March 4th is World Obesity Day - but what is Adiposity-Based Chronic Disease (ABCD)?

Did you know more than one-third of adults in the U.S. have obesity? Many people think obesity is due to a lack of willpower, however its a global medical disease. According to the World Health Organization, over 650 million people worldwide are fighting obesity and it’s linked to 4.7 million premature deaths each year. Yet there is hope. In honor of World Obesity Day, we want to share with you the common myths, causes, and treatment options to help raise awareness about this serious health problem.  

What is obesity (ABCD)? 

Obesity is a complex, chronic disease of excessive or abnormally accumulated body fat, resulting in medical problems such as high blood pressure, diabetes mellitus, heart disease, osteoarthritis, obstructive sleep apnea, liver disease, and even certain cancers. In 2017, we at AACE proposed the diagnostic terminology Adiposity-Based Chronic Disease (ABCD) because obesity is not about weight itself, but the health threats it causes due to the effects of excess weight or adipose tissue on your body. ABCD looks at the science of the disease and destigmatizes the term “obesity”.  


There are many misconceptions and stigmas when it comes to ABCD, but a common myth frequently heard is that it develops due to a lack of willpower or effort. However, ABCD is due to innumerable multifactorial contributions. For most people, ABCD can occur from a variety of factors such as genetics, our food environment or availability, sedentary lifestyle, underlying medical conditions, medications, and other environmental or economic factors.   

Another significant misconception is that ABCD is about weight and size, which may influence the misperception of weight as a negative attribute. Although weight plays a role for some complications such as arthritis, when it comes to metabolic health, it’s rather about the distribution and function of your adipose tissue and muscle mass. For example, a relatively muscular athlete without excess body fat may have a body-mass index (BMI) which meets criteria for obesity but obviously does not have the disease clinically. On the other hand, a person may have low amounts of healthy muscle mass and stores excess fat in the abdominal area without a high BMI, but has very high risk of adiposity-based disease. That’s why the diagnostic term, ABCD, was proposed as a more accurate term to define this global disease.  

What causes ABCD? 

ABCD results due to a complex combination of biological factors such as genetics and hormones along with a variety of unhealthy lifestyle and environmental factors producing dysfunctionally positive energy balance leading to accumulation of fat tissue. Below we've broken down the main risk factors to help raise awareness.


Genetics are an important factor for promoting health and preventing disease. Doctors gather your family’s medical history to determine if you, other family members, or future generations may have an increased risk of developing chronic health conditions. If you have a close family member with ABCD, there is a higher chance that you may develop the disease as well. Your genes can also influence your food behavior and appetite. According to genetic studies, heritability accounts for 30-70% individual variation in fat mass including the obesity-associated gene (FTO), which can make it challenging to limit your calorie intake and beyond. Although your genes can increase your appetite and reduce your metabolism, you can still change your behavior and physical activity levels to prevent and/or treat ABCD. 


Dietary therapy is the foundation of treating obesity and adiposity-based disease. The primary change that needs to happen is creating a caloric or energy-deficit (reducing the calories taken in). This is easier said than done with the body’s physiology working against you by driving hunger, cravings, and lack of satiety. A first step is to reduce refined/process foods and replace them with more unprocessed whole foods as this will automatically reduce caloric intake while providing healthful nutrients. If you're eating a healthy diet full of nutrients, vitamins, and minerals, you can prevent your risk of developing ABCD and other medical conditions. 

Eat more:

  • Vegetables and fruits in place of high calorie starches 
  • Whole grains (wheat, barley, rice, buckwheat, oats, quinoa, rye, sorghum, spelt) in place of refined starches
  • Fiber-rich foods (beans, lentils, nuts, fruits) 
  • Lean sources of protein from plants, fish, eggs, dairy and some animal meats while reducing animal fat 
  • Get fat from unprocessed whole foods such as nuts, seeds, fish, olives, and avocados 

Foods to limit and or reduce: 

  • Processed foods due to their high calories, sugar, and saturated fats 
  • Refined grains (white bread, white rice, white pasta) and sweets 
  • Red meat and processed meats 
  • Fried foods 
  • Sugar-sweetened beverageslike soda-pop and juice 
  • Alcohol like sugary cocktails, beer, and wine 

By limiting the foods that are high in calories from processed foods high in sugar, carbohydrates and fats, you can lose weight and prevent/treat ABCD, high blood pressure, high cholesterol level, type 2 diabetes, stroke, heart diseases, and/or other medical problems.   

