In 2017, the American Association of Clinical Endocrinologists (AACE) proposed a new diagnostic term to address the complexity of obesity: Adiposity-Based Chronic Disease (ABCD). The goal behind this terminology is to redefine obesity not by the number on the scale but by the real health threats it poses through the impact of excess adipose (fat) tissue on the body’s systems.
What is obesity?
Obesity is more than just excess weight. It’s a complex, chronic disease characterized by the accumulation of excessive or abnormal body fat. This accumulation contributes to several severe medical conditions. These include:
- High blood pressure
- Diabetes
- Heart disease
- Osteoarthritis
- Obstructive sleep apnea
- Liver disease
- Certain cancers
Globally, obesity is recognized as a leading health crisis. It affects over 650 million people and contributes to 4.7 million premature deaths each year according to the World Health Organization.
Related: The ABCD’s of Obesity – Episode 1: The Primer- with Q & A
What is Adiposity-Based Chronic Disease (ABCD)?
Adiposity-Based Chronic Disease describes obesity as a chronic disease stemming from the adverse effects of excess fat (adipose) tissue. Unlike traditional definitions of obesity that focus solely on weight or Body Mass Index (BMI), ABCD shifts the focus to the health risks posed by excess fat.
For instance, some individuals may appear to meet the BMI criteria for obesity but are metabolically healthy due to their muscle mass. In contrast, others with normal BMI may have unhealthy fat distribution, particularly around their abdominal area, which places them at high risk for adiposity-based diseases like diabetes or cardiovascular problems.
This shift in terminology to ABCD is crucial in understanding the true nature of obesity. It highlights that obesity is not just about appearance or size. It’s about the health impact of excess adipose tissue. The term aims to destigmatize obesity by emphasizing its biological and medical causes rather than reinforcing the negative stereotypes associated with being overweight.
Similarly, it promotes a more holistic approach to treatment. Rather than focusing solely on weight loss, healthcare providers can address the broader health risks, like cardiovascular disease and diabetes, and create a personalized treatment plan that includes nutrition, physical activity, and medical interventions if necessary.
The evolving understanding of obesity
The traditional view focused primarily on body weight and BMI (Body Mass Index) as the key health indicators. However, the modern understanding of obesity involves a crucial shift towards recognizing the importance of fat distribution and metabolic impact.
Research has shown that body fat distribution plays a significant role in determining health risks. For instance, individuals with excess fat concentrated in the abdominal area are at a higher risk for metabolic diseases, such as type 2 diabetes and cardiovascular diseases, compared to those with fat distributed in other areas of the body. This shift in focus is integral to Adiposity-Based Chronic Disease, which emphasizes the health consequences of excess adipose tissue rather than just weight.
Moreover, an individual’s metabolic health cannot be accurately assessed through weight alone. A person with a high BMI might possess significant muscle mass and be metabolically healthy. At the same time, another with a normal BMI might carry excess fat and face substantial health risks. This nuanced understanding allows healthcare providers to tailor treatment and intervention strategies based on an individual’s specific health profile rather than relying solely on weight as a measure of health.
Related: The ABCD’s of Obesity: Episode 2 – An Introduction to Pediatric Obesity with Q & A
Recognition of obesity as a chronic, relapsing, and progressive disease
One of the most significant advancements in the understanding of obesity is the recognition that it is a chronic, relapsing, and progressive disease. This perspective acknowledges that once obesity develops, it can become a lifelong condition that requires ongoing management. In this way it acts much like other chronic diseases such as diabetes or hypertension.
The chronic nature of obesity implies that it can recur after treatment, often leading to cycles of weight loss and regain. This is particularly relevant given that many individuals who lose weight may find it challenging to maintain their weight loss due to physiological adaptations that increase hunger and cravings, as well as changes in metabolism. This understanding emphasizes the need for long-term strategies rather than quick-fix solutions.
Health implications of Adiposity-Based Chronic Disease
The health consequences of obesity are profound. Individuals who are overweight or obese are at an increased risk of developing type 2 diabetes due to insulin resistance. With insulin resistance, the body fails to use insulin effectively. This leads to elevated blood sugar levels. Additionally, excess body weight is a significant contributor to cardiovascular diseases, including heart disease and stroke. The accumulation of abdominal fat can elevate cholesterol levels and blood pressure, further heightening the risk of heart-related complications.
