obesity presentation

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Obesity is a complex disease involving having too much body fat. Obesity isn't just a cosmetic concern. It's a medical problem that increases the risk of many other diseases and health problems. These can include heart disease, diabetes, high blood pressure, high cholesterol, liver disease, sleep apnea and certain cancers.

There are many reasons why some people have trouble losing weight. Often, obesity results from inherited, physiological and environmental factors, combined with diet, physical activity and exercise choices.

The good news is that even modest weight loss can improve or prevent the health problems associated with obesity. A healthier diet, increased physical activity and behavior changes can help you lose weight. Prescription medicines and weight-loss procedures are other options for treating obesity.

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Body mass index, known as BMI, is often used to diagnose obesity. To calculate BMI , multiply weight in pounds by 703, divide by height in inches and then divide again by height in inches. Or divide weight in kilograms by height in meters squared. There are several online calculators available that help calculate BMI .

See BMI calculator

Asians with a BMI of 23 or higher may have an increased risk of health problems.

For most people, BMI provides a reasonable estimate of body fat. However, BMI doesn't directly measure body fat. Some people, such as muscular athletes, may have a BMI in the obesity category even though they don't have excess body fat.

Many health care professionals also measure around a person's waist to help guide treatment decisions. This measurement is called a waist circumference. Weight-related health problems are more common in men with a waist circumference over 40 inches (102 centimeters). They're more common in women with a waist measurement over 35 inches (89 centimeters). Body fat percentage is another measurement that may be used during a weight loss program to track progress.

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If you're concerned about your weight or weight-related health problems, ask your health care professional about obesity management. You and your health care team can evaluate your health risks and discuss your weight-loss options.

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Although there are genetic, behavioral, metabolic and hormonal influences on body weight, obesity occurs when you take in more calories than you burn through typical daily activities and exercise. Your body stores these excess calories as fat.

In the United States, most people's diets are too high in calories — often from fast food and high-calorie beverages. People with obesity might eat more calories before feeling full, feel hungry sooner, or eat more due to stress or anxiety.

Many people who live in Western countries now have jobs that are much less physically demanding, so they don't tend to burn as many calories at work. Even daily activities use fewer calories, courtesy of conveniences such as remote controls, escalators, online shopping, and drive-through restaurants and banks.

Risk factors

Obesity often results from a combination of causes and contributing factors:

Family inheritance and influences

The genes you inherit from your parents may affect the amount of body fat you store, and where that fat is distributed. Genetics also may play a role in how efficiently your body converts food into energy, how your body regulates your appetite and how your body burns calories during exercise.

Obesity tends to run in families. That's not just because of the genes they share. Family members also tend to share similar eating and activity habits.

Lifestyle choices

• Unhealthy diet. A diet that's high in calories, lacking in fruits and vegetables, full of fast food, and laden with high-calorie beverages and oversized portions contributes to weight gain.
• Liquid calories. People can drink many calories without feeling full, especially calories from alcohol. Other high-calorie beverages, such as sugared soft drinks, can contribute to weight gain.
• Inactivity. If you have an inactive lifestyle, you can easily take in more calories every day than you burn through exercise and routine daily activities. Looking at computer, tablet and phone screens is inactivity. The number of hours spent in front of a screen is highly associated with weight gain.

Certain diseases and medications

In some people, obesity can be traced to a medical cause, such as hypothyroidism, Cushing syndrome, Prader-Willi syndrome and other conditions. Medical problems, such as arthritis, also can lead to decreased activity, which may result in weight gain.

Some medicines can lead to weight gain if you don't compensate through diet or activity. These medicines include steroids, some antidepressants, anti-seizure medicines, diabetes medicines, antipsychotic medicines and certain beta blockers.

Social and economic issues

Social and economic factors are linked to obesity. It's hard to avoid obesity if you don't have safe areas to walk or exercise. You may not have learned healthy ways of cooking. Or you may not have access to healthier foods. Also, the people you spend time with may influence your weight. You're more likely to develop obesity if you have friends or relatives with obesity.

Obesity can occur at any age, even in young children. But as you age, hormonal changes and a less active lifestyle increase your risk of obesity. The amount of muscle in your body also tends to decrease with age. Lower muscle mass often leads to a decrease in metabolism. These changes also reduce calorie needs and can make it harder to keep off excess weight. If you don't consciously control what you eat and become more physically active as you age, you'll likely gain weight.

Other factors

• Pregnancy. Weight gain is common during pregnancy. Some women find this weight difficult to lose after the baby is born. This weight gain may contribute to the development of obesity in women.
• Quitting smoking. Quitting smoking is often associated with weight gain. And for some, it can lead to enough weight gain to qualify as obesity. Often, this happens as people use food to cope with smoking withdrawal. But overall, quitting smoking is still a greater benefit to your health than is continuing to smoke. Your health care team can help you prevent weight gain after quitting smoking.
• Lack of sleep. Not getting enough sleep can cause changes in hormones that increase appetite. So can getting too much sleep. You also may crave foods high in calories and carbohydrates, which can contribute to weight gain.
• Stress. Many external factors that affect mood and well-being may contribute to obesity. People often seek more high-calorie food during stressful situations.
• Microbiome. The make-up of your gut bacteria is affected by what you eat and may contribute to weight gain or trouble losing weight.

