New obesity algorithm covers complications in addition to BMI

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New obesity algorithm covers complications in addition to BMI

NASEEM S. MILLER, Clinical Endocrinology News Digital Network | May 29, 2014

LAS VEGAS– A newly introduced statement proposes to change how obesity is diagnosed and treated.

The American Association of Clinical Endocrinologists and the American College of Endocrinology are suggesting algorithms to determine stages for the disease, each of which comes with a set of therapy recommendations.

"Right now it’s obesity, or overweight/obesity, or Class 1, 2, 3 obesity – it’s all [body mass index]. BMI doesn’t convey actionability. It doesn’t convey a medical meaning," said Dr. W. Timothy Garvey, chair of the AACE Obesity Scientific Committee at the annual meeting of the American Association of Clinical Endocrinologists.

AACE/ACE leaders hope that their new diagnostic algorithm will fill that gap.

"We’re using weight loss therapy to treat the complications of obesity in a medical model," Dr. Garvey said.

According to the framework, which is not finalized yet, the diagnostic categories of obesity will be:

  • Overweight: BMI of 25-29.9 kg/m2, with no obesity-related complications.
  • Obesity Stage 0: BMI of at least 30, with no obesity-related complications.
  • Obesity Stage 1: BMI of at least 25 and one or more complications that are mild to moderate in severity.
  • Obesity stage 2: BMI of greater than or equal to 25 and one or more severe complications.

Also, a four-step diagnosis and treatment approach is recommended for all patients:

  1. BMI screening and adjusting for ethnic differences.
  2. Clinical evaluation for the presence of obesity-related complications, by using a checklist.
  3. Staging for the severity of complications using complication-specific criteria.
  4. Selection of prevention and/or intervention strategies targeting specific complications guided by the AACE/ACE obesity management algorithm.

AACE/ACE leaders pointed out that today there are better tools to treat obesity than ever before, including improvements in lifestyle intervention, new medications, and improvements in bariatric surgery, yet there’s limited access and penetrance of these tools in the clinic. They said they hoped the new algorithm would help incorporate available therapies into treating obese patients.

The algorithm emerged from the AACE/ACE 2014 Consensus Conference on Obesity, which included medical professionals, industry representatives, advocacy groups, and regulators. One of the findings that everyone agreed on was that the diagnostic definition of obesity needed to improve.