American Association of Clinical Endocrinology Consensus Statement: Algorithm for the Evaluation and Treatment of Adults with Obesity/Adiposity-Based Chronic Disease – 2025 Update

Abstract

Objective: This 2025 consensus statement provides evidence-based visual guidance in graphic algorithms and a summary of evidence to assist health care professionals and adults with obesity and adiposity-based chronic disease (ABCD) in shared decision making to improve care and achieve health goals. Methods: AACE selected a task force of medical experts to update the 2016 AACE algorithm for the medical care of patients with obesity and align this algorithm update with related AACE clinical guidance. Details on surgical and procedural therapies for obesity treatment as well as the care of pediatric-aged patients are beyond the scope of this algorithm. Results: The algorithm includes 11 sections: (1) principles of person-centered and complication-centric management of obesity/ABCD, (2) care model for people with obesity/ABCD: screening and diagnosis, (3) diagnosis: anthropometric component, (4) diagnosis: clinical component, (5) individualized treatment plan, therapeutic goals, and follow-up, (6) response to therapy and weight-loss targets for people with ABCD, (7) behavioral/lifestyle therapy for people with obesity/ABCD, (8) hierarchies of preferred medications for complication-centric care of people with ABCD, (9) lower-cost pharmacologic step therapy for ABCD, (10) medications for obesity: individualization of therapy, and (11) medications for obesity approved by the U.S. Food and Drug Administration. Conclusions: This 2025 algorithm for the medical care of adults with obesity underscores that ABCD is a complex, chronic disease that necessitates long-term treatment and care. Emphasis is placed on optimizing health rather than just weight reduction and achieving clinical goals other than a singular focus on body mass index (ie, complication-centric care). Choice of interventions and intensity of treatment should be individualized, taking disease severity or stage into account. Equality of care and reducing weight bias and stigma through a biopsychosocial chronic care model are critical and included throughout this clinical guidance statement.