Even if you have one or more of these risk factors, it doesn't mean that you're destined to develop obesity. You can counteract most risk factors through diet, physical activity and exercise. Behavior changes, medicines and procedures for obesity also can help.

Complications

People with obesity are more likely to develop a number of potentially serious health problems, including:

• Heart disease and strokes. Obesity makes you more likely to have high blood pressure and unhealthy cholesterol levels, which are risk factors for heart disease and strokes.
• Type 2 diabetes. Obesity can affect the way the body uses insulin to control blood sugar levels. This raises the risk of insulin resistance and diabetes.
• Certain cancers. Obesity may increase the risk of cancer of the uterus, cervix, endometrium, ovary, breast, colon, rectum, esophagus, liver, gallbladder, pancreas, kidney and prostate.
• Digestive problems. Obesity increases the likelihood of developing heartburn, gallbladder disease and liver problems.
• Sleep apnea. People with obesity are more likely to have sleep apnea, a potentially serious disorder in which breathing repeatedly stops and starts during sleep.
• Osteoarthritis. Obesity increases the stress placed on weight-bearing joints. It also promotes inflammation, which includes swelling, pain and a feeling of heat within the body. These factors may lead to complications such as osteoarthritis.
• Fatty liver disease. Obesity increases the risk of fatty liver disease, a condition that happens due to excessive fat deposit in the liver. In some cases, this can lead to serious liver damage, known as liver cirrhosis.
• Severe COVID-19 symptoms. Obesity increases the risk of developing severe symptoms if you become infected with the virus that causes coronavirus disease 2019, known as COVID-19. People who have severe cases of COVID-19 may need treatment in intensive care units or even mechanical assistance to breathe.

Related information

• Link between extra pounds, severe COVID-19 illness grows stronger - Related information Link between extra pounds, severe COVID-19 illness grows stronger

Quality of life

Obesity can diminish the overall quality of life. You may not be able to do physical activities that you used to enjoy. You may avoid public places. People with obesity may even encounter discrimination.

Other weight-related issues that may affect your quality of life include:

• Depression.
• Disability.
• Shame and guilt.
• Social isolation.
• Lower work achievement.
• Overweight and obesity. National Heart, Lung, and Blood Institute. https://www.nhlbi.nih.gov/health-topics/overweight-and-obesity. Accessed Dec. 21, 2022.
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• BMI and waist circumference calculator

Associated Procedures

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• Cholesterol test
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The National Heart, Lung, and Blood Institute, in cooperation with the National Institute of Diabetes and Digestive and Kidney Diseases, released in June 1998 the first Federal guidelines on the identification, evaluation, and treatment of overweight and obesity in adults. About 108 million adults in the United States are overweight or obese. Obesity and overweight substantially increase the risk of morbidity from hypertension; dyslipidemia; type 2 diabetes; coronary heart disease; stroke; gallbladder disease; osteoarthritis; sleep apnea and respiratory problems; and endometrial, breast, prostate, and colon cancers. Higher body weights are also associated with increases in all-cause mortality.

The Clinical Guidelines Evidence Report has been made into a slide show. This slide show consists of six sections: Clinical Guidelines Core Set, Evidence-Based Methodology, Background Data, Practical Tips, Special Considerations, and Future Research. Presenters will be able to focus their presentation accordingly.

The slide set consists of six parts including:

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• Review Article
• Published: 07 May 2024

Epidemiology and Population Health

Obesity: a 100 year perspective

• George A. Bray   ORCID: orcid.org/0000-0001-9945-8772 1  

International Journal of Obesity ( 2024 ) Cite this article

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This review has examined the scientific basis for our current understanding of obesity that has developed over the past 100 plus years. Obesity was defined as an excess of body fat. Methods of establishing population and individual changes in levels of excess fat are discussed. Fat cells are important storage site for excess nutrients and their size and number affect the response to insulin and other hormones. Obesity as a reflection of a positive fat balance is influenced by a number of genetic and environmental factors and phenotypes of obesity can be developed from several perspectives, some of which have been elaborated here. Food intake is essential for maintenance of human health and for the storage of fat, both in normal amounts and in obesity in excess amounts. Treatment approaches have taken several forms. There have been numerous diets, behavioral approaches, along with the development of medications.. Bariatric/metabolic surgery provides the standard for successful weight loss and has been shown to have important effects on future health. Because so many people are classified with obesity, the problem has taken on important public health dimensions. In addition to the scientific background, obesity through publications and organizations has developed its own identity. While studying the problem of obesity this reviewer developed several aphorisms about the problem that are elaborated in the final section of this paper.

