The American Association of Clinical Endocrinology (AACE) 2025 consensus statement outlines a fundamental shift in obesity care, moving the focus from weight reduction alone to the comprehensive management of weight-related complications.
Full article at: https://pubmed.ncbi.nlm.nih.gov/40956256/
Key Takeaways
New Nomenclature and Definition:
The consensus recommends using the term Adiposity-Based Chronic Condition (ABCC) (or Adiposity-Based Chronic Disease, ABCD) to replace or supplement “obesity.” This change recognizes that excess or dysfunctional body fat is a complex, chronic, progressive, and relapsing disease that requires lifelong management, similar to hypertension or diabetes.
Complication-Centric Staging:
Diagnosis and treatment intensity must be based on a patient’s clinical complications (e.g., Type 2 diabetes, heart disease, sleep apnea) rather than relying solely on Body Mass Index (BMI). BMI remains a useful screening tool, but the severity of ABCC is staged by assessing the associated health risks. This shifts the goal from a number on the scale to the reversal or prevention of disease burden.
Prioritization of New Pharmacotherapies:
The guidelines introduce a hierarchy for pharmacological therapies, strongly recommending the use of newer, more potent second-generation weight-loss medications (e.g., GLP-1 and dual agonists) that have demonstrated 10-15% of total body weight loss in clinical trials. This level of weight reduction is often necessary to achieve remission or significant improvement in ABCCs. Medications are prioritized based on their proven efficacy in specific co-existing conditions.
Integration of Psychosocial Care:
AACE emphasizes a comprehensive and compassionate care model that directly addresses weight stigma, internalized weight bias (IWB), and psychological factors (e.g., anxiety, depression, disordered eating). Clinicians are advised to provide person-centered, nonjudgmental care that also considers social determinants of health.
Lifestyle as Foundation:
While pharmacotherapy and bariatric surgery are essential tools, intensive lifestyle intervention remains the foundation of long-term success. This includes:
- Nutrition: Emphasis on high-protein, nutrient-dense diets.
- Physical Activity: Combining aerobic and resistance training (targeting 150–300 minutes per week) for sustained weight management.
