New frontiers in obesity care: key updates from the American Association of Clinical Endocrinology International Recommendations for the diagnosis and treatment of adults with obesity

Obesity is a chronic, multifactorial condition associated with a high risk of cardiometabolic and biomechanical complications. In 2025, the American Association of Clinical Endocrinology (AACE) released an updated diagnostic and therapeutic algorithm grounded in the concept of obesity as a chronic disease driven by excess adipose tissue accumulation. This article presents a comparative appraisal of the AACE approach and the current clinical guidelines issued by the Russian Association of Endocrinologists. The authors outline revisions to diagnostic evaluation, including incorporation of additional anthropometric measures, specifically waist circumference and the waist‑to‑height ratio, and the adoption of a structured framework for assessing obesity‑associated complications as part of clinical staging. Particular emphasis is placed on a personalized patient management oriented toward achieving clinically meaningful targets and improving the course of comorbid conditions. Contemporary principles of non‑pharmacological therapy are reviewed, including dietary intervention, physical activity, and behavioral therapy. Key changes in pharmacological management are highlighted, notably the introduction of new‑generation agents, semaglutide and tirzepatide, with proven efficacy not only for weight loss but also for improving cardiometabolic outcomes. Overall, the updated AACE algorithm reflects a shift toward a modern paradigm that treats obesity as a chronic disease requiring long‑term, comprehensive care. Keywords: obesity, tirzepatide, semaglutide, pharmacotherapy for obesity, metabolic syndrome, metabolic dysfunction-associated steatotic liver disease. For citation: Karonova T.L., Nikulina A.A., Murasheva A.V., Eganyan Sh.A., Tikhonov N.I., Sukhotskaya N.A., Grineva E.N. New frontiers in obesity care: key updates from the American Association of Clinical Endocrinology International Recommendations for the diagnosis and treatment of adults with obesity. RMJ. 2026;3:24–29. DOI: 10.32364/2225-2282-2026-3-4