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Adult Obesity Prevalence Maps

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By Education and Age

Map: overall obesity, maps: obesity by race/ethnicity, related information.

The CDC 2022 Adult Obesity Prevalence Maps for 50 states, the District of Columbia, and 3 US territories show the proportion of adults with a body mass index (BMI) equal to or greater than 30 ( ≥30 kg/m 2 ) based on self-reported weight and height. Data are presented by race, ethnicity, and location. The data come from the Behavioral Risk Factor Surveillance System , an ongoing state-based, telephone interview survey conducted by CDC and state health departments.

The 2022 maps show that obesity impacts some groups more than others. There are notable differences by race and ethnicity, as shown by combined data from 2020–2022.

Among geographic groups (states, territories, or DC) with enough data, the number with an adult obesity prevalence of 35% or higher, by race/ethnicity, is:

• Non-Hispanic Asian adults: 0 (among 37 states, 1 territory, and DC)
• Non-Hispanic White adults: 14 (among 49 states, 1 territory, and DC)

See CDC PLACES  for community-level data.

• Non-Hispanic American Indian or Alaska Native adults: 33 (among 47 states)
• Non-Hispanic Blacks: 38 (among 48 states and DC)
• Obesity prevalence decreased as level of education increased. Adults without a high school diploma or equivalent had the highest prevalence of obesity (37.6%), followed by adults with some college education (35.9%) or high school graduates (35.7%), and then by college graduates (27.2%).
• Young adults were half as likely to have obesity as middle-aged adults. Adults aged 18–24 had the lowest prevalence of obesity (20.5%) compared to adults aged 45–54, who had the highest prevalence (39.9%).

Across States and Territories

• All states and territories had an obesity prevalence higher than 20% (more than 1 in 5 adults).
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• 19 states had an obesity prevalence between 35% and less than 40%.
• 3 states (Louisiana, Oklahoma, and West Virginia) had an obesity prevalence of 40% or greater.
• The Midwest (35.8%) and South (35.6%) had the highest prevalence of obesity, followed by the Northeast (30.5%), and the West (29.5%).

For adults aged 20 years and older, BMI categories are defined the same regardless of sex or age.

We encourage the use of person-first language (e.g., “adults with obesity” or “20% of children ages 12–19 have obesity” and not “obese adults” nor “20% of children are obese”) when discussing topics like obesity and other chronic diseases, as well as respectful images.

The Obesity Action Coalition has more information – please see the Guidelines for Media Portrayals of Individuals Affected by Obesity [PDF-1.72MB] .

Prevalence † of Obesity Based on Self-Reported Weight and Height Among U.S. Adults by State and Territory, BRFSS, 2022

Source: Behavioral Risk Factor Surveillance System *Sample size <50, the relative standard error (dividing the standard error by the prevalence) ≥30%, or no data in a specific year.

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TABLE: Prevalence of Obesity Based on Self-Reported Weight and Height by State and Territory, BRFSS, 2022

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Prevalence of obesity based on self-reported weight and height among non-hispanic asian adults by state and territory, brfss, 2020–2022, table: prevalence of obesity based on self-reported weight and height among non-hispanic asian adults by state and territory, brfss, 2020–2022.

*Sample size <50, the relative standard error (dividing the standard error by the prevalence) ≥30%, or no data in a specific year.

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Prevalence of obesity based on self-reported weight and height among non-hispanic white adults by state and territory, brfss, 2020–2022, table: prevalence of obesity based on self-reported weight and height among non-hispanic white adults by state and territory, brfss, 2020–2022, hispanic adults, prevalence of obesity based on self-reported weight and height among hispanic adults by state and territory, brfss, 2020–2022.

Source:   Behavioral Risk Factor Surveillance System *Sample size <50 or the relative standard error (dividing the standard error by the prevalence) ≥30%, or no data in a specific year.

TABLE: Prevalence of Obesity Based on Self-Reported Weight and Height Among Hispanic Adults by State and Territory, BRFSS, 2020–2022

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Prevalence of obesity based on self-reported weight and height among non-hispanic american indian or alaska native adult by state and territory, brfss, 2020–2022, table: prevalence of obesity based on self-reported weight and height among non-hispanic american indian or alaska native adults, by state and territory, brfss, 2020–2022.

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Non-Hispanic Black Adults

Prevalence of obesity based on self-reported weight and height among non-hispanic black adults by state and territory, brfss, 2020–2022, table: prevalence of obesity based on self-reported weight and height among non-hispanic black adults by state and territory, brfss, 2020–2022, media statement.

Read the 2023 Media Statement about the Adult Obesity Prevalence Maps.

PLACES: Local Data for Better Health

Model-based population-level analysis and community estimates on obesity and other chronic disease factors for counties, census tracts, and ZIP Code Tabulation Areas (ZCTAs) across the United States.

Data, Trends, and Maps

CDC’s Data, Trends, and Maps Interactive Tool  provides additional state and territory adult obesity prevalence estimates.

