Skip to main content

The Pathophysiology of Obesity and Obesity-Related Diseases

  • Chapter
  • First Online:
The ASMBS Textbook of Bariatric Surgery
  • 2645 Accesses

Abstract

The first half of this chapter addresses the pathophysiology of obesity itself. The chapter discussed the physiologic mechanisms that lead to the obesity phenotype and answers the question, “How do we become obese?” The chapter also discusses the genetic, evolutionary, and environmental forces that have molded these regulatory systems to create the modern obesity epidemic. In doing so, the chapter answers the question, “Why do we become obese?” Because obesity is associated with a wide range of pathology, the second half of the chapter explores the pathophysiology of obesity-related metabolic disease and studies the effects of nutrient excess on cellular metabolism and systemic physiology.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 109.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 139.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Friedman JM. Modern science versus the stigma of obesity. Nat Med. 2004;10(6):563–9.

    Article  PubMed  CAS  Google Scholar 

  2. Prentice AM. Fires of life: the struggles of an ancient metabolism in a modern world. BNF Nutr Bull. 2001;26:13–27.

    Article  Google Scholar 

  3. Conard NJ. A female figurine from the basal Aurignacian of Hohle Fels Cave in southwestern Germany. Nature. 2009;459:248–52.

    Article  PubMed  CAS  Google Scholar 

  4. Flegal KM, Carroll MD, Ogden CL, Curtin LR. Prevalence and trends in obesity among US adults. JAMA. 2010;303(3):235–41.

    Article  PubMed  CAS  Google Scholar 

  5. Zhang Y, Proenca R, Maffei M, Barone M, Leopold L, Friedman JM. Positional cloning of the mouse obese gene and its human homologue. Nature. 1994;372(6505):425–32.

    Article  PubMed  CAS  Google Scholar 

  6. Coleman DL. Effects of parabiosis of obese with diabetes and normal mice. Diabetologia. 1973;9:294–8.

    Article  PubMed  CAS  Google Scholar 

  7. Farooqi IS, Jebb SA, Langmack G, Lawrence E, Cheetham CH, Prentice AM, et al. Effects of recombinant leptin therapy in a child with congenital leptin deficiency. N Engl J Med. 1999;341:879–84.

    Article  PubMed  CAS  Google Scholar 

  8. Montague CT, Farooqi IS, Whitehead JP, Soos MA, Rau H, Wareham NJ, et al. Congenital leptin deficiency is associated with severe early-onset obesity in humans. Nature. 1997;387:903–8.

    Article  PubMed  CAS  Google Scholar 

  9. Considine RV, Sinha MK, Heiman ML, Kriauciunas A, Stephens TW, Nyce MR, et al. Serum immunoreactive-leptin concentrations in normal-weight and obese humans. N Engl J Med. 1996;334:292–5.

    Article  PubMed  CAS  Google Scholar 

  10. Heymsfield SB, Greenberg AS, Fujioka K, Dixon RM, Kushner R, Hunt T, et al. Recombinant leptin for weight loss in obese and lean adults: a randomized, controlled, dose-escalation trial. JAMA. 1999;282:1568–75.

    Article  PubMed  CAS  Google Scholar 

  11. Hetherington AW, Ranson SW. Hypothalamic lesions and adiposity in the rat. Anat Rec. 1940;78:149–72.

    Article  Google Scholar 

  12. Lord G, Matarese G, Howard J, Baker R, Blooms S, Lechler R. Leptin modulates T-cell immune response and reverses starvation-induced immunosuppression. Nature. 1998;394:897–901.

    Article  PubMed  CAS  Google Scholar 

  13. Zarkesh-Esfahani H, Pockley G, Metcalfe RA, Bidlingmaier M, Wu Z, Ajami A, et al. High-dose leptin activates human leukocytes via receptor expression on monocytes. J Immunol. 2001;167(8): 4593–9.

    Article  PubMed  CAS  Google Scholar 

  14. Hotamisligil GS, Shargill NS, Spiegelman BM. Adipose expression of tumor necrosis factor-alpha: direct role in obesity-linked insulin resistance. Science. 1993;259(5091):87–91.

    Article  PubMed  CAS  Google Scholar 

  15. Leibel RL, Rosenbaum M, Hirsch J. Changes in energy expenditure resulting from altered body weight. N Engl J Med. 1995;332: 621–8.

