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Pathophysiology of obesity: Focused, cause-driven
approach to control the epidemic
Sunil Wimalawansa, MD, PhD, MBA, DSc
Cardio Metabolic
Institute, 51 Veronica Avenue, Somerset, New Jersey,
08873, USA
E-mail:
wimalawansa1@hotmail.com
Accepted 9 October, 2013
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Obesity is a disease with serious public health and
economic outcomes. It is more than simply a
thermodynamic, genetic, or a metabolic problem of
handling calories; it is a behavioral disorder and
an inflammatory disease leading to dysregulation of
metabolism and energy balance, and impairment of the
neurohormonal systems, leading to accumulation of
intra-abdominal fat leading to serious
complications. Obesity rates as indicated by the
increasing body mass index (BMI)
or by
abdominal girth are escalating in the United States
and most industrialized countries. Approximately
two-thirds of these patients develop complications
that would cost billions of taxpayer dollars.
However, in Asians BMI is less relevant and the
increasing abdominal girth is a better indicator
that reflect accumulation of the visceral fat; the
most detrimental for the health. Obesity is a
multi-factorial disease for which genetics,
environment, behavioral, physical and other factors
contribute to the development. Those who are obese
and sick and unhealthy, secondary to accumulation of
excessive visceral fat are at high risk of
developing complications. At the current rates, it
is predicted that obesity-associated deaths are
going to surpass cardiovascular deaths within the
next two decades. For the majority of overweight
and obese people, it is necessary to reduce only
seven to ten percent of their body weight via
calorie-reduced diet and increasing physical
activity that would improve the metabolism and
decrease potential complications and premature
deaths. In addition to reasonable weight reduction
programs, controlling the obesity-associated
complications requires coordinated, cause-driven,
and complication-centric approaches. Understanding
the cause for the obesity in each patient would
greatly facilitate the development of an
individualized, sustainable, and successful
treatment plan. Therefore, the multi-factorial
nature of engender obesity needs a focused,
specific, cause-driven approaches to combat.
Considering the high cost of managing obesity, type
2 diabetes and their complications, prevention of
obesity is the way forward that is based on causes
and risk factors. This is one of the most
cost-effective approaches to decrease the
obesity-associated complications, morbidities and
premature deaths.
Keywords:
metabolism, epidemic, adepokines, body mass index
(BMI), cardiovascular, morbidity, overweight
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