Updated Adult Obesity Maps by State and Territory, 2011-2022

• Powerpoint slides  [PDF-2.44MB] .
• Acrobat file  [PDF-1.99MB] .

Updated Adult Race/Ethnicity Obesity Maps by State and Territory, 2020-2022

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• Acrobat file [PDF-1.28MB] .

Historical: Maps of Adult Obesity by State and Territory, 1985–2010*

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Historical: Maps of Adult Race/Ethnicity Obesity by State and Territory, 2011-2021*

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• Acrobat file [PDF-4.70MB] .

*The historical maps from 1985-2010 cannot be compared to maps from 2011-2022 because data analysis methodology changed in 2011. Like all public health public health surveillance systems,  BRFSS  must occasionally change its methods to adapt to the changing world and to maintain validity.

Citiation: Adult Obesity Prevalence Maps . Centers for Disease Control and Prevention. National Center for Chronic Disease Prevention and Health Promotion, Division of Nutrition, Physical Activity, and Obesity.  (21 September 2023).

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Dr. SUPANTHA CHATTERJEE PGT DEPT. OF COMMUNITY MEDICINE BURDWAN MEDICAL COLLEGE. OBESITY. DEFINITION. IT IS THE ABNORMAL GROWTH OF THE ADIPOSE TISSUE DUE TO AN ENLARGEMENT OF FAT CELL SIZE OR AN INCREASE IN FAT CELL NUMBER OR A COMBINATION OF BOTH.

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• unexplained variations
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• brocca index

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Dr. SUPANTHA CHATTERJEE PGT DEPT. OF COMMUNITY MEDICINE BURDWAN MEDICAL COLLEGE OBESITY

DEFINITION • IT IS THE ABNORMAL GROWTH OF THE ADIPOSE TISSUE DUE TO AN ENLARGEMENT OF FAT CELL SIZE OR AN INCREASE IN FAT CELL NUMBER OR A COMBINATION OF BOTH. • ENLARGEMENT OF FAT CELL SIZE – HYPERTROPHIC • INCREASE IN FAT CELL NUMBER – HYPERPLASTIC

PREVALENCE • Perhaps the most prevalent form of malnutrition in present days, affecting children as well as adult. • Prevalent in both developed and developing countries. • It is estimated by the WHO that globally, over 1 billion (16%) adults are overweight and 300 million (5%) are obese. • In India the prevalence of obesity is 12.6% in women and 9.3% in men.

EPIDEMIOLOGICAL DETERMINANTS Non-modifiable • Age: • It can occur at any age • The vulnerability is maximum in the middle age • Infants with excessive weight gain have increased chance of obesity in later life. • Gender: • Females are more likely to be obese • Women gain weight most at menopausal period (45-49 yrs) • It is claimed that women’s BMI increases with successive pregnancies.

Genetic factors: • Twin studies show that there is a close correlation between the weights of identical twin. • Ethnicity: • There are large unexplained variations in the prevalence of obesity in the people from different ethnic groups.

Modifiable • Physical Inactivity: • Avital component that keeps accumulation of fat and obesity under check. • Sedentary lifestyle brings about obesity. • Amajor reduction in activity without the compensatory decrease in energy intake causes increased obesity. • Physical inactivity and obesity – a vicious cycle. • Socio-economic status: • There is a clear inverse relationship between socio-economic status and obesity.

Dietary habit: • A diet rich in fats, refined sugar and carbohydrates predisposes to obesity. • Consumption of as little as 100 extra calories per day would increase the weight of an individual by 5 kg in one year. • Psychological factor: • Overeating may be a symptom of depression, anxiety, frustration and loneliness in childhood.

Family tendency: • Obese parents frequently have obese children. • Metabolic factors: • Cushing’s syndrome, hypothyroidism, growth hormone deficiency. • Alcohol: • High calorific value (7kcal per gm.) in itself is a risk factor for obesity. • The snacks consumed along with an alcoholic drink add many more calories and predisposing the individual to obesity.

Education levels : • In the Indian setting, people with a higher education level, are more likely to be obese. • In the west, however, the educated are in a better state of health i.e. less obesity. • Smoking: • Smoking per se reduces the likelihood of obesity, by virtue of nicotine being an anorexic agent. • Drugs: • Use of certain drugs e.g. corticosteroid, oral contraceptives, insulin

TYPES OF OBESITY • Gynecoid / ‘Pear shaped’: • The fat is evenly distributed (globally distributed). • Android/‘Apple shaped’: • The fat is centrally distributed or deposited preferentially in the abdominal region. • This expresses the peritoneal (visceral) distribution of fat in the individual. • Commonly seen in men of the South East Asian region, including India. • Such a distribution is a higher risk factor for coronary artery disease. • Higherwaist circumference or higher WHR is a good indicator of visceral (peritoneal) deposition of fat.

CLASSIFICATION OF OBESITY

GRADES OF OBESITY FOR SOUTH-EAST ASIANS REGION

ASSESSMENT OF OBESITY • BODY WEIGHT : In epidemiological studies it is conventional to accept +2SD from the median weight for height as a cut off point of obesity.