    Article  PubMed  CAS  Google Scholar 

  16. Bouchard C, Tremblay A, Despres JP, Nadeau A, Lupien PJ, Theriault G, et al. The response to long-term overfeeding in identical twins. N Engl J Med. 1990;322:1477–82.

    Article  PubMed  CAS  Google Scholar 

  17. Levine JA, Vander Weg MW, Hill JO, Klesges RC. Non-exercise activity thermogenesis: the crouching tiger hidden dragon of societal weight gain. Arterioscler Thromb Vasc Biol. 2006;26(4):729–36.

    Article  PubMed  CAS  Google Scholar 

  18. Rothwell NJ, Stock MJ. A role for brown adipose tissue in diet-induced thermogenesis. Nature. 1979;281:31–5.

    Article  PubMed  CAS  Google Scholar 

  19. Gesta S, Tseng YH, Kahn CR. Developmental origin of fat: tracking obesity to its source. Cell. 2007;131(2):242–56.

    Article  PubMed  CAS  Google Scholar 

  20. Bessesen DH. Regulation of body weight: what is the regulated parameter? Physiol Behav. 2011;104:599–607.

    Article  PubMed  CAS  Google Scholar 

  21. Neel JV. Diabetes mellitus: a “thrifty” genotype rendered detrimental by “progress”? Am J Hum Genet. 1962;14(4):353–62.

    PubMed  CAS  PubMed Central  Google Scholar 

  22. Blakemore AIF, Frougel P. Is obesity our genetic legacy? J Clin Endocrinol Metab. 2008;93(11):S51–6.

    Article  PubMed  CAS  Google Scholar 

  23. Stunkard AJ, Sørensen TI, Hanis C, Teasdale TW, Chakraborty R, Schull WJ, et al. An adoption study of human obesity. N Engl J Med. 1986;314(4):193–8.

    Article  PubMed  CAS  Google Scholar 

  24. Loos RJ, Lindgren CM, Li S, Wheeler E, Zhao JH, Prokopenko I, et al. Common variants near MC4R are associated with fat mass, weight and risk of obesity. Nat Genet. 2008;40(6):768–75.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  25. Adabs KF, Schatzkin A, Harris A. Overweight and obesity and mortality in a large prospective cohort. N Engl J Med. 2006;355: 763–78.

    Article  Google Scholar 

  26. Calle EE, Rodriguez C, Walker-Thurmond K, Thun MJ. Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults. N Engl J Med. 2003;348(17):1625–38.

    Article  PubMed  Google Scholar 

  27. Cypess AM, Lehman S, Williams G, Tal I, Rodman D, Goldfine AB, et al. Identification and importance of brown adipose tissue in adult humans. N Engl J Med. 2009;360:1509–17.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  28. Fabbrini E, Tamboli RA, Magkos F, Marks-Shulman PA, Eckhauser AW, Richards WO, et al. Surgical removal of omental fat does not improve insulin sensitivity and cardiovascular risk factors in obese adults. Gastroenterology. 2010;139(2):448–55.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Ye J. Emerging role of adipose tissue hypoxia in obesity and insulin resistance. Int J Obes (Lond). 2009;33(1):54–66.

    Article  CAS  Google Scholar 

  30. Ozcan U, Yilmaz E, Ozcan L, Furuhashi M, Vaillancourt E, Smith RO, et al. Chemical chaperones reduce ER stress and restore glucose homeostasis in a mouse model of type 2 diabetes. Science. 2006;313(5790):1137–40.

    Article  PubMed  Google Scholar 

  31. Williamson RT. On the treatment of glycosuria and diabetes mellitus with sodium salicylate. Br Med J. 1901;1(2100):760–2.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  32. Cancello R, Henegar C, Viguerie N, Taleb S, Poitou C, Rouault C, et al. Reduction of macrophage infiltration and chemoattractant gene expression changes in white adipose tissue of morbidly obese subjects after surgery-induced weight loss. Diabetes. 2005;54(8): 2277–86.

    Article  PubMed  CAS  Google Scholar 

  33. Chazenbalk G, Bertolotto C, Heneidi S, Jumabay M, Trivax B, Aronowitz J, et al. Novel pathway of adipogenesis through cross-talk between adipose tissue macrophages, adipose stem cells and adipocytes: evidence of cell plasticity. PLoS One. 2011;6(3):e17834.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  34. O’Rourke RW, White AE, Metcalf MD, Olivas AS, Mitra P, Larison WG, et al. Hypoxia-induced inflammatory cytokine secretion in human adipose tissue stromovascular cells. Diabetologia. 2011; 54(6):1480–90.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Lumeng CN, Bodzin JL, Saltiel AR. Obesity induces a phenotypic switch in adipose tissue macrophage polarization. J Clin Invest. 2007;117:89–93.

