During the 2026 Scientific Sessions in New Orleans, the American Diabetes Association^® (ADA) unveiled a new chapter for standards on the screening and diagnosis of obesity—including a grade “B” recommendation to screen for excess adiposity in adults using body mass index (BMI) at least annually.

The chapter was unveiled during the Sunday, June 7 symposium, Standards of Care in Overweight and Obesity: 2026 Updates, which also included discussion of a recently released chapter about pharmacological treatments for overweight and obesity and an overview of the processes behind the publication. On-demand access to recorded presentations is available to registered participants through August 10.

Kimberly Gudzune, MD, MPH, noted that obesity was recognized as a disease in 1999 by the World Health Organization and in 2013 by the American Medical Association. An Affiliate Faculty at the Johns Hopkins Bloomberg School of Public Health, Dr. Gudzune characterized these as important historical steps that failed to translate into public health changes, as significant gaps and roadblocks remain between knowledge and treatment. A 2024 study showed that only 7.1% of individuals living with obesity seek medical advice for weight loss, and less than 10% of primary care physicians use guidelines to inform obesity treatment decisions.

“While recognizing [obesity] as a disease was an important first step, it really didn’t solve any of the treatment challenges we were facing,” Dr. Gudzune said.

The Standards of Care for Overweight and Obesity is designed to address this gap between knowledge and practice by providing evidence-based, unified guidance and actionable recommendations for realistic solutions. Dr. Gudzune added that the document followed the approach that the ADA has taken with its Standards of Care in Diabetes, including a letter-coded, ranked evidence-grading system, the identification of gaps in knowledge, and planned annual updates.

Leigh Perreault, MD, presented the most recently released chapter, “Screening and Diagnosis of Obesity,” with a particular focus on the chapter’s recommendations for the use of BMI in clinical settings.

Dr. Perreault, Professor of Medicine in the Division of Endocrinology, Metabolism, and Diabetes at the University of Colorado Anschutz School of Medicine, noted Recommendation 3.2, which states: “Screen for excess adiposity in adults using BMI at least annually (B),” which is the second-highest ranking, reflecting the strength of the evidence behind the recommendation.

Acknowledging that BMI is widely criticized as an inadequate tool, Dr. Perreault walked through common arguments against it and explained how the committee’s reasoning was based on an examination of primary-source, evidence-based literature.

“When we put all of this together, we were agnostic going into the process—but again, this is not about what you hope to find, this is about what the literature supports,” Dr. Perreault said.

The grade “B” Recommendation 3.3 calls for different BMI thresholds for specific waist-to-height ratios or waist circumference measurements for men, women, and those with a non-Asian or an Asian background.  Dr. Perreault said this modification closes the gap on known shortcomings and false negatives in the BMI measurement.

“This is expanding the diagnosis so we can capture the people who we have missed all these years,” she explained.

Louis J. Aronne, MD, FACP, DABOM, the Sanford I. Weill Professor of Metabolic Research at Weill Cornell Medical College, presented an overview of the chapter, “Pharmacologic Treatment of Obesity in Adults,” which was released in January 2026.

Grade “A” recommendations in the chapter include offering obesity medications as part of initial treatment for obesity to adults with or at high risk of obesity-related diseases or complications.

“If someone has a disease that is the result of their obesity or is worsened by their obesity, starting medication from the very beginning makes sense and should be offered,” Dr. Aronne said. “That’s a change. It used to be that if you tried anything, you tried behavior, and then six months or a year later, if the patient hadn’t lost weight, maybe you would offer it or not, but if the patient didn’t lose weight, it would be their fault, they weren’t trying hard enough. Now, what we are saying is that medicine should be offered as part of the initial treatment.”

Other grade “A” recommendations that Dr. Aronne highlighted include the continuation of obesity medication after reaching treatment goals and the recommendation that individualized maintenance doses balance efficacy, health benefits, and tolerability.

A grade “C” guidance was issued against recommending compounded products not approved by the U.S. Food and Drug Administration. A grade “E” recommendation was issued on treatment goals being incremental and individualized, based on factors such as severity of obesity, life circumstances, and preferences.

The ADA released the first chapters of the Standards of Care for Overweight and Obesity in 2025. Currently, four chapters are published, and two more chapters—”Lifestyle Treatment in Adults” and “Metabolic-Bariatric Procedures in Adults”—are set to be released later in 2026.

Save the date

Make plans to join us June 18–21, 2027, for the 2027 Scientific Sessions at the Walter E. Washington Convention Center in Washington, DC. Registration will open in January.