SOME INDICATORS TO MEASURE OBESITY • BODY MASS INDEX (BMI) • PONDERAL INDEX • BROCCA INDEX • LORENTZ’S FORMULA • CORPULENCE INDEX

Body mass index (BMI): • Weight in kilograms divided by the square of the height in meters (kg/m²) Weight in kg • BMI = ---------------------------------------- Height in meter² Example : Weight = 74 kg Height = 1.75 meter 74 BMI = ------------ = 24.2 1.75²

Height (cm) • Ponderal index = ----------------------------------------------- Cube root of body weight (kg) • Brocca index = Height (cm) - 100 Ht (cm) - 150 • Lorentz’s formula = Ht (cm) – 100 - ------------------------------ 2(women) /4(men) Actual weight • Corpulence index = ------------------------------------- Desirable weight

SKINFOLD THICKNESS • Rapid and noninvasive method • Harpenden skin callipers are used • Measurement at four sites – mid-triceps, biceps, subscapular and suprailiac regions • Sum of the measurement should be – • <40 mm in boys • <50 mm in girls • Main drawback – Poor repeatability

WAIST CIRCUMFERENCE AND WAIST : HIP RATIO (WHR) • Unrelated to height • Approximate index for intra-abdominal fat mass and total body fat. • Reflects changes in risk factors for cardiovascular diseases and other chronic diseases. • Indicates increased risk for metabolic complications if the waist circumference – • ≥ 102 cm in men • ≥ 88 cm in women • Indicates abdominal fat accumulation if WHR – • > 1.0 in men • > 0.85 in women

METHODS USED IN DETERMINING OBESITY IN CHILDREN WEIGHT TO HEIGHT TABLES – • Indian Council of Medical Research gives general ranges for healthy weight for a child's height. • However, the child’s age and growth pattern also has to be considered. • Generally a child is considered obese if the weight is 20 percent or more what is recommended as healthy range for the height and body type.

BODY MASS INDEX – • This measure is used to assess weight relative to height. Most of the studies use BMI as a measure of obesity in children. The Centers of Disease Control and Prevention suggests two levels of concern for children based on the BMI-for-age charts. A child with a BMI of • ≥85th percentile for age and sex is considered at risk of being overweight • ≥95th percentile for age and sex is considered obese.

RELATIVE RISK OF HEALTH PROBLEMS ASSOCIATED WITH OBESITY

Prevention and control Indicated prevention • Individuals who are already overweight or showing biological markers associated with excessive fat stores but who are not yet obese. • Indicated prevention strategies usually involve working with patients on a one-to-one basis or, alternatively, through the establishment of special groups to provide guidance and support. • Primary objectives of this preventive strategy are restricted to preventing further weight gain and reducing the number of people who develop obesity-related comorbidities.

Selective prevention • Aimed at sub-groups of the population who are at a high risk for the development of obesity. • Selective prevention is concerned with improving the knowledge and skills of groups of people to allow them to deal more effectively with the factors which put them at a high risk of developing obesity.

High risk groups - • Genetically susceptible individuals, certain ethnic groups, socially or economically disadvantaged, Recent successful weight reducers, Recent past smokers, Patients who have been prescribed certain drugs that, promote weight gain Vulnerable period – • Adolescence, Early adulthood, Pregnancy, Menopause

Universal or public health prevention • Population or community as a whole regardless of their current level of risk. • Where the prevalence of the condition is already extremely high, universal approaches have the potential to be the most cost effective form of prevention, to reduce the incidence as well as the prevalence of obesity. • Other objectives of universal prevention include a reduction in weight-related ill health, improvements in general diet and exercise levels and a reduction in the level of population risk of obesity.

WAYS TO PREVENT OBESITY DIETARY THERAPY • Restrictions of calories represent the first line therapy in all cases • Low calorie diets (LCD), which provide 1000–1500 kcal/day, resulted in weight loss of 8% of baseline body weight over six months • Very low calories diets (VLCD), which provide 300–800 kcal/day, can be useful in severely obese patients . They are found to produce 13% weight loss over six months. • Meal replacement programmes and formula diets can be used as an effective tool in weight management. • Fat substitutes like Olestra (Olean), which is a non-digestible, non-caloric fat, can be used in food preparations taken by obese patients.

PHYSICAL ACTIVITY • Physical activity, which increases energy expenditure, has a positive role in reducing fat storage and adjusting energy balance in obese patients. • Various exercises preceded and followed by short warm up and cool down sessions help to decrease abdominal fat, prevent loss of muscle mass. • Patients who exercise regularly had increased cardio vascular fitness along with betterment in their mental and emotional status. • Aminimum of 30 minutes exercise is recommended for people of all ages as part of comprehensive weight loss therapy.

