocrinology (ACE) have published a new position statement proposing adiposity-based chronic disease (ABCD) as a new diagnostic term for obesity. The statement was published in Endocrine Practice.

The new term is not meant merely to “re-brand” obesity, but to frame it as a chronic disease with distinct complications, in order to promote a complications-centered approach to management. In particular, the term is meant to draw attention to the distinct pathophysiology of adiposity-related complications, related to inflammation and disordered metabolism.

“This new terminology of obesity offers distinct opportunities to demystify the imprecise term “obesity” with a diagnostic term that describes the disease state. The clinical use of ABCD has the potential to promote improvements in patient care, appropriate screening for associated health comorbidities, and structured treatment protocols. We propose that the term ABCD be used for medical diagnostic purposes and precise reference to the chronic disease state, with related disease stages, divested from the stigmata and ambiguity associated with the word obesity in the general public sphere,” wrote first author Jeffrey Mechanick, MD, of the Icahn School of Medicine at Mount Sinai, New York, NY, and colleagues.

The statement proposes three distinct stages for ABCD:

• Stage 0: No identifiable adiposity-based complications

• Stage 1: Mild to moderate adiposity-based complications

• Stage 2: Severe adiposity-based complications

The proposal hinges on the idea that BMI is imprecise and fails to quantify abnormalities in fat mass, distribution and function. BMI as a diagnostic screening tool carries different cutoffs based on different ethnicities and different levels of muscle mass. Moreover, BMI may be an imprecise estimate of cardiometabolic risk, for which increased waist circumference (as opposed to fat in the buttocks and thigh region) has been linked to metabolic dysregulation.

A major challenge of the new approach, however, lies in developing appropriate markers for the impact of adiposity on health. The authors acknowledge that further research is needed on this front, and that the new term does not eliminate BMI.

They also mention that this approach encompasses both primary prevention, as well as secondary and tertiary intervention to decrease adiposity-related complications, with a central role for fair reimbursement for lifestyle medicine. They also identify key elements for improving the care of patients with ABCD, including standardized protocols for comprehensive care, evidence-based practices adapted to the local culture and socio-economic environment, and evidence-based strategies for implementing, monitoring, and optimizing patient care.

“The AACE/ACE is dedicated to advancing preventive and therapeutic practices for obesity that improve health for all people and believe that the adoption of ABCD as a precise pathophysiologic term referring to the medical diagnosis of obesity and importance of addressing body fat and related adiposity-based complications will advance this goal,” they stressed.

AACE/ACE is developing educational materials and conferences about ABCD in partnership with other professional organizations, and is actively engaged in legislative and regulatory initiatives to advance the adoption of ABCD.

Take-home Points

• AACE/ACE have proposed adiposity-based chronic disease (ABCD) as a new diagnostic term for obesity.

• The statement proposes three distinct stages for ABCD: stage 0 (no identifiable adiposity-based complications); stage 1 (mild to moderate adiposity-based complications; and stage 2 (severe adiposity-based complications).

• Without eliminating BMI, the proposal hinges on the idea that BMI fails to quantify abnormalities in fat mass, distribution, and function.

• AACE/ACE is developing educational materials about ABCD, and is engaged in legislative and regulatory initiatives to advance its adoption.

Reference: Mechanick JI, et al. Adiposity-based chronic disease as a new diagnostic term: the American Association of Clinical Endocrinologists and American College of Endocrinology position statement. Endocrine Pract. 2017;23(3):372-378.