This 2025 AACE consensus statement updates the organization’s obesity algorithm by framing obesity as adiposity-based chronic disease: a chronic, heterogeneous, neuroendocrine disease that requires long-term care rather than short-term weight-loss efforts alone. The guidance emphasizes a person-centered, complication-centric model in which clinicians diagnose and stage disease using both an anthropometric component—body mass index (BMI) plus physical confirmation of excess adiposity, waist measures, and sometimes body-composition tools—and a clinical component based on the presence and severity of obesity-related complications and diseases (ORCD). In this framework, stage 1 refers to “preclinical” obesity without established complications but still warrants treatment to prevent progression. Stages 2 and 3 reflect mild-to-moderate or severe ORCD and help determine treatment intensity. The statement also repeatedly stresses shared decision-making, long-term follow-up, and the need to reduce weight bias and stigma as part of high-quality obesity care.

On treatment, the update moves beyond a singular focus on BMI or pounds lost. Instead, it prioritizes improving health outcomes tied to specific complications. Lifestyle and behavioral therapy remain foundational, but pharmacotherapy should be individualized based on complication profile, efficacy, adverse effects, and cost/access. The document notes that second-generation anti-obesity medications such as semaglutide and tirzepatide generally produce greater average weight loss and are especially important when more substantial loss is needed. First-generation options still have an important role as well, particularly in stage 1 or 2 disease and when cost or insurance barriers limit access. It also supports metabolic/bariatric surgery as a highly effective option for appropriate patients, generally including BMI thresholds of at least 40 or at least 35 with complications. It further warns that obesity care should not be reduced to online prescribing without proper evaluation and follow-up.

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Reference: Nadolsky K, Garvey WT, Agarwal M, et al. 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;31:1351-1394. doi: 10.1016/j.eprac.2025.07.017. Epub 2025 Sep 16.

Researchers of this retrospective real-world study analyzed US children, adolescents, and young adults with obesity from 2019 to 2024. The goal was to understand clinical characteristics, treatment patterns, and healthcare use as newer anti-obesity medications became available. Across age groups, obesity-related complications were common, with asthma especially prevalent in children and anxiety and depression more common in adolescents and young adults. Treatment rates remained low overall: lifestyle interventions were documented in fewer than 10% of patients, bariatric surgery was rare, and obesity management medications were used by only a minority of adolescents and young adults. Still, use of these medications increased over time, especially incretin-based therapies such as semaglutide and tirzepatide between 2022 and 2024.

Researchers also found that adolescents and young adults who used obesity management medications tended to have higher body mass index and a heavier burden of obesity-related complications than non-users. The results suggest these therapies were more often used in patients with more severe disease. These patients also had higher overall healthcare costs, particularly pharmacy costs, although healthcare resource use was otherwise fairly stable across the study period. In the discussion, the authors emphasize that despite growing uptake of GLP-1–based therapies, obesity treatment remains underused in younger populations, likely due to access barriers, insurance and cost issues, safety concerns, stigma, and continued reliance on lifestyle intervention as first-line care. Overall, the paper argues that earlier and more effective obesity treatment may be needed to reduce long-term complications and improve outcomes in young people.

Reference: Gibble TH, Huang A, Higgins C, et al. Clinical characteristics, treatment patterns, and healthcare utilization among children, adolescents, and young adults with obesity in the United States. Obes Pillars. 2026 Feb 14;18:100252. doi: 10.1016/j.obpill.2026.100252.

Authors of this narrative review examine how intentional weight loss achieved through lifestyle changes such as calorie restriction and exercise affects bone health in adults with overweight or obesity. Overall, the review finds that lifestyle-induced weight loss is commonly associated with increased bone turnover, especially greater bone resorption, along with small but meaningful reductions in bone mineral density at clinically important sites. These effects appear most consistent at the hip. Findings at the spine are more variable, partly because spinal measurements may be affected by DXA-related artifacts and age-related changes. The review also notes that fracture risk remains less clear: some data suggest no increase in fractures, but longer-term studies, including Look AHEAD, raise concern that intentional weight loss may increase fragility fracture risk in some higher-risk groups.

The authors conclude that weight loss can still be beneficial overall, but bone health should not be ignored when treating obesity. Potential mechanisms for bone loss include reduced mechanical loading from loss of body mass, hormonal and metabolic changes, and inadequate intake of bone-supporting nutrients such as calcium, vitamin D, and protein during hypocaloric diets. Current evidence suggests that regular exercise, adequate calcium intake, sufficient vitamin D, and higher protein intake may help protect bone during weight loss, though they may not fully eliminate skeletal risk. The review calls for more real-world research on repeated weight loss and regain, different dietary strategies, and which patients—such as postmenopausal women, older adults, and those with poorer musculoskeletal health—may be most vulnerable to bone loss during weight reduction.

Reference: Legrand MA, Paccou J, Lecerf JM, et al. Bone Health Following Lifestyle-Induced Weight Loss in Individuals With Overweight/Obesity: A Narrative Review. Obesity (Silver Spring). 2026 Jan;34(1):19-35. doi: 10.1002/oby.70047.