    Article  Google Scholar 

  36. Patsouris D, Li PP, Thapar D, Chapman J, Olefsky JM, Neels JG. Ablation of CD11c-positive cells normalizes insulin sensitivity in obese insulin resistant animals. Cell Metab. 2008;8:301–9.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  37. Feuerer M, Herrero L, Cipolletta D, Naaz A, Wong J, Nayer A, et al. Lean, but not obese, fat is enriched for a unique population of regulatory T cells that affect metabolic parameters. Nat Med. 2009;15(8):930–9.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  38. De Rosa V, Procaccini C, Calì G, Pirozzi G, Fontana S, Zappacosta S, et al. A key role of leptin in the control of regulatory T cell proliferation. Immunity. 2007;26:241–55.

    Article  PubMed  Google Scholar 

  39. Saberi M, Woods NB, de Luca C, Schenk S, Lu JC, Bandyopadhyay G, et al. Hematopoietic cell-specific deletion of toll-like receptor 4 ameliorates hepatic and adipose tissue insulin resistance in high-fat-fed mice. Cell Metab. 2009;10(5):419–29.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  40. Brown MS, Goldstein JL. Selective versus total insulin resistance: a pathogenic paradox. Cell Metab. 2008;7:95.

    Article  PubMed  CAS  Google Scholar 

  41. Thaler JP, Choi SJ, Schwartz MW, Wisse BE. Hypothalamic inflammation and energy homeostasis: resolving the paradox. Front Neuroendocrinol. 2010;31(1):79–84.

    Article  PubMed  CAS  Google Scholar 

  42. Turnbaugh PJ, Ley RE, Mahowald MA, Magrini V, Mardis ER, Gordon JI. An obesity-associated gut microbiome with increased capacity for energy harvest. Nature. 2006;444:1027–31.

    Article  PubMed  Google Scholar 

  43. Donnelly KL, Smith CI, Schwarzenberg SJ, Jessurun J, Boldt MD, Parks EJ. Sources of fatty acids stored in liver and secreted via lipoproteins in patients with nonalcoholic fatty liver disease. J Clin Invest. 2005;115:1343–51.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  44. Faghihimani E, Aminorroaya A, Rezvanian H, Adibi P, Ismail-Beigi F, Amini M. Salsalate improves glycemic control in patients with newly diagnosed type 2 diabetes. Acta Diabetol. 2013;50: 537–43.

    Article  PubMed  CAS  Google Scholar 

  45. Larsen CM, Faulenbach M, Vaag A, Vølund A, Ehses JA, Seifert B, et al. Interleukin-1 receptor antagonist in type 2 diabetes mellitus. N Engl J Med. 2007;356:1517–26.

    Article  PubMed  CAS  Google Scholar 

  46. Adams TD, Stroup AM, Gress RE, Adams KF, Calle EE, Smith SC, et al. Cancer incidence and mortality after gastric bypass surgery. Obesity (Silver Spring). 2009;17(4):796–802.

    Article  Google Scholar 

  47. Larsson SC, Orsini N, Wolk A. Diabetes mellitus and risk of colorectal cancer: a meta-analysis. J Natl Cancer Inst. 2005;97: 1679–87.

    Article  PubMed  Google Scholar 

  48. Gallagher EJ, LeRoith D. Diabetes, cancer, and metformin: connections of metabolism and cell proliferation. Ann N Y Acad Sci. 2011;1243:54–68.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Robert W. O’Rourke MD .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer Science+Business Media New York

About this chapter

Cite this chapter

O’Rourke, R.W. (2015). The Pathophysiology of Obesity and Obesity-Related Diseases. In: Nguyen, N., Blackstone, R., Morton, J., Ponce, J., Rosenthal, R. (eds) The ASMBS Textbook of Bariatric Surgery. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-1206-3_2

Download citation

  • DOI: https://doi.org/10.1007/978-1-4939-1206-3_2

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4939-1205-6

  • Online ISBN: 978-1-4939-1206-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics