The American Association of Clinical Endocrinology (AACE) has released its 2025 Consensus Statement, introducing a transformative approach to managing excess body weight in adults. The update, published in the journal Endocrine Practice,moves beyond traditional weight-focused care. The new guidance defines obesity as a complex, chronic, neuroendocrine, progressive, and/or relapsing disease, termed Adiposity-Based Chronic Disease (ABCD) and promotes a complication-centric care model. Top highlights from the article include: The new AACE framework replaces BMI-centric classification with a clinical staging system based on the severity of obesity-related complications and diseases (ORCD). While BMI remains a useful screening tool, diagnosis now requires assessment of both anthropometric measures (such as BMI, waist circumference, and waist-to-height ratio) and the clinical severity of complications. This staging enables treatment intensity to be matched to an individual's health risk, rather than focusing solely on weight. ABCD is defined as a heterogeneous, progressive, chronic disease driven by abnormal neuroendocrine control of energy balance. This leads to excess or abnormal adiposity, which in turn drives downstream complications. These complications can impair quality of life, increase morbidity, and raise the risk of mortality. The 2025 guidelines introduce a hierarchy of pharmacological therapies, emphasizing second-generation obesity medications that have shown ≥15% weight loss in clinical trials, levels that can prevent or reverse many complications. For the first time, medications are prioritized based on their proven effectiveness in specific conditions, enabling more precise and personalized obesity care. First-generation medications, such as phentermine/topiramate and liraglutide, remain viable, particularly in early ABCD stages or where newer drugs are inaccessible due to cost. Metabolic and bariatric surgery continues to play an important role in severe obesity treatment. It is recommended for patients with a BMI ≥40 kg/m² or ≥35 kg/m² with complications. It may also be considered for those with BMI between 30–34.9 kg/m² if they have severe cardiometabolic disease. The most commonly recommended procedures remain sleeve gastrectomy and Roux-en-Y gastric bypass. The AACE emphasizes individualized, nonjudgmental care that also addresses weight stigma, mental health, and social determinants of health. Providers are encouraged to assess internalized weight bias (IWB), which can affect mental well-being and treatment adherence. Screening for depression, anxiety, and disordered eating is advised. Social and cultural factors should also be evaluated to tailor care effectively. Although medications and surgery play important roles, lifestyle interventions remain foundational to managing ABCD. As a lifelong disease, ABCD requires ongoing management. The guidelines call for regular follow-up to monitor metabolic adaptation, prevent weight regain, and adjust therapies based on patient response and the reversal of complications. Ongoing tracking of clinical markers such as A1C, blood pressure, and lipids is essential. The 2025 AACE Consensus Statement represents a paradigm shift in obesity care. By reclassifying obesity as Adiposity-Based Chronic Disease (ABCD) and emphasizing a complication-centric, individualized, and long-term approach, the new guidance moves away from outdated, weight-focused models. The goal is not just weight loss, but improving health outcomes, reducing disease burden, and enhancing quality of life through evidence-based, patient-centered care. *The degree of severity for ORCD is based on clinical judgement, incorporating findings from physical examination, laboratory testing, and/or other diagnostic procedures, as well as a person’s symptomatology, in ways that apply to each individual complication. Reference:Nadolsky K, Garvey WT, Agarwal M, Bonnecaze A, Burguera B, Chaplin MD, Griebeler ML, Harris SR, Schellinger JN, Simonetti J, Srinath R, Yumuk V. American Association of Clinical Endocrinology Consensus Statement: Algorithm for the Evaluation and Treatment of Adults with Obesity/Adiposity-Based Chronic Disease - 2025 Update. Endocr Pract. 2025 Sep 18:S1530-891X(25)00977-2. doi: 10.1016/j.eprac.2025.07.017. Epub ahead of print. PMID: 40956256.