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ABCD of Obesity



abcdLast week, at the 23rd Annual Scientific & Clinical Congress of the American Association of Clinical Endocrinology meeting in Las Vegas, I attended a discussion on developing a consensus on obesity as a chronic disease.

One of the key issues that came up in the discussion (besides the fact that BMI is pretty useless and we need to use a staging system to better define risk), was the notion that we need to discard the term “obesity” as it conjures up all kinds of negative responses and in fact hinders a rationale discussion on the role of excess body fat in health and disease.

An analogy that came up was the renaming of “impotence” as “erectile dysfunction (ED)” – this simple name change turned a highly emotionally laden and negative word into something that you’d be a lot more comfortable discussing with your physician.

But renaming obesity is no simple matter. Among all of the suggestions, the one that struck a note with me (and I believe many in the audience), was the term “Adiposity-Based Chronic Disease” or ABCD.

Although the term may sound a bit awkward, it does have a few merits.

For one, it focusses our attention on the “disease” aspect of adiposity. As my readers are well aware, not everyone with adiposity has or is even at risk of a “chronic disease”. Thus, you may well have adiposity but only when you have signs of ABCD do you actually have a “disease”.

It also does away with the negative stigma attached to the word “obesity” – I would imagine that having ABCD in your chart sounds a lot better than seeing the word “obesity”, especially if this is simply based on the rather arbitrary BMI, which says little about your actual health.

It may also provide a different angle from which to view treatments – whereas someone with adiposity may be interested in weight loss, the focus of treatment (and measure of success) for someone with ABCD would be an improvement in this condition (which may or may not involve weight loss).

Of course, the devil lies in the detail. You would still need to define “adiposity” and we would need to have a clear definition of how to assess this to decide if someone has ABCD or simple adiposity.

Clearly, the field is in motion – thankfully in the right direction.

@DrSharma
Barcelona, ES

 

7 Comments

  1. It is definitely a progress in terms of the awareness of the huge individual difference regarding the biological effect of adiposity. It will be a great challenge to define the cut-off of adiposity in ABCD. More accurate methods to measure adiposity will be critical especially a method that is accurate but affordable to apply at the population level.

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  2. Here is how London Cockneys will make a partial diet of that:

    ” A for ‘orses (hay for horses)
    B for mutton (beef or mutton)
    C for ‘th highlanders (Seaforth Highlanders)
    D for ‘ential (deferential) “

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  3. Good – this redirects medical resources to where they are needed – actual diseases.

    If a patient’s weight is a personal concern, but not a medical one, the doctor can reassure the patient that no medical intervention is necessary, and move on to real medical problems in that patient or other patients.

    If it is medically warranted, the doctor could inform the patient that increasing weight may possibly increase the risk of developing ABCD in the future, though that is not inevitable.

    Adipose tissue that is merely cumbersome or unfashionable or socially disapproved of should be dealt with as a cosmetic issue.
    In Canada, that means the client pays, not the government.
    That is what happens in other cases. For example, in dermatology. I have had unsightly hair-sprouting moles removed from my face, but it was just a cosmetic procedure, so I paid. My friend had a skin cancer removed (by the same doctor), she didn’t pay. I think that is quite fair. I dentistry, severely mangled teeth will get medical treatment, but if you just want a prettier smile, you pay an orthodontist.

    The social demand for cosmetic weight loss programs is huge and growing. If we in Canada try to fund that publicly, for non-ABCD cases, we’l be wasting money on non medical issues.

    If someone with adiposity (not ABCD) is interested in weight loss, he or she should deal with that outside our medicare system.

    If it is really true that weight itself isn’t a medical problem, then a doctor should have no qualms about focusing on ABCD cases and leaving other weight issues to private business.

    By the way, I am not involved in any weight loss business myself. I do support Canadian public health care. Weight loss is a big concern, and there is a danger that people will think losing weight is something they should see a doctor about and get treatment for even though they do not have ABCD.

    This is much more than just a “naming” issue.
    It puts the whole area of non-ABCD excess weight outside the medical system. Like the Halloween witch moles on my face – it’s not a medical problem at all.

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  4. Words can have such impact. I was thrilled when a doctor wrote down on a form that I had “grand obesity” rather than the usual “morbid obesity”. It made me feel much better – not that I was abnormal and dying.

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  5. The problem I have with ABCD is that most of these chronic diseases have a lot of risk factors, of which adiposity is only one and often not the most important one, and people who are not ‘adipose’ can also have these diseases. So I think it is kind of misleading. Most of these, in fact, are probably AGE related more than anything else. It just perpetuates the idea floating around that somehow heart disease etc is all due to adiposity and if you were thin you would never have heart disease and if you are even slightly overweight and do have heart disease it’s caused by your adiposity.

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  6. Concerning the change in attitude after “impotence” became “erectile dysfunction”,
    it wasn’t just the name change, but those brilliant Viagra ads.
    “Erectile dysfunction” would have been just another medical term if it weren’t for those cheery upbeat ads showing happy guys strutting down the street after a successful Viagra treatment.

    I expect “The Obesity Network” will soon be “The ABCD Network”.

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