Doctors Should Do More Screening for Excess Body Fat and Its Health Risks

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On Tuesday, the AHA (American Heart Association) and three other medical societies published the first guidelines to help clinicians prevent and manage CKM, as it is called, urging them to focus on their patients’ overall metabolic health. The goal is to prevent or slow the progression of conditions that may ultimately lead to heart attacks and strokes, which are becoming more common in younger adults.

The new guidelines call for doctors—from primary care to cardiology—to screen patients for metabolic risk factors and kidney function routinely. Risk from excess fat should be measured both by body-mass index (BMI) and waist circumference, according to the new guidelines, which were developed by the AHA and the American College of Cardiology with the American Diabetes Association and American Society of Nephrology.

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Nearly 90% of Americans meet the criteria for CKM, according to a 2024 study. Most people are in the first two of four stages, with excess body fat and some risk factors such as high blood pressure or cholesterol. Only 9.2% are at the most advanced stage, with heart failure or another diagnosed form of heart disease, along with other metabolic conditions such as kidney disease, according to the study.

There are drugs on the market that studies show have benefits for more than one of these conditions at once, such as GLP-1s and another class of drugs known as SGLT inhibitors. While these diseases and even some treatments are interrelated, they are often treated as separate conditions with their own specialists—cardiologists, endocrinologists and nephrologists, which can lead to delayed diagnoses or treatments.

Most people with high blood pressure, diabetes and obesity aren’t screened for kidney disease, for example, said Dr. Daniel Weiner, a nephrologist at Tufts Medical Center, who was on a review committee for the new guideline. “If you delay treatment for too long, you lose an opportunity to prevent something that could be more serious down the road,” he said. Understanding the connection helps both the clinician and the patient, said Dr. Jay Shubrook, a family physician and professor at Touro University California, who wasn’t involved with the new guideline. “I can say I’m worried that your current conditions are not affecting just your diabetes, but they’re also affecting your heart and your kidneys.”

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