Obesity Is a Chronic Disease, Say New Guidelines

AACE's evidence-based guidelines aim to help physicians

ORLANDO -- Obesity is a chronic disease and should be treated as such, according to new evidence-based guidelines for treating obesity from the American Association of Clinical Endocrinologists (AACE).

The guidelines are a first for AACE. An executive summary was published in Endocrine Practice earlier this week, along with a graphic algorithm and a separate statement, and the full guidelines are expected later this year.

Timothy Garvey, MD, the chair of the eight-person committee that drafted the guidelines, presented the guidelines along with colleagues at AACE's annual meeting here. The association first recognized obesity as a disease in 2012, and past efforts to help doctors treat it included an algorithm and a "framework," but those were "piecemeal efforts," according to Garvey.

They also were not evidence-based: "Rather, they were the consensus of a small group of experts," he added.

But the new guidelines are intended to be both evidence-based and comprehensive. After they were created by the committee, they underwent extensive review by more than a dozen specialists.

"The thrust of the final recommendations is to recognize that obesity is a complex, adiposity-based chronic disease, where management targets both weight-related complications and adiposity to improve overall health and quality of life," wrote the authors. The guidelines were an attempt to answer nine pragmatic and clinical questions about treating obesity like who should be treated and how diagnoses should be made.

The guidelines don't rely on body mass index (BMI) alone, because of it's unreliability, but do incorporate waist circumference and other measures to improve accuracy, said Karl Nadolsky, DO, of the Walter Reed National Military Medical Center, in an interview with MedPage Today. The guidelines are based on anthropomorphic and clinical measures that vary by group to determine who should be screened for obesity or 15 related comorbidities.

Physicians can then use that data from screening to determine individual treatment plans including options such as lifestyle and behavioral modification, diet changes, pharmacological solutions, and bariatric surgery. The screening process was designed to be easy and straightforward, said Garvey. "It doesn't require a Herculean effort," he said.

About 85% of the evidence used in the guidelines was rated as high quality. It can work together with other guidelines, but Garvey said the AACE guidelines are far more comprehensive than efforts from other societies.

The guidelines don't, however, recommend or endorse any specific diet, just a reduction of calories.

The pharmacological aspect is "the engine of the guidelines", according to committee co-chair Jeffrey Mechanick, MD, of Mount Sinai Hospital in New York, who spoke about the guidelines during an oral session. The guidelines are "nuance-based" since it's very difficult to come up with an exact model for each patient since so many factors influence what medication is best for a patient.

"The guidelines are very extensive, and they provide a good resource," said Nadolsky. "But it's a huge document, and that's why we developed the algorithm, which really breaks down the principles of what we are talking about: Obesity is a clinical disease."

He added that the individualization of pharmacotherapy is a big advantage of the guidelines, and that they will be updated as new data come in. "This is truly a holistic guideline and algorithm that we put together," he said. "And that's how medicine should be -- it should be holistic, that's what we are supposed to do, and obesity is the quintessential holistic disease."

Garvey disclosed relationships with Novo Nordisk, AstraZeneca, Janssen, Eisai, and several other companies.

Many of the authors and most of the reviewers also reported extensive relationships with industry.

last updated 05.27.2016

Primary Source: Garvey, T et al "American Association of Clinical Endocrinologists and American College of Endocrinology clinical practice guidelines for comprehensive medical care of patients with obesity -- executive summary" Endocrin Pract 2016; DOI: 10.4158/EP161365.GL.

This article was first published on MedPage Today and reprinted with permission from UBM Medica. Free registration is required.