New Obesity Guidelines Emphasize Individualized Treatment
More than one third of adults in the United States today are classified as obese. Defined as a body mass index (BMI) of ≥30 kg/m2, obesity is associated with extremely high medical costs, including absenteeism. In addition, comorbidities related to obesity are many of the leading causes of preventable death: heart disease, stroke, type 2 diabetes, and certain types of cancer.4
Significant and clinically relevant improvements in cardiovascular disease risk factors such as glycemia, blood pressure, triglycerides, and HDL cholesterol can be produced with modest weight loss, 5% to 10% of body weight, with even greater improvements observed with reductions of 10% to 15% of body weight.4
As a heterogenous disease, obesity requires an individualized approach to treatment. The new evidence-based American Association of Clinical Endocrinologists/American College of Endocrinology Comprehensive Clinical Practice Guidelines for Medical Care of Patients with Obesity provides a comprehensive treatment algorithm that includes whether the patient presents with “weight-related disease or complication that could be improved by weight loss therapy.”1
The guidelines differentiate between an “anthropometric component” of the medical diagnosis of obesity, defined as excess adiposity, and the “clinical component,” defined as weight-related complications. These 16 complications are prediabetes, metabolic syndrome, type 2 diabetes, dyslipidemia, hypertension, cardiovascular disease, nonalcoholic fatty liver disease, polycystic ovary syndrome, female infertility, male hypogonadism, obstructive sleep apnea, asthma/reactive airway disease, osteoarthritis, urinary stress incontinence, gastroesophageal reflux disease, and depression.
Based on clinical judgment, for patients who are obese with at least 1 severe complication, suggested treatment may include lifestyle therapy (meal plan, physical activity, and behavioral intervention), the addition of pharmacotherapy (BMI ≥27 kg/m2), or consideration for bariatric surgery (BMI ≥35 kg/m2).1, 3