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AACE unveils new clinical practice guideline for obesity management
ORLANDO, Fla. — A patient-centric approach to obesity management that individualizes treatment and focuses on overall health — not just weight loss — can optimize outcomes and improve safety, according to a new clinical practice guideline released by the American Association of Clinical Endocrinologists.
The evidence-based guideline, developed by the AACE Obesity Scientific Committee, encompasses screening, diagnosis, staging, therapeutic decisions, endpoints and goals of therapy related to obesity management.
“We think these guidelines can really inform when to use the different treatment modalities, and the intensity of those modalities, based on the phases of chronic disease prevention and treatment, establishing goals for therapy that do not simply reflect the amount of weight loss but improvements in patient health,” W. Timothy Garvey, MD, FACE, chair of the AACE Obesity Scientific Committee, said during a press conference. He called the guideline “a rational model of care that we hope our health care system can get its arms around.”
W. Timothy Garvey
Garvey noted that the three phases of chronic disease — preventing disease, preventing disease progression and treating disease complications — should inform obesity management and evaluation of patients, and were the basis for the guideline.
“Our recommendation was that the modality and intensity of obesity interventions should be based on the primary, secondary and tertiary phases of disease prevention,” Garvey said. “This three-phase paradigm for chronic disease aligns with the pathophysiology and natural history of obesity, and provides a rational framework for appropriate treatment at each phase of prevention.”
The 123 recommendations, translated from an obesity algorithm for care, suggest “packages” of interventions based on the stage of disease. Stage 0, for example, could require lifestyle intervention to prevent progressive weight gain, whereas stages 2 or 3, depending on weight-related complications, may call for pharmacotherapy or surgery.
The guideline also addresses specific obesity-related complications, and whether they can be treated with weight-loss therapy.
Lifestyle therapy is a “key part” of treatment, Garvey said. The guideline includes recommendations for nutritional and behavioral interventions.
“All of these therapies are based on evidence,” Garvey said. “They have been employed in randomized controlled trials that have been associated with successful outcomes.”
The guideline also outlines the five approved medications for obesity, and lists dosing, mechanisms of action, adverse effect profiles and contraindications. Garvey stressed that optimal obesity therapy calls for the availability of all five medications to properly individualize therapy.
Treatment goals are explained in detail, Garvey said, including those specific to complications that exist when tertiary prevention is required.
“There is a dose-response between the amount of weight loss you need and the clinical improvement for different complications,” Garvey said. “We reviewed the evidence and established that relationship, and what therapeutic success looks like, specific to each of these weight-related complications.”
Jeffrey I. Mechanick, MD, FACN, FACP, FACE, an Obesity Scientific Committee member, said using a chronic care model allows the guideline to address key physician questions and concerns.
Jeffrey I. Mechanick
“What we wanted to do was build a care model at the beginning to anchor and provide context for the clinical practice guidelines, that would translate, not just in getting evidence-based recommendations, but evidence-based recommendations that were relevant and that were actionable within the real world,” Mechanick said.
The guidelines were also published online in Endocrine Practice. – by Regina Schaffer
References:
Garvey WT. AACE Comprehensive Clinical Practice Guidelines for Medical Care of Patients with Obesity. Presented at: AACE Annual Scientific and Clinical Congress; May 25-29, 2016; Orlando, Fla.
Garvey WT, et al. Endocr Pract. 2016;doi:10.4158/EP161365.GL.
Disclosure: Garvey reports receiving consultant fees from or serving as a researcher for multiple pharmaceutical companies. Mechanick reports receiving honoraria from Abbot Nutrition.