The obesity epidemic: pathophysiology and consequences of obesity.

Obesity has reached epidemic proportions in the United States: more than 20% of adults are clinically obese as defined by a body mass index of 30 kg/m(2) or higher, and an additional 30% are overweight. Environmental, behavioral, and genetic factors have been shown to contribute to the development of obesity. Elevated body mass index, particularly caused by abdominal or upper-body obesity, has been associated with a number of diseases and metabolic abnormalities, many of which have high morbidity and mortality. These include hyperinsulinemia, insulin resistance, type 2 diabetes, hypertension, dyslipidemia, coronary heart disease, gallbladder disease, and certain malignancies. This underscores the importance of identifying people at risk for obesity and its related disease states.

[1]  E. Ravussin,et al.  3 Energy and macronutrient metabolism , 1994 .

[2]  T. Lakka,et al.  Abdominal obesity is associated with increased risk of acute coronary events in men. , 2002, European heart journal.

[3]  B V Howard,et al.  Reduced rate of energy expenditure as a risk factor for body-weight gain. , 1988, The New England journal of medicine.

[4]  Y. Z. Ider,et al.  Quantitative estimation of insulin sensitivity. , 1979, The American journal of physiology.

[5]  J. Després,et al.  7 Dyslipidaemia and obesity , 1994 .

[6]  R. Bergman,et al.  Quantification of the Relationship Between Insulin Sensitivity and β-Cell Function in Human Subjects: Evidence for a Hyperbolic Function , 1993, Diabetes.

[7]  D A Schoeller,et al.  Balancing energy expenditure and body weight. , 1998, The American journal of clinical nutrition.

[8]  P. Björntorp,et al.  The Influence of Body Fat Distribution on the Incidence of Diabetes Mellitus: 13.5 Years of Follow-up of the Participants in the Study of Men Born in 1913 , 1985, Diabetes.

[9]  A. Mokdad,et al.  The spread of the obesity epidemic in the United States, 1991-1998. , 1999, JAMA.

[10]  L. Garfinkel,et al.  Variations in mortality by weight among 750,000 men and women. , 1979, Journal of chronic diseases.

[11]  W. Rosner,et al.  Plasma free and non-sex-hormone-binding-globulin-bound testosterone are decreased in obese men in proportion to their degree of obesity. , 1990, The Journal of clinical endocrinology and metabolism.

[12]  A. Stunkard,et al.  Weights of parents and infants: Is there a relationship? , 1999, International Journal of Obesity.

[13]  L. Groop,et al.  Effect of insulin on oxidative and nonoxidative pathways of free fatty acid metabolism in human obesity. , 1992, The American journal of physiology.

[14]  G. Dagenais,et al.  Hyperinsulinemia as an independent risk factor for ischemic heart disease. , 1996, The New England journal of medicine.

[15]  A. Stunkard.  The Salmon lecture. Some perspectives on human obesity: its causes. , 1988, Bulletin of the New York Academy of Medicine.

[16]  Després Jp.  Abdominal obesity as important component of insulin-resistance syndrome. , 1993, Nutrition.

[17]  G A Colditz,et al.  Obesity, Fat Distribution, and Weight Gain as Risk Factors for Clinical Diabetes in Men , 1994, Diabetes Care.

[18]  A. Fontbonne,et al.  Insulin and Cardiovascular Disease: Paris Prospective Study , 1991, Diabetes Care.

[19]  P. Björntorp,et al.  Abdominal adipose tissue distribution, obesity, and risk of cardiovascular disease and death: 13 year follow up of participants in the study of men born in 1913. , 1984, British medical journal.

[20]  A. Rimm,et al.  The association of girth measurements with disease in 32,856 women. , 1984, American journal of epidemiology.

[21]  J. Christman,et al.  Hypertension and type 2 diabetes comorbidity in adults in the United States: risk of overall and regional adiposity. , 2001, Obesity research.

[22]  C Bogardus,et al.  Relationship of genetics, age, and physical fitness to daily energy expenditure and fuel utilization. , 1989, The American journal of clinical nutrition.

[23]  J. Albu,et al.  Effect of exercise training on insulin sensitivity and glucose metabolism in lean, obese, and diabetic men. , 1991, Journal of applied physiology.