BEHAVIOUR THERAPY • Patients need to be trained in gaining self-control of their eating habits. • Behaviour modification programmes which seek to eliminate improper eating behaviour include individual or group counseling of patients. • Self-help groups (weight watchers) use a program of diet, education and self-monitoring like maintenance of logbook, keeping an account of food intake etc. are beneficial.

OTHER MEASURES • Appetite suppressing drugs can be used. • Surgical treatment for controlling obesity e.g. gastric bypass, gastroplasty, jaw wiring, liposuction etc. • Take appropriate measures to prevent childhood obesity • Health education

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StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.

StatPearls [Internet].

Pathophysiology of obesity.

Deepesh Khanna ; Brian S. Welch ; Anis Rehman .

Affiliations

Last Update: October 20, 2022 .

• Continuing Education Activity

Obesity is a chronic disease having a major public health concern. Obesity is a mild state of chronic inflammation of adipose tissue and a state of malnutrition by excess, which leads to a defective hormonal and immune system. This activity reviews the pathophysiology of obesity, inflammatory markers secreted by excessive fat deposition in adipose tissue, and their effects on chronic diseases such as hypertension, diabetes, and dyslipidemia.

• Describe obesity as a mild state of chronic inflammation of adipose tissue.
• Explain the role of inflammatory markers released by adipose tissue in worsening chronic conditions such as hypertension, diabetes, and dyslipidemia.
• Describe obesity in light of hormonal considerations and as an immune disease.
• Explain the role of the interprofessional team in managing patients with obesity.
• Introduction

Obesity is one of the most common preventable diseases. [1] [2]  It is a major public health concern. Obesity has a multifactorial etiology that includes genetic, environmental, socioeconomic, and behavioral or psychological influences. [3]  Obesity results from a chronic positive energy balance regulated by a complex interaction between endocrine tissues and the central nervous system. [4]  

Obesity measurement can also be used to estimate morbidity and mortality. Body mass index (BMI) has been used to screen overweight and obese individuals. However, waist circumference is the best anthropometric indicator of visceral fat and a better predictor of metabolic disorders such as diabetes, hypertension, and dyslipidemia. [5]  People with a normal BMI with a large waist are at higher risk. However, combining BMI and waist circumference adds relatively less risk prediction since they are collinear in nature. Furthermore, hip circumference is inversely related to metabolic syndrome. Large hip circumference is related to lower risks of diabetes and coronary heart disease. This is probably due to having a large muscle mass in the hip region. [5]  

Compared to the Body Mass Index (BMI), the Visceral Adiposity Index (VAI) is a more specific and sensitive examination tool. The VAI is, therefore, a reliable indicator of increased patient risk for cardiometabolic diseases. [6] [7]  There is currently a lack of scientific knowledge regarding the biochemical and physiologic mechanisms associated with this. A possible explanation for the increased specificity and sensitivity of the VAI is that visceral fat has direct access to the portal venous system, whereas subcutaneous white adipose tissue does not. [8]

Obesity has inflammatory components, directly and indirectly, related to major chronic diseases such as diabetes, atherosclerosis, hypertension, and several types of cancer. [9] [10]  Overweight and obese individuals have altered circulatory levels of inflammatory cytokines, such as IL-6, TNFα, C-reactive protein (CRP), IL-18, resistin, and visfatin. [11] [12]  Measures of body fat have a stronger correlation with inflammatory markers than BMI. [13] [1] . Exercise and dietary restrictions have been strongly advocated to reduce weight gain and its related complications. Caloric restriction has been proven effective in reducing inflammation in obesity. [14] [15]  However, a few studies showed that dietary weight loss has less impact on a long-term anti-inflammatory intervention. [16]  On the other hand, regular exercise significantly affects chronic inflammation related to obesity and obesity-associated conditions such as hypertension, diabetes, dyslipidemia, etc. [16]

It is well-documented that obesity and its inflammatory markers have significant effects on hypertension, diabetes, and other chronic conditions. This review provides detailed insight into chronic inflammation, immune and hormonal disturbance related to the pathophysiology of obesity and their effects on chronic conditions.

• Issues of Concern

Obesity: An immune Disease?

Obesity is a state of malnutrition by excess that leads to defective immune function. Excess body fat is associated with changes in leukocyte count such as monocyte, lymphocyte, and neutrophil counts but lower B- and T-cell mitogen-induced proliferation. [17]  Based on current research, it is too early to say that an altered immune system underlies the onset of obesity. Most of the studies showed that immune dysfunction involves obesity-associated alterations like inflammation and insulin resistance. Macrophages aggregates grew larger with increasing degree of obesity, similar to those observed in other inflammatory conditions, led to the idea that macrophages aggregate could explain the obesity-related inflammatory state to a certain extent. [18]  

There are two types of phenotypic macrophages described that have been related to obesity: M1 (classically activated) acts as pro-inflammatory, and M2 (alternatively activated) acts as an anti-inflammatory. In obesity, there is a switch from M2 to M1 phenotype, which is pro-inflammatory. [19]  Furthermore, most of the research findings showed the lack of M2 phenotype correlated to obesity and inflammation. [20]

