Good lord that abstract is a word salad of polysyllabic, mostly invented/portmanteau words, which obfuscates the true intent of what they are trying to do. Item 3 is a particular gem:
The American Association of Clinical Endocrinologists (AACE) and American College of
Endocrinology (ACE) have created a chronic care model, advanced diagnostic framework, clinical
practice guidelines, and clinical practice algorithm for the comprehensive management of obesity.
This coordinated effort is not solely based on body mass index as in previous models, but
emphasizes a complications-centric approach that primarily determines therapeutic decisions and
desired outcomes. Adiposity-Based Chronic Disease (ABCD) is a new diagnostic term for obesity
that explicitly identifies a chronic disease, alludes to a precise pathophysiological basis, and
avoids the stigmata and confusion related to the differential use and multiple meanings of the
term “obesity”. Key elements to further the care of patients using this new ABCD term are: (1)
positioning lifestyle medicine in the promotion of overall health, not only as the first algorithmic
step, but as the central, pervasive action, (2) standardizing protocols that comprehensively and
durably address weight loss and management of adiposity-based complications, (3) approaching
patient care through contextualization (e.g., primordial prevention to decrease obesogenic
environmental risk factors and transculturalization to adapt evidence-based recommendations for
different ethnicities, cultures, and socio-economics), and lastly, (4) developing evidence-based
strategies for successful implementation, monitoring, and optimization of patient care over time.
This AACE/ACE blueprint extends current work and aspires to meaningfully improve both
individual and population health by presenting a new ABCD term for medical diagnostic purposes,
use in a complications-centric management and staging strategy, and precise reference to the
obesity chronic disease state, divested from counterproductive stigmata and ambiguities found in
the general public sphere.
Good things: may help distinguish better between people who are relatively low BMI due to hereditary body build (e.g., Asians as compared to Samoans), who are sicker at lighter weight (Asians tend to gain weight as bad abdominal fat, as opposed to butt and thighs, and thus manifest metabolic disease at a much lower BMI), as well as distinguishing people who have a high BMI due to body-building/high muscle mass.
Bad things: May make it harder for morbidly obese patients who aren't already sick from comorbidities to get WLS, when those comorbidities are inevitable.
Here's an interesting turn of phrase:
Therapeutic Nihilism: on the part of both health care professionals (HCP) and the
general public, based on beliefs that patients with obesity will have poor responses to
current efforts because obesity is solely a lifestyle choice rather than a chronic disease
with important behavioral components.
