Obesity conference sets path for treatments

Obesity requires a medical definition that goes beyond gauging a person’s body mass index if cost-effective care is to be delivered in an integrated fashion, according to a consensus statement issued by the American Association of Clinical Endocrinologists and the American College of Endocrinology.

“The definition of obesity as disease is not perfect,” said by the chair of the AACE/ACE Obesity Consensus Conference in a media briefing. “They rely upon an [anthropometric] measure of body mass index, which is a measure of height versus weight, and there was consensus that this was… divorced from the impact of weight gain on health of the individual. This imprecision in diagnosis of obesity was constraining.”

In 2013, the American Medical Association officially recognized obesity as a disease. Better codification of what actually constitutes “obesity, the disease,” will allow a more integrated and effective approach to treating it, the chair of the department of nutrition sciences at the University of Alabama at Birmingham said. To do so, the AACE/ACE held an intensive, two-day session that featured spontaneous discussions between panelists and audience members representing four specific obesity “pillars”: biomedical, government and regulation, health industry and economics, and research and education sectors.

A constant theme across the sectors was the need for a definition of obesity that accounts for cultural differences, ethnicity, and the presence or absence of cardio metabolic markers of disease in persons who are overweight or obese.

The conference’s multidiscipline approach informed the consensus statement that obesity is a chronic disease that should be treated with the established AACE/ACE obesity algorithm and met with lifestyle interventions. The consensus statement also addressed our current “obesogenic” environment, which many participants said was created in part by the abundance of non-nutritious foods.

Deputy commissioner of the New York City Department of Health and Mental Hygiene said that by working with local vendors and their suppliers, among other actions, her agency is focused on increasing access to more nutritious foods in neighborhoods across the city as a way to shape the food environment. “It’s not people who’ve changed over the past 30 years; it’s the environment.”

The consensus statement also addressed the need for preventive care and more cohesive public awareness campaigns that could affect how private payers develop their reimbursement strategies. The medical director of CIGNA Healthcare, said that payers would respond to the need for obesity care, but that what currently is missing is “a tie between the evidence and the complication [of obesity].”

“We learned that different stakeholders require different levels of evidence,” ACCE president said in the media briefing. “So, we’re going to be able to come up with a more efficient way to make recommendations about research so that private insurance carriers, the Centers for Medicare & Medicaid Service, or regulatory agencies have the type of data they require to facilitate the action [they need].”

These differences were brought to light during the conference as various audience members representing the Center for Disease Control and Prevention, the Food and Drug Administration, the CMS, the National Institutes of Health, and others involved in research and policy making, addressed the panel to either explain or defend why their agency operates as it does.

In the case of the CMS, a statutory organization, it can apply coverage only according to what the agency is mandated to do, said CMS. The level of evidence the agency looks for includes “ hard endpoints of clinical relevance, like reductions in sleep apnea and generative joint disease.” YOUR DOSE OF MEDICINE   Charles C. Chante, MD