The ABCD of Obesity: An EASO Position Statement on a Diagnostic Term with Clinical and Scientific Implications

Abstract

Obesity is a frequent, serious, complex, relapsing, and chronic disease process that represents a major public health problem. The coining of obesity as an adiposity-based chronic disease (ABCD) is of particular relevance being in line with EASO's proposal to improve the International Classification of Diseases ICD-11 diagnostic criteria for obesity based on three dimensions, namely etiology, degree of adiposity, and health risks. The body mass index as a unique measurement of obesity does not reflect the whole complexity of the disease. Obesity complications are mainly determined by 2 pathological processes, i.e., physical forces (fat mass disease) as well as endocrine and immune responses (sick fat disease), which are embedded in a cultural and physical context leading to a specific ABCD stage.

Keywords: Adiposity; Comorbidities; Dysfunctional adipose tissue; Noncommunicable diseases.

Fig. 1

Schematic diagram of the adiposity-based chronic disease (ABCD) conceptual framework of obesity, which incorporates the characteristics of adiposity including the total amount, distribution, as well as function of adipose tissue (a), the physical (human-made or built environment, i.e., food availability, urban planning, endocrine disruptors, etc.) and cultural (socio-political-economic aspects, i.e., customs, attitudes towards food and physical activity, culture, ethnicity, beliefs, policy, inequalities, and stigmatization, among others) context in which it is embedded (b), together with the clinical burden derived from the impact of the dysfunctional fat over time, which leads to the development of complications and a gender-specific disease stage (c).