Redefining Obesity: An Interview With Jeffrey Mechanick, MD

The healthcare community’s quest to solve the obesity epidemic has long been filled with obstacles, including economic and regulatory hurdles, social stigma, and diagnostic shortcomings. Now, however, experts suggest that the next step in curbing the epidemic may be as simple as “ABCD.”

Recently, the American Association of Clinical Endocrinologists (AACE) and the American College of Endocrinology (ACE) published a position statement urging the medical community to adopt a new term in place of obesity: adiposity-based chronic disease (ABCD). Along with the new term, the statement emphasizes a complications-centric approach to therapeutic decision-making in the management of obesity.

To help place this position statement into context, Endocrinology Advisor interviewed one of the authors, Jeffrey I. Mechanick, MD, from the Icahn School of Medicine at Mount Sinai in New York City. During the interview, Dr Mechanick, 2016 to 2017 ACE president, discussed the aim of this effort and how it will help create meaningful change in the obesity crisis.

Endocrinology Advisor: What was the catalyst for redefining obesity?

Dr Mechanick: This was an emergent concept from the 2013 AACE/ACE Consensus Conference on Obesity. We were not comfortable with the terminology of obesity, which does not convey information about the disease state and is fraught with stigma. We also expressed concern with the term “metabolically healthy obese,” as people define it in different ways, mostly by metabolic markers; however, when you look at the different complications, including stigma, degenerative joint disease, depression, etc, these individuals may not be healthy after all.

Endocrinology Advisor: What was the decision-making process behind selecting adiposity-based chronic disease (ABCD) as the new term for obesity?

Dr Mechanick: If you parse out ABCD, there are 2 components: adiposity and chronic disease. For adiposity, we chose the word because it is not stigmatized but, rather, scientific. When you hear it, you think of adipose tissue and a part of the body that potentially has the health problem. In other words, you think of fat cells without having to use the word “fat” or “obesity.” The other advantage of adiposity is it does not solely mean the amount of adipose tissue but includes the distribution and function of adipose tissue as well.

With chronic disease, it has to start somewhere. For instance, diabetes, hypertension, cancer, and HIV are all different types of chronic diseases that have a single initiating event. In the case of obesity, we believe this event is adiposity disturbance, whether it is weight distribution or function. When you start to embrace this idea, concepts like the metabolically healthy obese or the metabolically unhealthy lean become easy to understand because you are not pigeonholed into just characterizing obesity in terms of weight.

Endocrinology Advisor: What are some of the ways in which renaming this disease state would affect patients and patient care?

Dr Mechanick: It is aspirational that the new term reduces stigma and helps attract research dollars and more education. But the final gold standard is whether we can bend the prevalence rate of obesity in the United States, particularly in a way that ends disparities in care. Our goal is to have a direct effect on changing the way we approach and manage patients, including introducing lifestyle medicine earlier and in a more structured way and getting approvals, finances, and reimbursements for correct applications of pharmacotherapy and bariatric surgery. Ultimately, with everything we know and all the money that has been invested thus far, we have to ask ourselves why we are not seeing better results in our prevalence rates. We are missing something. And it could be something that is as easy and simple as going back to the basics and redefining the disease.