Obesity and Inflammatory Markers

Obesity is also referred to as chronic-low grade inflammation or “metabolic inflammation,” which is often the focus in the pathogenesis of several diseases such as coronary artery disease, atherosclerosis, and insulin resistance, etc. [21] [22]  Adipose tissue is classified as a complex secretory organ that plays many roles in metabolism. It can modulate energy expenditure, appetite, insulin sensitivity, bone metabolism, reproductive and endocrine functions, inflammation, and immunity and act as a triacylglycerol reservoir. Visceral adiposity correlates well with an increased risk of CVD and diabetes compared to a high body mass index (BMI). [23] [24]  However, the biochemical and physiologic reasons for having a better correlation of visceral adiposity are still unclear. One possible explanation is that visceral fat has direct access to the portal circulation compared to subcutaneous white adipose tissue, leading to the substances produced by visceral fat directly affecting the liver. 

Adipocytes produce and secrete several proteins called adipokines which play important roles in inflammation. These adipokines include TNF-α, leptin, resistin, visfatin, IL-6, and adiponectin. [25]  There are over 50 known adipokines in existence, and they are primarily differentiated by their roles in inflammation. A discrepancy in adipokine secretion has been noted in individuals depending on their BMI; obese individuals have adipose tissue that mainly secretes pro-inflammatory adipokines, while lean individuals secrete anti-inflammatory adipokines. Adipokines implicated in the promotion of inflammation include TNFs, interleukin (IL)- 6, leptin, angiotensin II, visfatin, and resistin. [26] [27]  Anti-inflammatory adipokines include transforming growth factor-beta (TGF), IL- 4, IL- 10, IL- 13, IL- 1 receptor antagonist (IL- 1Ra), and adiponectin. [28]  

The role of increased pro-inflammatory cytokine secretion in obese patients is currently unknown. It is speculated that the answer to this question is correlated with the enlarged, lipid-rich adipocytes seen in obese individuals. Physiological processes likely exist within the adipose cells that allow for the maintenance and restoration of energy homeostasis in the occurrence of an overwhelmingly large introduction of nutrients. A regulatory mechanism should exist in which the local production of certain adipokines limits the hypertrophied adipocyte(s) from storing excess lipids. [29]  The issue arises when this locally occurring instance progresses to systemic, chronic pathology. In sustained obesity cases, an inflammatory response is not sufficient to resolve the ongoing issue. There is a lack of scientific knowledge regarding the physiological and biochemical processes associated with obesity and chronic low-grade inflammation.

Role of Hormones in Obesity

Several studies suggest adipose tissue can collectively secrete more than 50 hormones and signaling molecules termed adipokines. These adipokines play a vital role in immunity and glucose metabolism. [30]  The adipose tissue of a lean individual secretes anti-inflammatory adipokines such as transforming growth factor-beta (TGF-beta), interleukins (IL)-10, IL-4, IL-13, IL-1 receptor antagonist (IL-1Ra), adiponectin, and apelin. In contrast, the adipose tissue of an obese individual secretes mainly pro-inflammatory cytokines such as TNFs, IL-6, resistin, visfatin, leptin, angiotensin II, and plasminogen activator inhibitor-1. [31]

Leptin, a hormone that plays a role in appetite and energy balance regulation, along with pro-inflammatory cytokines, such as tumor necrosis factor-alpha (TNF-alpha), are secreted by adipose tissue cells. [32]  Leptin is secreted in proportion to the amount of fat stored in adipose tissue. Another hormone secreted by adipose tissue is adiponectin, which decreased in proportion to fat storage in the body. [33]  

Both leptin and adiponectin are associated with the cardiovascular risk profile. The ratio of leptin and adiponectin has been associated with adipose tissue malfunction. Another hormone secreted by adipose tissue is resistin, a pro-inflammatory adipokine characterized as an insulin antagonist. [34]  One study showed that resistin exists in a higher concentration in obese diabetic mice versus those that are lean and not diabetic. [35]  Previously conducted studies have demonstrated that exogenously administered resistin translates to an increase in the endogenous production of glucose in rodents and an increased amount of overall plasma glucose. [36] [37]  

A key difference in resistin production in different species is that humans produce adipokine by only mononuclear cells, such as macrophages and peripheral blood mononuclear cells. In rodents, resistin production can come from both macrophages and adipocytes. [37]  Fukuhara et al. identified a new novel adipose tissue cytokine called visfatin. [38] This cytokine is a protein mediator secreted by fat cells (high levels of expression in visceral fat cells), which acts like the enzyme nicotinamide phosphoribosyltransferase (Nampt), which is involved in the NAD+ salvage pathway. Initially, it was identified as a Pre- B cell Colony Enhancing Factor (PBEF) secreted by human peripheral blood lymphocytes. [39]  Visfatin has an insulin-mimetic effect originally discovered in the liver, skeletal muscle, and bone marrow as a growth factor for B lymphocyte precursors. [40]  

The concentration of visfatin in circulation is positively correlated with the amount of white adipose tissue (WAT). There are a number of other hormones and cytokines produced by adipose tissue. We still do not know the role of increased cytokine production in obesity. We can only speculate that there must be mechanisms operating within and from the adipose cell to maintain or restore energy homeostasis in a situation of excessive energy storage. There should be a regulatory mechanism constituted by the local production of these cytokines to stop lipid-loaded adipocytes from storing more lipids. The problem arises when this becomes a systemic chronic state from a local reaction when the inflammatory response cannot be resolved due to sustained obesity. The mechanisms between obesity and chronic inflammation are not completely understood, but different likely explanations have been proposed.

