AACE/ACE Position Statement: Obesity as a Chronic Disease
AACE/ACE Position Statement: Obesity as a Chronic Disease
A new definition and diagnostic strategy for obesity is required that is actionable, medically meaningful, and adds value to the health-promoting effects of weight loss. The AACE/ACE defines obesity as a chronic disease characterized by pathophysiological processes that result in increased adipose tissue mass and which can result in increased morbidity and mortality. In an environment that interacts with susceptibility genes to promote weight gain (i.e., obesogenic), many individuals have a BMI ≥25 kg/m, which is associated with increased likelihood for obesity- related complications and risk of progressive obesity. The new obesity diagnostic algorithm (Fig. 1) incorporates two components: 1) an assessment of body mass, including validated ethnicity-adjusted anthropometrics to identify individuals with increased adipose tissue placing them at risk and 2) the presence and severity of obesity-related complications. Thus, the complete diagnosis does not simply depend upon BMI level but also the impact of that weight gain on health. Individuals with BMI ≥25 kg/m (or in certain populations a BMI of 23–25 kg/m) then require evaluation for the presence and severity of specific obesityrelated complications to complete the diagnostic process. Each complication is evaluated for severity and impact on the patient's health as Stage 0 (no complication is present), Stage 1 (complication is mild-moderate), or Stage 2 (complication is severe) using complication-specific criteria. The staging of complications can be used to guide selection of treatment modality and intensity of weight-loss therapy in the context of the AACE obesity management algorithm that is part of the AACE/ACE Comprehensive Diabetes Management Algorithm.
(Enlarge Image)
Figure 1.
The diagnosis facilitates another mandate of the CCO that a comprehensive action plan to combat obesity must include primary, secondary, and tertiary disease interventions. If the BMI is <25 kg/m (and waist circumference is not increased), these patients have normal weights and are candidates for primary interventions to prevent obesity, perhaps through healthy lifestyle education and reductions in the obesogenic nature of their environment. If the patients are overweight or obese and have no complications (Stage 0), they are eligible for secondary interventions to prevent progressive weight gain and the emergence of obesity- related complications. Once complications develop, whether individuals are overweight or obese, it has become clear that the increase in body weight is adversely affecting the health of the individual, and tertiary interventions are required to prevent worsening of the disease and to treat the complications. Thus, all patients with BMI ≥25 kg/m and obesity-related complications require tertiary interventions, and have Obesity Stage 1 if mild-moderate (but no severe) complications are present and Obesity Stage 2 if severe complications are present. The identification and staging of obesity-related complications is based on complication- specific criteria. Table 2 illustrates the Advanced Framework to incorporate the principles of primary, secondary, and tertiary interventions and treatment.
The new diagnosis aligns itself with a 4-step approach for the evaluation of patients with obesity, and entrains professionals by providing them with a structured paradigm for patient management consistent with high-quality care. The 4 recommended steps are: 1) screening with BMI with adjustments for ethnic differences, 2) clinical evaluation for the presence of obesity-related complications using a checklist, 3) staging for the severity of complications using complication-specific criteria, and 4) selection of prevention and/or intervention strategies targeting specific complications as guided by the AACE/ACE obesity management algorithm. These recommendations have been translated from concepts and evidence derived from the AACE/ACE CCO on March 23–24, 2014 in Washington, DC.
The Diagnosis of Obesity
A new definition and diagnostic strategy for obesity is required that is actionable, medically meaningful, and adds value to the health-promoting effects of weight loss. The AACE/ACE defines obesity as a chronic disease characterized by pathophysiological processes that result in increased adipose tissue mass and which can result in increased morbidity and mortality. In an environment that interacts with susceptibility genes to promote weight gain (i.e., obesogenic), many individuals have a BMI ≥25 kg/m, which is associated with increased likelihood for obesity- related complications and risk of progressive obesity. The new obesity diagnostic algorithm (Fig. 1) incorporates two components: 1) an assessment of body mass, including validated ethnicity-adjusted anthropometrics to identify individuals with increased adipose tissue placing them at risk and 2) the presence and severity of obesity-related complications. Thus, the complete diagnosis does not simply depend upon BMI level but also the impact of that weight gain on health. Individuals with BMI ≥25 kg/m (or in certain populations a BMI of 23–25 kg/m) then require evaluation for the presence and severity of specific obesityrelated complications to complete the diagnostic process. Each complication is evaluated for severity and impact on the patient's health as Stage 0 (no complication is present), Stage 1 (complication is mild-moderate), or Stage 2 (complication is severe) using complication-specific criteria. The staging of complications can be used to guide selection of treatment modality and intensity of weight-loss therapy in the context of the AACE obesity management algorithm that is part of the AACE/ACE Comprehensive Diabetes Management Algorithm.
(Enlarge Image)
Figure 1.
The diagnosis facilitates another mandate of the CCO that a comprehensive action plan to combat obesity must include primary, secondary, and tertiary disease interventions. If the BMI is <25 kg/m (and waist circumference is not increased), these patients have normal weights and are candidates for primary interventions to prevent obesity, perhaps through healthy lifestyle education and reductions in the obesogenic nature of their environment. If the patients are overweight or obese and have no complications (Stage 0), they are eligible for secondary interventions to prevent progressive weight gain and the emergence of obesity- related complications. Once complications develop, whether individuals are overweight or obese, it has become clear that the increase in body weight is adversely affecting the health of the individual, and tertiary interventions are required to prevent worsening of the disease and to treat the complications. Thus, all patients with BMI ≥25 kg/m and obesity-related complications require tertiary interventions, and have Obesity Stage 1 if mild-moderate (but no severe) complications are present and Obesity Stage 2 if severe complications are present. The identification and staging of obesity-related complications is based on complication- specific criteria. Table 2 illustrates the Advanced Framework to incorporate the principles of primary, secondary, and tertiary interventions and treatment.
The new diagnosis aligns itself with a 4-step approach for the evaluation of patients with obesity, and entrains professionals by providing them with a structured paradigm for patient management consistent with high-quality care. The 4 recommended steps are: 1) screening with BMI with adjustments for ethnic differences, 2) clinical evaluation for the presence of obesity-related complications using a checklist, 3) staging for the severity of complications using complication-specific criteria, and 4) selection of prevention and/or intervention strategies targeting specific complications as guided by the AACE/ACE obesity management algorithm. These recommendations have been translated from concepts and evidence derived from the AACE/ACE CCO on March 23–24, 2014 in Washington, DC.