A new clinical guideline published today by the American Heart Association and the American College of Cardiology reframes excess weight as a central driver of cardiovascular-kidney-metabolic syndrome, or CKM syndrome, urging healthcare professionals to initiate earlier, prevention-focused conversations about weight and metabolic health.
The first-ever guideline for CKM syndrome identifies excess weight, particularly abdominal fat, as a key metabolic factor in the syndrome's development and progression. Nearly 9 in 10 adults in the U.S. have at least one of the conditions within CKM syndrome, which includes high blood pressure, abnormal cholesterol, high blood glucose, reduced kidney function, and excess weight, according to the associations.
As obesity rates continue to rise, the guideline underscores supporting a healthy weight and calls on clinicians to begin prevention-focused discussions with patients about how managing weight now can prevent future health problems. "In terms of CKM health, weight is not just about a number on a scale — people with the same body weight can have very different health profiles," said Chiadi E. Ndumele, M.D., Ph.D., chair of the writing committee. "Rather, what's most important is how fat tissue affects your metabolic health. This includes how your body manages blood sugar levels and how fat is used and stored."
The CKM syndrome guideline replaces the 2013 guideline for managing overweight and obesity. CKM syndrome was first defined by the American Heart Association in 2023. "CKM syndrome is a real, rising public health threat," said Ndumele, director of obesity and cardiometabolic research at Johns Hopkins University. He noted that having one condition increases the risk of having others, a common challenge in CKM syndrome.
The guideline emphasizes that maintaining a healthy weight has long been essential to heart health, but doctors don't always raise the topic of weight unless a patient brings it up, often focusing on appearance rather than health. "We are saying that prevention is as important, if not more important, than treatment," said Ambar Kulshreshtha, M.D., Ph.D., a primary care physician who helped write the guideline.
Medically, the problem with overweight or obesity arises when fat tissue accumulates in the belly and clings to organs, causing inflammation that leads to insulin resistance and vascular problems. If caught early, the disease process in CKM syndrome can be stopped or even reversed. Excess weight increases the risk of heart disease and stroke by at least 21% for men and 32% for women, and each 5-unit increase in BMI is associated with a 41% higher risk of heart failure.
Ndumele said the guideline offers ways for healthcare professionals to discuss weight non-judgmentally, starting with questions like, "Is now a good time for us to address your weight and your health and how they may be affecting each other?"
The guideline also outlines the use of increasingly effective medications that benefit multiple body systems, including SGLT2 inhibitors, GLP-1 based therapies, and nonsteroidal mineralocorticoid receptor antagonists. "We want people in the community to be more aware of the fact that, 'Hey, there's a process here,' and that if there's intervention earlier, 'I can dramatically improve my long-term outcomes,'" Ndumele said.
Additionally, the guideline emphasizes coordinating care through navigators or care coordinators to improve communication between primary care and specialty clinicians. "People with CKM syndrome don't experience one condition at a time — it often all hits at the same time," said Fatima Rodriguez, M.D., M.P.H., vice-chair of the writing committee. "The idea is that patient care is a team effort, and the patient is team captain."
The guideline also highlights identifying social barriers to healthy lifestyle and quality healthcare, providing social support as needed. In 2024, the American Heart Association launched the CKM Health Initiative to improve diagnosis and treatment for CKM syndrome.
The full guideline is available online in Circulation.