Learn how to meal prep for healthy living here.

Social and economic factors 

We all know good nutrition is a widely understood indication for good health, however due to complex social, economic, ethnic, and cultural factors, not all people can easily access healthy foods. Studies have reported that diet quality is directly linked to socioeconomic status. Low-cost foods are typically highly processed, composed of refined grains with added sugars and added fats, which is why they are inexpensive. Healthier foods tend to cost more which make it challenging for lower income groups to budget for. 

Diseases and medications 

Certain diseases such as Prader-Willi Syndrome, Cushing Syndrome and other conditions can cause weight gain leading to ABCD overtime. There are also certain medications such as antidepressants, that have side effects of weight gain as well. It’s important to speak with your healthcare provider to determine which medications can alter the function of your body and brain, causing you to have an increased appetite or lower metabolism which can lead to ABCD.   


ABCD can happen at any age, however your risk increases as you get older due to hormonal and lifestyle changes. As you age, your body's muscle mass and metabolism can decrease, which makes it harder to reduce calorie intake and keep off excessive weight. The best way to prevent ABCD as you age is to incorporate physical activity into your lifestyle. Not only will you have more energy and burn extra calories, but also reduce your risk of developing other diseases.  

Other factors 

Other major lifestyle factors can increase your risk of ABCD, including:  

  • Smoking 
  • Lack of sleep 
  • Stress 

ABCD is a global health problem. Knowing your risk can change your future. 

What is the Best Treatment for ABCD? 

ABCD is a highly treatable disease. Making lifestyle modifications such as losing weight and maintaining a healthy weight through diet and exercise programs are key components in treating ABCD. In addition to a healthy lifestyle, your healthcare provider may recommend additional treatment options, including:

  • Dietitian counseling - Dietitians play a key role in managing obesity. They offer individualized support based on your personal lifestyle and goals, while understanding the complex psycho-neurobiology of the disease. 
  • Exercise and physical activity - We know that staying active is one of the best ways to keep ourbodies healthy. Physical activity improves sleep quality, reduces anxiety, blood pressure and a verity of medical complications that can arise from ABCD or other medical conditions. Healthcare providers recommend spending at least 150 minutes a week on moderate physical activity. The goal is to gradually increase your exercise routine by starting with moderate intensity (like brisk walking) and add on resistance training of major muscle groups as your build your endurance.
  • Medications - If diet and exercise programs dont work, your provider may recommend medications to help you reduce your hunger and maintain a low-calorie diet. These are indicated based upon the severity of ABCD (complications of obesity), not the size, per se. 
  • Surgery - Depending on your personal condition and BMI level, surgery may be an option. Bariatric surgery, also known as “metabolic” surgery, refers to surgical procedures to treat ABCD and its complications. The most common bariatric surgeries include: laparoscopic Roux-en-Y gastric bypass surgery, adjustable gastric banding, biliopancreatic diversion with duodenal switch, and laparoscopic gastric sleeve. Bariatric surgery still requires exercise, a healthy diet, and lifestyle modifications before and after surgery.
  • Weight Loss Programs - Before starting a new fad diet or weight loss programspeak with your provider to find the right program for you.  

The goal of treatment is to get to a healthy weight while lowering your risk of developing health complications. Speak with your healthcare provider to determine the best personalized treatment plan for you. Visit our nutrition and obesity page to learn more about ABCD and how nutrition can enhance your health. 

Learn More 

Dr. Karl Nadolsky contributed to the production of this blog.


Karl Nadolsky, DO, FACE, Chair, Nutrition & Obesity Disease State Network