Physically, obesity leads to various health issues that can affect mobility and overall quality of life. Joint pain is a common problem. Excess weight places additional stress on joints, particularly in the lower body, potentially resulting in osteoarthritis. Sleep apnea is another serious concern, characterized by interrupted breathing during sleep. This affects sleep quality and increases the risk of cardiovascular problems. These physical challenges can create a cycle of inactivity, exacerbating obesity and related health issues.
The psychological impact of obesity is equally significant. Individuals struggling with excess weight often experience higher rates of depression and anxiety. The societal stigma associated with being overweight can lead to feelings of hopelessness and self-doubt. Many also grapple with negative body image, which can diminish self-esteem and result in social withdrawal, ultimately reducing their quality of life.
Evidence-based treatment approaches for ABCD
Central to ABCD management is integrating multiple strategies, including lifestyle changes, pharmacotherapy, and surgical interventions for severe cases. The treatment aims not only at weight loss but also at managing the associated comorbidities that often accompany obesity.
Lifestyle changes
The cornerstone of any successful obesity treatment plan is lifestyle management. This involves modifications in diet, increased physical activity, and behavioral changes. Patients are encouraged to self-monitor their calorie intake and physical activity, set realistic weight loss goals, and identify and control environmental triggers that lead to overeating.
Nonfood rewards are motivational tools to reinforce progress. Relapse prevention strategies are crucial for sustaining weight loss. However, long-term success requires a dedicated partnership between the patient and a multidisciplinary healthcare team, which may include physicians, dietitians, psychologists, and exercise specialists.
Pharmacotherapy for Adiposity-Based Chronic Disease
Pharmacotherapy is typically introduced when lifestyle changes alone do not result in sufficient weight loss. Medications can be an adjunct to lifestyle modification for patients with a body mass index (BMI) of 27 kg/m² and higher with comorbidities or a BMI over 30 kg/m².
These drugs can help patients adhere to behavioral changes and improve physical function, particularly for those unable to engage in physical activity initially. Medications should be continued if they result in at least a 5% reduction in body weight within three months. Otherwise, they should be discontinued and alternative treatments explored.
Certain medications, such as glucagon-like peptide-1 (GLP-1) receptor agonists and sodium-glucose-linked transporter-2 (SGLT-2) inhibitors, can also benefit patients with type 2 diabetes. These offer weight loss benefits alongside diabetes management.
Surgical intervention
For patients with severe obesity, particularly those with a BMI of 35 kg/m² or higher with comorbidities, bariatric surgery is a highly effective treatment option. Surgical procedures such as gastric bypass or sleeve gastrectomy can lead to significant and sustained weight loss, significantly reducing the risk of obesity-related health problems.
However, newer pharmacological options, such as GLP-1 receptor agonists like semaglutide and tirzepatide, have demonstrated impressive results. Patients experience weight loss ranging from 15% to 22.5%, on average. These medications may offer a non-surgical alternative for some patients.
The role of pharmacists in managing Adiposity-Based Chronic Disease
As frontline healthcare professionals, pharmacists are crucial in managing obesity. They contribute to patient education, medication management, and promoting healthy lifestyle changes.
Pharmacists are accessible healthcare providers who can educate patients about the risks associated with obesity. They can counsel patients on maintaining a healthy weight and guide effective weight management strategies, including nutritional guidance, physical activity, and behavioral modifications.
Pharmacists are also well-positioned to manage and monitor pharmacotherapy for obesity. Several medications have been approved for weight management, including Orlistat (Alli, Xenical), a lipase inhibitor that reduces fat absorption in the intestines. Phentermine-topiramate (Qsymia) is another combination drug that suppresses appetite and promotes feelings of fullness. Liraglutide (Saxenda), originally developed for diabetes management, has shown efficacy in promoting weight loss by reducing appetite.
Naltrexone-bupropion (Contrave) works on the central nervous system to reduce hunger and cravings. Pharmacists should assess patients’ medication regimens, monitor for side effects, and ensure adherence to prescribed therapies. They can also provide information on the appropriate use of these medications and lifestyle modifications that enhance their efficacy.
Collaboration is vital in managing obesity. Pharmacists should work alongside other healthcare professionals, such as dietitians, physicians, and mental health providers, to develop comprehensive obesity management plans. This multidisciplinary approach ensures that patients receive holistic care that addresses the physical, emotional, and psychological aspects of obesity. Ultimately, collaboration leads to better outcomes.
Conclusion
By leveraging their skills, pharmacists can empower patients to make informed decisions about their health and contribute significantly to obesity management strategies. Through collaborative efforts and ongoing education, pharmacists can enhance their impact in promoting healthier lifestyles and improving patient outcomes.