• Clinical Significance

Multiple organ systems maintain metabolic homeostasis. Adipose tissue and muscles are a few of them. Adipocytes secrete hormones/chemicals known as adipokines which act on multiple cells or organs to regulate metabolism. Further research needs to be done to understand better the concentrations of these hormones in different populations, including elderly and overweight/obese people, and the role these hormones play in obesity.

It is also important to understand how lifestyle choices such as dietary intervention, regular exercise (aerobic or resistance), supplementation, or combination of any of these affect adipokines/hormones concentrations so there is a better insight into their regulation and pathophysiology.

• Enhancing Healthcare Team Outcomes

Having a better understanding of the pathophysiology of obesity is important to all the health professionals involved in curbing obesity. To manage and prevent obesity requires an interprofessional healthcare team to be involved in patient management, such as physicians, nurses, nutritionists, dieticians, and exercise physiologists.

As is known, obesity is an autoimmune disease and a chronic low-grade inflammation, and the inflammatory markers secreted by adipose tissue in an obese person lead to other chronic diseases such as hypertension, diabetes, dyslipidemia, and cancer or worsen them, prevention is better than cure. To prevent obesity, the interprofessional team needs to educate patients regarding diet and exercise as a lifestyle change. To make it happen, every interprofessional team member, including clinicians, mid-level practitioners, nurses, dieticians, and pharmacists, needs to understand the pathophysiology of obesity and its consequences to contribute from their specialties and drive better patient outcomes. [Level 5]

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Disclosure: Deepesh Khanna declares no relevant financial relationships with ineligible companies.

Disclosure: Brian Welch declares no relevant financial relationships with ineligible companies.

Disclosure: Anis Rehman declares no relevant financial relationships with ineligible companies.

This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ), which permits others to distribute the work, provided that the article is not altered or used commercially. You are not required to obtain permission to distribute this article, provided that you credit the author and journal.

• Cite this Page Khanna D, Welch BS, Rehman A. Pathophysiology of Obesity. [Updated 2022 Oct 20]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.

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Fact Check Team: Study finds majority of Americans at risk of a heart condition

by COURTNEY RAU AND KONNER MCINTIRE | The National Desk

WASHINGTON (TND) — A new study published in the Journal of the American Medical Association found that a majority of American adults are at risk of developing heart disease.

The condition behind the risk is called cardiovascular-kidney metabolic (CKM) syndrome, which is the overlap of cardiovascular disease, kidney disease, type 2 diabetes and obesity. According to the study, 90% of adults over the age of 20 may have it, which puts them at risk of developing heart diseases like stroke, heart attack or heart failure.

There are five stages of the condition: zero through four. Stage 0 means no risk at all, while Stage 4 is the highest risk.

• 10.6% met the criteria for stage 0 (no risk for heart disease)
• 26% met the criteria for stage 1 (excess body fat, higher than normal blood pressure)
• 49% met the criteria for stage 2 (type 2 diabetes, high cholesterol, high blood pressure)
• 5% met the criteria for stage 3 (issues with heart and blood vessels)
• 9% met the criteria for stage 4 (signs of heart disease, heart failure, stroke or atrial fibrillation, kidney failure)

The study found that people over the age of 65 were more likely to be at an advanced stage of the condition than people between the ages of 45 and 64. Surprisingly, being young was not as protective as one would expect. Only 18% of people ages 20 to 44 fell into the Stage 0 category.

Scientists are exploring ways to reduce the risk of heart disease and discovered that weight loss drugs can have an impact on heart health.

An ingredient called Semaglutide is used in weight loss injections like Ozempic and Wegovy, and it could help lower the risk of heart attacks and strokes, according to the results of a five-year trial. The trial was funded by Novo Nordisk, which is the company that makes those weight loss drugs.

The trial found that patients taking Semaglutide had a 20% lower risk of heart attack, stroke or death due to heart disease after three years of treatment and was the first to show Wegovy – which has a higher dose of Semaglutide than Ozempic – also lowers the risk, even for people that do not have diabetes.

Access, however, is an issue. The drug costs over $1,300 for a 28-day supply, which is usually only covered by insurance if it is used to treat diabetes. In late March, the Centers for Medicare and Medicaid Services issued new guidance saying Medicare Part D plans can start covering anti-obesity drugs if they have FDA approval for an additional benefit like heart health.

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