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‘ABCD’ recommended as more accurate term for obesity
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In response to the public health threat posed by obesity, the American Association of Clinical Endocrinologists and the American College of Endocrinology have published a position paper advocating for replacing the word “obesity” with a new name: “adiposity-based chronic disease, or ABCD. The new term is intended to more accurately represent the condition as a true health threat, not simply as an appearance-based issue.
Jeffrey I. Mechanick, MD, 2016-2017 American College of Endocrinology (ACE) president and a past president of AACE, clinical professor of medicine at the Icahn School of Medicine at Mount Sinai, told Endocrine Today. “It isn’t just related to someone’s weight or total fat mass. That does play a role, but just as important is the distribution of fat and the abnormal function of fat.”
Endocrine Today spoke with Mechanick about the reasons for the name change, how this particular term was chosen, and what AACE and ACE hope to achieve with the new name.
How did this name change come about?
Mechanick : The first point that needs to be made is that we’re not presenting this as a replacement term for obesity. That’s really critical to understand. What we’re presenting is a diagnostic term. It might be that, down the line, the term obesity washes out just through attrition and this term becomes more popular, but attempts in medicine with all these names and taxonomy a lot of times don’t work. People have to psychologically catch on to it.
The strategy is to present a cogent rationale for what we want to do and just let people offer their opinions and buy-in. Through a team effort we all get various stakeholders to agree, and then we move toward something that everyone accepts and can use, so there aren’t silos of interest, which have plagued a lot of these chronic diseases.
In terms of where it came from, I think you have to go back and look at how AACE has been involved in obesity. Prior to 2013, we at AACE did declare obesity a disease. Then around 2013, the beginning of my year serving as president of AACE, we authored a bill presented to the AMA to declare obesity a disease. We prevailed, and the AMA did declare obesity a disease. That fueled our fire. We held our first obesity consensus conference in Washington.
Mechanick : When you look at the science of obesity, we find that it’s a chronic disease. People generally don’t have acute obesity. It’s a chronic, noncommunicable disease that affects the global population. When you look at the biology, it isn’t just about weight or total fat mass, but also the distribution of fat: ectopic fat, visceral fat, fat that’s depositing in cells. We also know that fat makes a lot of proteins, like leptin and adiponectin. It’s the ratio and networking effects of these adipocyte-derived proteins that actually confers adverse effects on appetite, intermediary metabolism, and the cardiovascular system.
You have a triad of descriptors for obesity: the total amount, the distribution and the function. What we did was we pulled all the words together. I’d be lying if I said I wasn’t mindful of the acronym “ABCD,” but “adiposity-based chronic disease” really does work. It describes exactly what we wanted. Because of its simplicity, it destigmatizes obesity, and, although it’s a complex chronic disease, it’s something that will help us with the health messaging. We’re being forward-looking.
This also essentially eradicates the whole concept of the obesity paradox in the metabolically healthy because, in fact, if you have a high BMI but don’t have a lot of the other metabolic parameters, maybe you do have some abnormal secretory function of the adipocyte, or you’re looking at non-metabolic complications within a complication-centric framework, which AACE has promoted. Our guidelines are all consistent with this, as are our algorithm and our chronic care model. It was a natural extension.
Given that not everyone’s obesity is caused by the same mechanism, is this term inclusive or all of the possible causes?
Mechanick : Yes. The intent was that the term be robust and comprehensive. For example, the new term would cover sarcopenic obesity, which is related to decreased muscle mass. The relative excess in fat mass confers, in the genetically susceptible individual (of which there are many), insulin resistance. With insulin resistance comes increased risk of cardiovascular disease, and it’s associated with that abnormal distribution — not amount, but distribution of body fat. That’s an example where the new diagnostic term would perform better than the older disease term, which would be “obesity.”
What are your plans and goals for the use of this new term?
Mechanick
: The term has been published, and we’re fielding a lot of commentary. We’ll be extending this concept at our second obesity consensus conference in October. Our intent, like with the first obesity conference, is to bring many stakeholders around the table and brainstorm the obesity epidemic.
How do you plan to familiarize the public with the new term?
Mehcanick
: I think this would involve a campaign. It would be a series of lay press publications, a series of media opportunities. We have people who can do this at AACE. It would also involve trying to get other stakeholders on board, so whatever effects we have get amplified through different venues. We’re in the process, for instance, of putting together our third bariatric surgery guidelines, and we have five societies that are cosponsoring it. We’re going to incorporate the ABCD paradigm within that. We’ve incorporated it in our obesity guidelines; we’re incorporating it in our obesity resource. We’re hoping that as people write papers, they will include the term. There was just another paper that recently came out where someone cited it, and it seems to represent a common ground of what everyone is really saying.
and also something that has words that mean something. In the ABCD acronym, each word actually means something. It’s a chronic disease, and it’s related to adiposity. Just as you can have chronic disease that’s related to the heart or to blood vessels, blood sugar or neurodegenerative disease, you can have chronic disease related to adiposity. That’s where we’re going in clinical medicine. – compiled by Jennifer Byrne
For more information:
Jeffrey I. Mechanick , MD, can be reached at 1192 Park Ave., New York, NY 10128; email: jeffreymechanick@gmail.com.
Disclosure: Mechanick reports receiving honoraria from Abbott Nutrition for lectures and program development.
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