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New definition for obesity shifts diagnostic approach
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LAS VEGAS — The obesity diagnosis is getting an overhaul, and with it comes key concepts that offer actionable opportunities to reshape the landscape around treating the disease, according to presentations at the American Association of Clinical Endocrinologists 23rd Annual Scientific & Clinical Congress.
At the Obesity Consensus Conference in Washington, DC, in March, stakeholders from four pillars — biomedical; regulatory and legislative; economic and financial; education, research and professional societies — considered five questions that dealt with fundamental issues to understanding obesity.
Next Steps
The next step was to translate the emergent concepts into actionable recommendations and this was set forth at the annual meeting with a new diagnostic approach to obesity.
The diagnosis must integrate two components: the anthropometric measure of adiposity and the indication of the impact on health, W. Timothy Garvey, MD, of University of Alabama, said. It translates to presence and severity of obesity-related complications in addition to the more traditional BMI used to define obesity in the past.
“Our objectives were to create an actionable and medically meaningful definition of obesity,” Garvey said.
The following diagnostic framework, which aligns with a 4-Step Process, has been laid out.
- Screening the anthropometric component
- Clinical evaluation of the overweight/obese patient
- Stage using complication-specific criteria
- Treatment based on clinical judgment
The staging of the complications is done using complication-specific criteria, which Garvey said does fall in line with the complications-centric model for care of patients with obesity by AACE.
“We’re not dictating therapy for any of these diagnostic categories,” Garvey said. “We encourage physicians to use clinical judgment and to individualize therapy.”
The obesity diagnosis is getting an overhaul, and with it comes key concepts that offer actionable opportunities to reshape the landscape around treating the disease, according to presentations at the American Association of Clinical Endocrinologists 23rd Annual Scientific & Clinical Congress.
Daniel Einhorn, MD, W. Timothy Garvey, MD, and Jeffrey I. Mechanick, MD, discuss the diagnostic framework for treating obesity at AACE 2014.
This general set of recommendations based on the severity of obesity requires further translation, which the researchers are eager to develop.
“The overall goal is to improve the medical care of patients with obesity,” Garvey said, “and to enhance access to the therapies our patients need.”
‘A complex disease’
“Obesity, we realize, is a complex disease,” Jeffrey I. Mechanick, MD, FACN, FACP, FACE, ECNU, current president of AACE said. He noted the disease has a number of “real bona fide” drivers — the genetic, genomic molecular and endogenous ones as well as the environmental and contextual.
With years of trying tactics that have not won the war against the disease, Mechanick said obesity is best addressed using complexity.
“It’s the migration from pure BMI-centric decision-making to complications,” he said. “This is the result of expanding evidence base. We’re smarter now. Complexity is not something to fear — it’s a natural evolution, and we embrace it and we address it.”
For more information: Garvey WT. F21. Presented at: AACE 23rd Annual Scientific & Clinical Congress; May 13-18, 2014; Las Vegas, Nevada.
Disclosures: Mechanick reports that he has received lecture and program development honoraria from Abbott Laboratories. Garvey reports that he has received advisory board honoraria and research support from various pharmaceutical companies.