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Finally, a New System for Classifying Obesity?

A new classification system for obesity could pave the way for more holistic care for the condition, according to recent research. At its center is a relatively new diagnostic term, “Adiposity-Based Chronic Disease” (ABDC), which experts hope will one day replace “obesity.”

“Obesity” vs. “ABDC”

The current diagnosis and treatment for obesity rely primarily on body mass index and the assumption that it comes from consuming excess calories, Mitchell Roslin, MD, chief of bariatric surgery at Lenox Hill Hospital in New York City, told Florence Health.

“Obese people eat more because their regulatory system is broken,” Dr. Roslin explained. “It’s not by choice. Reducing calories and exercising more are failed strategies that exacerbate the misunderstanding.”

RELATED: Why the Flu Shot may be Less Effective in Obese Patients

Enter ABDC, which, as a term, leaves room to address the disease’s pathophysiology and acknowledges the severity and chronic nature of its complications. In this vein, the authors of the study, published in Obesity, proposed new codes for the next edition of the popular diagnostic tool, International Classification of Diseases (ICD).

A new obesity coding system

As the researchers note, the ICD currently categorizes obesity within “endocrine, nutritional and metabolic diseases,” which leaves out the “pathophysiological processes” leading to adiposity. It also describes “obesity due to excess calories,” which ignores how energy expenditure affects weight — and which readers could easily interpret to mean, “You’re fat because you eat too much.” What’s more, “there is no accurate methodology in clinical practice for quantifying caloric ingestion,” the authors write.

Instead, the researchers proposed a four-part ICD coding system:

  • A codes reflect pathophysiology.
  • B codes indicate BMI classification.
  • C codes specify specific biomechanical and cardiovascular complications remediable by weight loss.
  • D codes indicate the degree of the severity of complications. 

The authors believe that, in addition to facilitating more individualized treatment plans, these codes will lend to more appropriate reimbursements for comprehensive obesity prevention and management.

Why does the research matter?

“The coding reflects ‘what we are treating’ and ‘why we are treating it,’ and hopefully will provide impetus for greater access of patients to evidence-based treatments,” said W. Timothy Garvey, MD, study author, director of the Diabetes Research Center at the University of Alabama, Birmingham, in a news release.

In an interview with Florence Health, he added that the new classification system would mean better access to healthcare for those with obesity because it “would hopefully bring about a more medicalized conceptualization” of the condition.

“The bottom line is that we need to stop blaming patients for their disease and start treating them,” Dr. Roslin said. “A new classification system is a start, but public perception must change, and coverage for medications and surgery must be provided.”

More than 40 percent of U.S. adults are obese, according to 2017-to-2018 research recently released by the Centers for Disease Control and Prevention. It’s the highest this stat has been in 20 years. The report also found severe obesity affects about 9 percent of U.S. adults — twice as many as 20 years ago.


Proposal for a Scientifically Correct and Medically Actionable Disease Classification System (ICD) for Obesity, Obesity.

Prevalence of Obesity and Severe Obesity Among Adults: United States, 2017–2018, Centers for Disease Control and Prevention.

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