Adiposity-Based Chronic Disease: A New Name for Obesity?

Becky McCall

December 29, 2016

In a new position statement, the American Association of Clinical Endocrinologists (AACE) and the American College of Endocrinology (ACE) introduced a novel term for obesity — adiposity-based chronic disease (ABCD) — which frames it as a far-reaching, complications-centric chronic disease.

The statement, published online December 14 in Endocrine Practice, redefines the medical diagnostic term for obesity and shifts the emphasis to the pathophysiological effects of excess weight rather than the weight and/or body mass index (BMI) itself.

The "adiposity-based" component of ABCD points to abnormalities in the mass, distribution, and/or function of adipose tissue, whereas the "chronic disease" part underscores associated complications such as hypertension, diabetes, and sleep apnea that produce morbidity and mortality.

The authors, led by Jeffrey I Mechanick, MD, president of the ACE and clinical professor of medicine at Icahn School of Medicine at Mount Sinai, New York City, argue that ABCD represents a structured approach to reducing disease risk and illness burden through improved nutrition, increased levels of physical activity, and behavioral interventions.

"It allows a more robust ability for diagnostics based not only on weight and height and waist circumference, but also body imaging and molecular biology," Dr Mechanick told Medscape Medical News.

The term ABCD grew out of the 2014 AACE/ACE Consensus Conference on Obesity, where participants from biomedicine, government agencies, the health industry, and professional organizations acknowledged a disconnection between use of the term obesity in relation to the health of individuals.

Also, the stigma associated with the term was recognized as a barrier to successful disease management.

Challenging the Status Quo

In an interview with Medscape Medical News, Dr Mechanick emphasized that the new statement challenges the status quo and explained that although prevalence of overweight/obesity is reaching a plateau in the general US population, prevalence is continuing to rise in certain subgroups, including those with severe obesity, children, and minority groups.

"We're not bending the curve as well as we'd like to, so we need to change the health messaging of this disease," he said. He notes that, despite advances in disease understanding, medications, surgery, and awareness of lifestyle medicine, "we are missing the right messaging and communications around obesity, including the stigma attached to it."

Dr Mechanick said that the term ABCD is not set to replace the term obesity. He said that valuable traction had been gained with the term obesity, so it would be wrong to displace it. "Rather, we are introducing it as a new diagnostic term so the medical community can familiarize with the term and reconceptualize this chronic disease within the ABCD paradigm."

Ultimately, the aim is to improve care for people with obesity. "We believe that when this disease is viewed through the lens of ABCD, it will become clearer and we'll be able to help more people," he said. The position statement is also aimed at shifting the physician–patient dialogue toward the need to prevent downstream complications and problems as a result of adipose tissue problems.

Importantly, lifestyle medicine lies at the core of the new paradigm. "Physical activity, eating patterns, sleep, behavior, all the nonpharmacologic and nonsurgical means of disease management, are central," Dr Mechanick pointed out.

He also stressed that taking the ABCD approach to disease management addresses prevention on various levels. "We know this paradigm is part of primary, secondary, and tertiary prevention, but also primordial prevention, which is population-based when risk has not been identified. It also works at the quaternary prevention level that prevents overmedicalization of disease, where treatments and surgeries can represent unnecessary risk if not absolutely necessary. In this situation, lifestyle measures can prevent this overtreatment and associated iatrogenic complications."

ABCD and ICD-10 Coding

The authors write that the AACE/ACE also endorses a "continued, concerted, and vigorous effort regarding health policy and the legislative agenda pertaining to reimbursement for structured lifestyle medicine and indeed all evidence-based therapeutic modalities for patients with ABCD."

Regarding International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10) coding, Dr Mechanick said, "we would envisage different ICD codes for adiposity-related complications."

The authors add that the AACE/ACE will "spearhead clear definition and positioning of ABCD in the human disease ontology database and then creation of relevant complication-based ICD-10 coding to facilitate [healthcare professionals] reimbursements, routine implementation, and realizable quality metrics."

Further, Dr Mechanick pointed out that it would be necessary to develop the technology to better establish normative data, including further research on specific tools to quantify abnormalities in adiposity mass, distribution, and function.

However, a major challenge to using the ABCD term, according to the authors, is identification of appropriate, available, and affordable markers/metrics reflecting the effect of adiposity on health. They highlight that BMI still plays an important role but that, "to combat this prevalent, chronic, and injurious disease, [healthcare professionals] will need to incorporate a conceptual approach to management that goes beyond a singular focus on BMI. The adoption of the new ABCD diagnostic term is a clear step forward."

Dr Mechanick has received honoraria for program development by Abbott Nutrition International and honoraria for lectures from the NCD Pre-Disease Forum. Disclosures for the coauthors are listed in the article.

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Endocr Pract. Published online December 14, 2016. Article

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