[24]  M. Carroll,et al.  Overweight and obesity in the United States: prevalence and trends, 1960–1994 , 1998, International Journal of Obesity.

[25]  W. Pories,et al.  Cellular alterations in liver, skeletal muscle, and adipose tissue responsible for insulin resistance in obesity and type II diabetes. , 1989, Diabetes/metabolism reviews.

[26]  A. Stunkard,et al.  An adoption study of human obesity. , 1986, The New England journal of medicine.

[27]  Graham A. Colditz,et al.  Body weight and mortality among women , 1995 .

[28]  K. Kendler.  The Salmon lecture Psychiatric genetics: an intellectual journey , 2002, Clinical Neuroscience Research.

[29]  F. Pi‐Sunyer,et al.  Medical Hazards of Obesity , 1993, Annals of Internal Medicine.

[30]  A. Folsom,et al.  Hyperinsulinemia, dyslipidemia, and obesity as risk factors for hospitalized gallbladder disease. A prospective study. , 2002, Annals of epidemiology.

[31]  S. Haffner,et al.  Greater influence of central distribution of adipose tissue on incidence of non-insulin-dependent diabetes in women than men. , 1991, The American journal of clinical nutrition.

[32]  R. Mueller,et al.  Glucose metabolism in obesity: influence of body fat distribution. , 1988, The Journal of clinical endocrinology and metabolism.

[33]  E. Ravussin,et al.  Low ratio of fat to carbohydrate oxidation as predictor of weight gain: study of 24-h RQ. , 1990, The American journal of physiology.

[34]  E. Ravussin,et al.  Effects of a Traditional Lifestyle on Obesity in Pima Indians , 1994, Diabetes Care.

[35]  A Tremblay,et al.  The response to long-term overfeeding in identical twins. , 1990, The New England journal of medicine.

[36]  J. Redón.  Hypertension in obesity. , 2001, NMCD. Nutrition Metabolism and Cardiovascular Diseases.

[37]  K. Polonsky,et al.  Abnormal patterns of insulin secretion in non-insulin-dependent diabetes mellitus. , 1988, The New England journal of medicine.

[38]  G. Colditz,et al.  Weight Gain as a Risk Factor for Clinical Diabetes Mellitus in Women , 1995, Annals of Internal Medicine.

[39]  G. Colditz,et al.  The disease burden associated with overweight and obesity. , 1999, JAMA.

[40]  A. Rissanen,et al.  Glucose metabolism in identical twins discordant for obesity. The critical role of visceral fat. , 1997, The Journal of clinical endocrinology and metabolism.

[41]  J. Manson,et al.  Prospective study of nutritional factors, blood pressure, and hypertension among US women. , 1996, Hypertension.

[42]  A. Folsom,et al.  Increased incidence of diabetes mellitus in relation to abdominal adiposity in older women. , 1991, Journal of clinical epidemiology.

[43]  U. Smith,et al.  Abdominal obesity is associated with an impaired fibrinolytic activity and elevated plasminogen activator inhibitor-1. , 1990, Metabolism: clinical and experimental.

[44]  P. Ducimetiere,et al.  Upper-body fat distribution: a hyperinsulinemia-independent predictor of coronary heart disease mortality. The Paris Prospective Study. , 1992, Arteriosclerosis and thrombosis : a journal of vascular biology.

[45]  G. Hunter,et al.  Do adaptive changes in metabolic rate favor weight regain in weight-reduced individuals? An examination of the set-point theory. , 2000, The American journal of clinical nutrition.

[46]  J. Friedman,et al.  Restoration of insulin responsiveness in skeletal muscle of morbidly obese patients after weight loss. Effect on muscle glucose transport and glucose transporter GLUT4. , 1992, The Journal of clinical investigation.

[47]  A. Goldberg,et al.  Adverse effects of abdominal obesity on lipoprotein lipids in healthy older men , 1993, Experimental Gerontology.

[48]  L. Garfinkel.  Overweight and cancer. , 1985, Annals of internal medicine.

[49]  M. Jensen,et al.  Influence of body fat distribution on free fatty acid metabolism in obesity. , 1989, The Journal of clinical investigation.