New Diagnostic Framework for Obesity Goes Beyond BMI
When it comes to obesity prevention and treatment, health care providers need to look beyond body mass index (BMI) and take into account the health-related complications that come along with this chronic disease.
At least, that’s what the American Association of Clinical Endocrinologists (AACE) and the American College of Endocrinology (ACE) propose in a new framework presented recently at the AACE 23rd Annual Scientific and Clinical Congress in Las Vegas.
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It calls for staging patients based on both BMI and obesity-related complications, and recommends a treatment approach based on the designated stage. The framework suggests a 4-step approach.
• Screen patients using BMI with adjustments for ethnic differences.
• Use a checklist to perform a clinical evaluation for the presence of obesity-related complications.
• Use complication-specific criteria to stage the severity of complications.
• Select prevention and/or intervention strategies that target specific complications, guided by the AACE/ACE obesity management algorithm.
“This advanced framework for obesity will serve as a foundation for major change in the anti-obesity arena,” said AACE president Jeffrey I. Mechanick, MD, clinical professor of medicine at Mt. Sinai School of Medicine, New York.
There’s been an increased focus on developing new approaches to obesity since the American Medical Association designated it as a chronic disease in June 2013, which originated with a proposal from the AACE.
The need for an updated definition of obesity emerged from the March 2014 AACE/ACE Consensus Conference on Obesity, which involved participants from health care, research, science, government, industry, insurers, and advocacy.
“Regarding obesity as simply a number reflecting BMI to then dictate the way you manage it may be a good reason why—after so many years—the prevalence rates of overweight and obesity haven’t changed much,” Dr. Mechanick said at a press briefing. “What we’re doing is rebooting the system, essentially.”
That new system involves classifying patients into 1 of 5 categories:
1. Normal weight (BMI < 25).
2. Overweight (BMI 25–29.9, with no obesity-related complications).
3. Obesity stage 0 (BMI 30 or greater, with no obesity-related complications).
4. Obesity stage 1 (BMI 25 or greater*, with 1 or more mild to moderate obesity-related complications).
5. Obesity stage 2 (BMI 25 or greater*, with 1 or more severe obesity-related complications).
*BMI 23–25 and elevated waist circumference in certain ethnic groups
“It’s not so much the additional BMI that’s of primary importance; it’s the degree to which that weight gain has impacted the health of the individual in terms of the presence and severity of obesity-related complications,” W. Timothy Garvey, MD, chair of the AACE/ACE Consensus Conference on Obesity and Obesity Scientific Committee and author of the AACE/ACE Obesity Consensus Statement, said at the press briefing.
Next, the committee will obtain input and recommendations about the framework from those who participated in the Consensus Conference on Obesity.
—Colleen Mullarkey
Reference
Garvey T, Mechanick J, Einhorn D. “2014 Advanced Framework for a New Diagnosis of Obesity as a Chronic Disease.” Presented at: 2014 American Association of Clinical Endocrinologists Annual Scientific and Clinical Congress, Las Vegas. May 16, 2014.