Currently, millions of American children and adults are considered overweight, and approximately one-third of U.S. adults are believed to be obese, according to recent data.2

“We know that almost 70% of America is overweight or obese and we can’t do bariatric surgery or intensive therapies on them all. We have to have staging for identifying the patients who are having the most adverse side effects from their adiposity,” said Dr. Garvey.


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The AACE/ACE Position Statement

On Sept. 19, 2014, the American Association of Clinical Endocrinologists (AACE) and the American College of Endocrinology (ACE) issued a new position statement detailing an advanced framework for a new diagnosis of obesity as a chronic disease.3 The framework is meant to be a medically actionable and economically viable model for diagnosing and treating obesity as a disease state. 

The framework is based on a staging system. It includes a new obesity diagnosis algorithm that combines BMI and waist circumference measurements with the assessment of the presence and severity of obesity-related complications.

The framework also has structured criteria for diagnostic staging of weight-related medical conditions. In addition, it recommends tiered primary, secondary and tertiary therapeutic interventions for preventing and treating obesity and its related complications.

“The medicines only affect appetite and food intake. Obesity is much more complex. You have to address behavior and food choices. We have to view this as a disease and treat it just as aggressively as we do hypertension,” Dr. Bush said in an interview with Endocrinology Advisor

“We are in a new era. However, new in medicine is always a double-edged sword, and there are doctors who will shy away from new things. We now have new tools, and it is up to doctors to find the best way to use them.”

Dr. Lee agrees and said many clinicians are “shy” about prescribing these agents on a long-term basis and their concerns are valid. Even so, she said, as the armamentarium expands there will be an excellent opportunity for endocrinologists to much more effectively and aggressively treat obesity. 

“Having these new agents empowers the endocrinologist. There is excitement about this whole issue because obesity is a tremendous public health problem,” said Dr. Lee.

References

  1. Guo F, Moellering DR and Garvey WT. Obesity. 2014;22(1):110-118.
  2. Ogden CL et al. JAMA. 2014;311(8):806-814.
  3. Garvey WT et al. Endocr Pract. 2014;20(9):977-989.