Obesity Redefined: New Clinical Guidelines Urge Primary Care to Take the Lead in Chronic Disease Management
In a presentation at the Practical Updates in Primary Care 2025 virtual conference, Angela Fitch, MD, FACP, MFOMA, Dipl ABOM, past president of the Obesity Medicine Association and current Chief Medical Officer of knownwell, unveiled a comprehensive review of the latest clinical guidelines in obesity care. Dr Fitch noted that primary care physicians are no longer passive observers in the fight against obesity but key players in a new era of proactive, evidence-based intervention.
The Lancet Commission’s redefinition of obesity as a disease rooted in the dysfunction of adipose tissue rather than BMI alone moved the focus from weight thresholds to the clinical impact of excess fat on health outcomes. For instance, a 37-year-old woman with a BMI of 34 kg/m², coupled with conditions such as prediabetes, metabolic dysfunction-associated fatty liver disease, sleep apnea, and polycystic ovary syndrome, would be diagnosed with clinical obesity under this new framework. The therapeutic goal in such a case would be a 15 to 20% weight reduction specifically aimed at the remission of comorbidities.
Dr Fitch outlined multiple guidelines now available to help clinicians operationalize this modern understanding of obesity. The Obesity Medicine Association’s annually updated algorithm, available as an eBook, serves as a practical, how-to manual that supplements the more traditional guideline documents. While not a formal guideline itself, it is a valuable, extensively referenced tool for translating current science into clinical care strategies.
The 2016 guidelines from the American Association of Clinical Endocrinologists advocate for a staged model of treatment based on the severity of disease and associated complications. Initial stages focus on lifestyle modifications, progressing to pharmacotherapy, and eventually to surgical options for patients with more severe disease or when earlier interventions are unsuccessful. This stratified model emphasizes tailoring treatment to the individual's risk profile and therapeutic response.
Pharmacological treatment has also gained prominence. The American Gastroenterological Association (AGA) issued a strong 2022 recommendation to add pharmacologic therapy for adults with obesity or overweight who have not responded adequately to lifestyle modifications. This recommendation is backed by moderate-certainty evidence and includes a systematic GRADE-based evaluation of all FDA-approved obesity medications available at the time.
Surgical intervention has likewise evolved, as outlined by the International Federation for the Surgery of Obesity (IFSO) in its 2022 metabolic and bariatric surgery (MBS) guidelines. MBS is now recommended for patients with a BMI over 35 kg/m², regardless of the presence of comorbidities, and even for those with a BMI as low as 30 kg/m² if they have type 2 diabetes. The guidelines eliminate any upper age limit for surgery and emphasize the need to account for ethnic-specific BMI thresholds, notably recommending MBS for Asian populations beginning at a BMI of 25 kg/m². For pediatric patients, the guidelines advise considering surgery for those with a BMI exceeding 120% of the 95th percentile when complicated by comorbidities.
Children and adolescents are also at the forefront of new guidance. The American Academy of Pediatrics 2023 guidelines call for BMI screening to begin as early as age two and lay out a comprehensive, family-centered approach to managing pediatric obesity. These include early lab evaluations, lifestyle counseling, motivational interviewing, and—where appropriate—pharmacotherapy and bariatric surgery. The AAP’s endorsement of Intensive Health Behavior and Lifestyle Treatment, consisting of at least 26 hours of engagement over a 3-to-12-month period, marks a decisive step toward structured, long-term intervention.
Dr Fitch’s presentation emphasized that obesity must be treated as a chronic, relapsing disease requiring long-term management strategies, whether through lifestyle changes, medications, surgery, or multidisciplinary care teams.
Reference:
Fitch A. Current Updates on Obesity Care Guidelines. Presented at: Practical Updates in Primary Care; May 9, 2025. https://www.hmpglobalevents.com/pupc