ABCD of Obesity

Last 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