Now that obesity has been officially designated as a chronic disease, the American Association of Clinical Endocrinologists (AACE) and the American College of Endocrinology (ACE) have begun a multistep approach for combating it.
Following a 2-day multistakeholder consensus conference, representatives from AACE and ACE held a press briefing to issue a new statement that affirms areas of broad consensus, such as the "obesity-is-a-chronic-disease" paradigm and use of the complications-based AACE/ACE obesity algorithm (included within the type 2 diabetes algorithm) for management.
The statement also highlights yet-to-be-validated "emerging-concept" areas, including the need for a better definition of obesity and measures that should be taken to ensure reimbursement for obesity interventions.
"Obesity is a disease, deserving of the full force of our medical model. It should be addressed when patients are seen in the office," conference cochair W. Timothy Garvey, MD, from the University of Alabama at Birmingham, told Medscape Medical News in an interview.
"A complications-centric approach should be used when deciding on the treatment modality to optimize the risk/benefit ratio so that the most intensive therapies are directed at those people with complications who would benefit most. All of those things were affirmed at this conference," he added.
Becoming Impatient With Obesity Epidemic
In 2012, AACE published a position statement designating obesity a chronic disease, as reported byMedscape Medical News. Later, AACE joined other organizations in submitting that proposal to the American Medical Association's House of Delegates, which voted to affirm it in June 2013.
This AACE/ACE consensus conference and the statement issued from it represent the next step, with 2 more to follow, AACE president and conference cochair Jeffrey I. Mechanick, MD, from Mt. Sinai Hospital, New York, said during the briefing yesterday.
The current conference's aim was to build a broad evidence base. Next — in about a year's time — another meeting will be convened to "formulate specific, actionable recommendations that are relevant to individual patients." After that, the third step will be to develop the logistics of how to actually implement the recommendations, Dr. Mechanick explained.
"With everything that we know, with all the information and all the action and activity that's been going on, there's been a woefully slow dip in the obesity prevalence rates. I think we're becoming impatient with this obesity epidemic. We have to act now," he said.
The conference was unique in bringing together a wide range of stakeholders — dubbed "pillars" — including biomedical, government/regulatory, health industry and economics, and society/education/research representatives.
"We expanded beyond the pure biomedical model and incorporated the public-health model. We anticipated that we'd have ideas that would be different," Dr. Mechanick said.
Better Definition of Obesity Required
Along with the idea that obesity is a chronic disease and use of the complications-centric AACE algorithm, other "affirmed concepts" from the conference include: lifestyle intervention as a critical component of a comprehensive obesity care plan; the need for reduction of obesogenic environmental factors; and the importance of both primary- and secondary-prevention strategies.
And much discussion surrounded the idea that the definition of obesity needs to be improved. Participants generally agreed that body mass index (BMI) is inadequate as a sole indicator of obesity and endorsed a framework that would involve combining BMI with other measures such as waist circumference and assessment of complications, along with consideration of variables such as ethnicity and age.
Dr. Garvey told Medscape Medical News, "People are using BMI, but what does that mean for large payers to invest in healthcare coverage?" If payers understood the impact of that level of body weight on the health of an individual, they might begin to appreciate that coverage of obesity could improve health when applied more generally, he added.
Establishment of a more "medically meaningful" definition of obesity may require a separate initiative from AACE and other stakeholders. This idea will be among those discussed in a special symposium on May 16 at the AACE 2014 annual meeting in Las Vegas, Dr. Garvey told Medscape Medical News.
Rethinking Reimbursement Strategy for Obesity
Another speaker at the briefing, conference cochair and ACE president Daniel Einhorn, MD, from Scripps Memorial Hospital, La Jolla, California, addressed the emerging concepts that public awareness can change private insurance carriers' reimbursement strategies and healthcare coverage by employers and that a clear understanding of the value of obesity care should play a role in reimbursement decisions.
Until now, he said, obesity treatment has been specifically excluded from reimbursement. "If we can move the ball down the field and open up the opportunities to recognize and reimburse medical management of obesity for those who request and want that management, we begin to crowd-source opportunities to rethink what's possible."
Dr. Einhorn added, "Hopefully, we can help demonstrate that it's possible to treat overweight and obesity. If it's possible, it will begin to be asked for and become a common part of our landscape….One of the real hopes of this conference is to raise awareness."
Logistics for the consensus conference were supported by Takeda Pharmaceuticals, Novo Nordisk, VIVUS, and Eisai. Dr. Garvey reports research with Merck, Eisai, Vivus, and others. Dr. Mechanick reports speaking/consulting for Abbott Nutrition. Dr. Einhorn is a shareholder in MannKind and Halozyme and consults and/or does clinical research for Eli Lilly, Novo Nordisk, Medtronic, Bristol-Myers Squibb/AstraZeneca, and Janssen.