New Framework for Considering Obesity
Written by Editor   
Monday, May 19, 2014 08:19 AM

Endocrinologists are redefining obesity and the way physicians manage it.  The American Association of Clinical Endocrinologists (AACE) released a novel "framework" for diagnosing and managing obesity at its annual meeting.

The new model, developed in conjunction with the American College of Endocrinology (ACE), moves away from an approach centered on body mass index (BMI) approach toward a complications-centered approach.  The framework will redefine obesity so that it doesn't come down to a single number, such as BMI, but instead focuses on complications.

"This is an approach that will entrain primary care practitioners in way that will enhance the quality of obesity care and add some structure to the way physicians need to engage patients, evaluate them, and treat them."

The new framework -- the society is not calling it a guideline -- arose out of a conference that brought together all stakeholders in obesity, including healthcare providers, regulators, drugmakers, insurers, and advocacy groups, to develop a new approach to deal with the ongoing obesity epidemic.

A white paper that was developed from the conference noted that the "imprecision and uncertainties regarding the current diagnosis of obesity, and the need for a more medically meaningful and actionable definition of obesity, clearly emerged as major impediments to concerted action and were responsible for a degree of immobilization across pillars."

The four-step approach involves screening, clinical evaluation for obesity-related complications, staging for the severity of complications, and selecting prevention or treatment strategies.

BMI is recommended as the initial screen, but the second step involves evaluating the patient for obesity-related complications by using a checklist that includes such conditions as metabolic syndrome, prediabetes, type 2 diabetes, dyslipidemia, hypertension, and other conditions.

Next, clinicians should stage for the severity of complications. For instance, those who are overweight or obese but are "metabolically healthy" with no complications would be in stage 0.

Finally, patients would receive prevention or treatment based on that status.

The framework recommends primary prevention for those with a BMI below 25 kg/m2, secondary prevention for the "metabolically healthy" obese and overweight, and tertiary prevention for those with stage 1 and 2 obesity.  

Primary prevention aims to block obesity before it develops, secondary prevention treats obesity to prevent disease complications, and tertiary prevention treats obesity to ameliorate disease complications, the researchers said.

The next steps will involve reviewing the framework with stakeholders to gather their input.  Once the additional recommendations are taken into account, the committee plans to publish the work in Endocrine Practice, the flagship journal of AACE.

The last step is implementation, which would involve another consensus conference to increase concerted application.

"A lot of traditional approaches to obesity are BMI-centric, and risk stratification is based on BMI with some inclusion of complications ... but it's all indexed to BMI."  "This strategy prioritizes the pathophysiologic correlate, or complications."