ADA2025: Defining Standards of Care in Obesity Is Tricky

“It takes a village to create standards of care,” said Nuha Ali El Sayed as she opened a symposium on the emerging standards of care for obesity. Truer words were never spoken. Defining these standards is tricky. That’s because they they need to reflect both what is desirable and a standard that good health professionals are practicing.

The trouble in obesity is that for decades now, as we lamented years ago, the standard of care has amounted to “we don’t care.” Thus, creating standards of care for obesity requires going from doing almost nothing to providing real care that makes a real difference.

Such drastic change is daunting.

Starting with Stigma and Bias

ADA has published two chapters in its emerging standards. Of course the first is all about methodology. With that opening chapter came the chapter on weight stigma and bias. This sequence makes perfect sense for one simple reason. It is bias and stigma that have made it possible for everyone from policymakers to health systems to healthcare providers to rationalize providing no real care for obesity for so long. Just put the blame and the burden on the patient and move on.

Kimberly Gudzune described a slow acceptance that obesity really is a disease and explained that it is this evolution in thinking that has opened the door to defining robust standards for care.

Moving on to Pharmacotherapy

If you’ve been living under a rock, maybe you missed that everyone has been talking about obesity medicines for the last three years. Otherwise, it should be plain that pharmacotherapy for obesity will be an important part of the emerging standards. This is a fast moving subject. Here at the ADA Scientific Sessions the intensity of focus on innovation for obesity medicine is making us dizzy. Potential new drugs are emerging at a pace we can hardly follow.

Lou Aronne spoke with a measure of frustration about the standards for pharmacotherapy, because they are still under review. So he could not share all the details. But he made a number of core principles quite clear. First is that pharmacotherapy decisions should be centered on the needs of the person receiving care. Shared decision making is key. Those decisions should be no different than the manner of decision-making for diabetes and other metabolic diseases.

But the last principle he presented was perhaps the most important. “Treat obesity before you have to treat its complications.” This is precisely why standards of care for obesity will require infinite change. It is the opposite of what health systems are accustomed to doing.

Change Is Daunting

So that reminds us how daunting the task of producing these standards really is. It requires people to buy into standards that are very different from the old, comfortable status quo. It requires specialists who produced outstanding guidelines years ago to support the new standards and recognize that they will reach a broad audience.

It indeed will take the whole village to make this happen.

Click here for the ADA statement on these guidelines, here and here for the first two chapters. For further reporting on the standards of care symposium, click here.

ADA Scientific Sessions Opening, photograph by Ted Kyle / ConscienHealth

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June 21, 2025