Excess body fat, particularly around the abdomen, is no longer being viewed simply as a weight issue but as a powerful driver of heart disease, kidney disease and diabetes, according to the first-ever clinical guidelines on cardiovascular-kidney-metabolic (CKM) syndrome, released jointly by the American Heart Association and the American College of Cardiology on Tuesday.

The landmark guideline arrives at a time when obesity rates are climbing worldwide and health systems are struggling to cope with the growing burden of chronic diseases that often occur together. Experts behind the document say the goal is to encourage earlier conversations about weight and metabolic health before irreversible damage begins.

Though the term CKM syndrome remains unfamiliar to many people, its effects are already widespread. Nearly nine out of ten adults in the United States have at least one condition linked to the syndrome, including high blood pressure, abnormal cholesterol levels, elevated blood sugar, reduced kidney function, or excess weight.

“CKM syndrome is a real, rising public health threat,” said Dr Chiadi E. Ndumele, chair of the guideline writing committee and director of obesity and cardiometabolic research at Johns Hopkins University.

According to the guideline, the danger lies not merely in the number shown on a weighing scale but in how fat tissue behaves inside the body. Fat that accumulates deep within the abdomen can surround vital organs and trigger chronic inflammation. Over time, this inflammation interferes with the body's ability to use insulin effectively, damages blood vessels and puts increasing strain on the heart and kidneys.

Researchers have increasingly linked abdominal obesity to a cascade of biological changes. Studies published over the past decade have shown that inflammatory chemicals released by visceral fat contribute to insulin resistance, a condition that often precedes type 2 diabetes. These same processes are associated with a higher risk of heart attacks, strokes, and kidney failure.

“In terms of CKM health, weight is not just about a number on a scale,” Ndumele said. “People with the same body weight can have entirely unique health profiles.”

Dr Ambar Kulshreshtha, a primary care physician and guideline co-author at Emory School of Medicine, said healthcare professionals have historically hesitated to discuss weight unless patients initiated the conversation.

“We are saying that prevention is as important, if not more important, than treatment,” he said.

To explain the process to patients, Kulshreshtha compares blood vessels to household plumbing. Inflammation caused by obesity acts like rust, gradually damaging the pipes; the pump is represented by the heart; and the filters are represented by the kidneys.

The consequences can be severe. According to American Heart Association data cited in the guideline, excess weight raises the risk of heart disease and stroke by at least 21% in men and 32% in women, while every five-unit increase in body mass index is associated with a 41% higher risk of heart failure.

However, experts emphasise that early identification can often slow, stop, or even reverse the disease process. The guideline points out useful lifestyle changes and new medications like GLP-1-based therapies and SGLT2 inhibitors, which have been proven to help various parts of the body.

Another major recommendation focuses on improving coordination among healthcare providers. Patients with obesity, diabetes, kidney disease and heart disease frequently move between specialists, who may treat only one condition at a time.

“We operate from our silos,” said Dr Fatima Rodriguez, vice-chair of the writing committee and chief of preventive cardiology at Stanford University. “But people with CKM syndrome don’t experience one condition at a time — it often all hits at the same time.”

The guideline therefore recommends the greater use of care coordinators or navigators who can help connect patients, primary care doctors, and specialists while ensuring follow-up care and addressing social barriers to healthy living.

For millions of people facing obesity and related illnesses, the message from experts is simple but urgent: the pathway to heart attacks, strokes, and kidney failure often begins years earlier than symptoms appear. Identifying that connection—and acting on it early—could dramatically improve long-term health outcomes and reduce the burden of chronic diseases worldwide.