American Association of Clinical Endocrinologists and American College of Endocrinology Comprehensive Clinical Practice Guidelines for Medical Care of Patients with Obesity |
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| Institution: | 1. Professor and Chair, Department of Nutrition Sciences, University of Alabama at Birmingham, Director, UAB Diabetes Research Center, GRECC Investigator & Staff Physician, Birmingham VA Medical Center, Birmingham, Alabama;2. Director, Metabolic Support, Clinical Professor of Medicine, Division of Endocrinology, Diabetes and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, New York;3. Associate Clinical Professor, Division of Endocrinology, Diabetes and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, New York;4. Professor, Departments of Medicine, Biochemistry and Molecular Biology, and Molecular and Cellular Biology, Baylor College of Medicine, Houston, Texas;5. Assistant Professor of Medicine, Mayo Clinic, Rochester, Minnesota;6. Assistant Professor, Yale University School of Medicine, Internal Medicine, Endocrinology, Pediatrics, Pediatric Endocrinology, New Haven, Connecticut;7. Walter Reed National Military Medical Center, Diabetes Obesity & Metabolic Institute, Bethesda, Maryland;8. Assistant Clinical Professor, Mount Sinai School of Medicine, NY, ProHealth Care Associates, Division of Endocrinology, Lake Success, New York;9. Center for Weight Management, Division of Endocrinology, Diabetes and Metabolism, Scripps Clinic, San Diego, California. |
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| Abstract: | Objective: Development of these guidelines is mandated by the American Association of Clinical Endocrinologists (AACE) Board of Directors and the American College of Endocrinology (ACE) Board of Trustees and adheres to published AACE protocols for the standardized production of clinical practice guidelines (CPGs).Methods: Recommendations are based on diligent review of clinical evidence with transparent incorporation of subjective factors.Results: There are 9 broad clinical questions with 123 recommendation numbers that include 160 specific statements (85 53.1%] strong Grade A], 48 30.0%] intermediate Grade B], and 11 6.9%] weak Grade C], with 16 10.0%] based on expert opinion Grade D]) that build a comprehensive medical care plan for obesity. There were 133 (83.1%) statements based on strong (best evidence level BEL] 1 = 79 49.4%]) or intermediate (BEL 2 = 54 33.7%]) levels of scientific substantiation. There were 34 (23.6%) evidence-based recommendation grades (Grades A-C = 144) that were adjusted based on subjective factors. Among the 1,788 reference citations used in this CPG, 524 (29.3%) were based on strong (evidence level EL] 1), 605 (33.8%) were based on intermediate (EL 2), and 308 (17.2%) were based on weak (EL 3) scientific studies, with 351 (19.6%) based on reviews and opinions (EL 4).Conclusion: The final recommendations recognize that obesity is a complex, adiposity-based chronic disease, where management targets both weight-related complications and adiposity to improve overall health and quality of life. The detailed evidence-based recommendations allow for nuanced clinical decision-making that addresses real-world medical care of patients with obesity, including screening, diagnosis, evaluation, selection of therapy, treatment goals, and individualization of care. The goal is to facilitate high-quality care of patients with obesity and provide a rational, scientific approach to management that optimizes health outcomes and safety.Abbreviations:A1C = hemoglobin A1cAACE = American Association of Clinical EndocrinologistsACE = American College of EndocrinologyAMA = American Medical AssociationBEL = best evidence levelBMI = body mass indexCCO = Consensus Conference on ObesityCPG = clinical practice guidelineCSS = cross-sectional studyCVD = cardiovascular diseaseEL = evidence levelFDA = Food and Drug AdministrationGERD = gastroesophageal reflux diseaseHDL-c = high-density lipoprotein cholesterolIFG = impaired fasting glucoseIGT = impaired glucose toleranceLDL-c = low-density lipoprotein cholesterolMNRCT = meta-analysis of non-randomized prospective or case-controlled trialsNE = no evidencePCOS = polycystic ovary syndromeRCT = randomized controlled trialSS = surveillance studyU.S = United States |
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