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Physiology & Behavior Dec 2005Obesity develops when energy intake exceeds expenditure. A constant neural, metabolic and hormonal "conversation" between the brain and periphery underlies the defense... (Review)
Review
Obesity develops when energy intake exceeds expenditure. A constant neural, metabolic and hormonal "conversation" between the brain and periphery underlies the defense of a given level of adiposity. For the majority of humans, obesity becomes a permanent condition once it develops, possibly because of irreversible changes in the distributed network of specialized "metabolic sensing" neurons which regulate energy intake, expenditure and storage. Plasma leptin and insulin are catabolic hormones whose levels reflect the amount of adiposity and act as signal to metabolic sensing neurons. Obesity-prone individuals have an inborn reduction in their catabolic responses to glucose, leptin and insulin. These raised metabolic and hormonal sensing thresholds precede the development of obesity and predispose individuals to become and remain obese on energy dense diets. High fat diets exacerbate this problem by independently inhibiting central insulin and leptin signaling. In addition, intake of highly palatable diets overrides the homeostatic controls of ingestion because it is regulated by neural systems mediating reward and motivation. The genetic predisposition to become obese is accentuated in offspring of mothers who are obese or nutritionally deprived during gestation and/or lactation or by overfeeding during the early postnatal period. On the other hand, chronic stress and illness can both reduce adiposity, as does gastric bypass surgery. However, for chronic obesity treatment, both exercise and pharmacotherapy help but both must be continued chronically to provide sustained lowering of body weight in obese subjects. Given the permanent upward resetting of body weight set-point that occurs when genetically predisposed individuals become obese, identification of factors that prevent the development of obesity is likely to be the most successful means of ameliorating the current obesity epidemic.
Topics: Energy Metabolism; Homeostasis; Humans; Obesity
PubMed: 16229869
DOI: 10.1016/j.physbeh.2005.08.054 -
Journal of Gastrointestinal Surgery :... Oct 2022Obesity is epidemic in the USA. Limited data exist examining obesity's influence on necrotizing pancreatitis (NP) disease course.
BACKGROUND
Obesity is epidemic in the USA. Limited data exist examining obesity's influence on necrotizing pancreatitis (NP) disease course.
METHODS
Retrospective review of prospectively maintained database of 571 adult necrotizing pancreatitis patients treated between 2007 and 2018. Patients were grouped according to body mass index (BMI) at disease onset. Patient characteristics, necrotizing pancreatitis course, and outcomes were compared between non-obese (BMI < 30) and obese (BMI > 30) patients.
RESULTS
Among 536 patients with BMI data available, 304 (57%) were obese (BMI > 30), and 232 (43%) were non-obese (BMI < 30). NP etiology in the obese group was more commonly biliary (55% versus 46%, p = 0.04) or secondary to hypertriglyceridemia (10% versus 2%, p < 0.001) and less commonly alcohol (17% versus 26%, p = 0.01). Obese patients had a higher incidence of baseline comorbid disease. The CT severity index was similar between groups though obese patients had a higher rate of > 50% pancreatic gland necrosis (27% versus 19%, p = 0.02). The rates of infected necrosis and organ failure were higher among obese patients. Percutaneous drainage was more common in obese patients. Time to first necrosis intervention was earlier with increasing BMI. NP disease duration was longer in obese patients. The overall mortality rate of non-obese and obese patients did not differ. However, mortality rate increased with increasing BMI.
CONCLUSION
Necrotizing pancreatitis in obese patients is characterized by a prolonged disease course, a higher risk of organ failure, infected necrosis, and the need for early necrosis-related intervention. Mortality increases with increasing BMI.
Topics: Adult; Disease Progression; Drainage; Humans; Necrosis; Obesity; Pancreatitis, Acute Necrotizing; Retrospective Studies
PubMed: 35960426
DOI: 10.1007/s11605-022-05383-0 -
Obesity Reviews : An Official Journal... Sep 2008This study reviews the recent literature on the relationship between obesity and indirect (non-medical) costs. Medline and Web of Science searches were conducted to... (Meta-Analysis)
Meta-Analysis Review
This study reviews the recent literature on the relationship between obesity and indirect (non-medical) costs. Medline and Web of Science searches were conducted to identify published studies from 1992 to present that report indirect costs by obesity status; 31 studies were included. The indirect costs were grouped into six categories: costs associated with absenteeism, disability, premature mortality, presenteeism, workers' compensation, and total indirect costs. Compared with non-obese workers, obese workers miss more workdays due to illness, injury, or disability. Costs of premature mortality vary substantially across countries. The results for presenteeism and workers' compensation were mixed. More research is needed to determine obesity's causal role in increasing indirect costs, especially for workers' compensation and presenteeism. Cohort and longitudinal study designs should be a priority.
Topics: Cost of Illness; Humans; Obesity; Physical Fitness; Quality of Life; Sick Leave; Workers' Compensation
PubMed: 18331420
DOI: 10.1111/j.1467-789X.2008.00472.x -
JAMA Nov 2007
Topics: Activities of Daily Living; Cost of Illness; Disabled Persons; Humans; Longevity; Morbidity; Obesity; Risk
PubMed: 17986703
DOI: 10.1001/jama.298.17.2066 -
The Journal of Clinical Endocrinology... Jun 2004Obesity is thought to be a heterogeneous disorder with several possible etiologies; therefore, by examining subtypes of obesity we attempt to understand obesity's... (Review)
Review
Obesity is thought to be a heterogeneous disorder with several possible etiologies; therefore, by examining subtypes of obesity we attempt to understand obesity's heterogeneous nature. The purpose of this review was to investigate the roles of metabolic, body composition, and cardiovascular disease risk in subtypes of obesity. We briefly consider two subtypes of obesity that have been identified in the literature. One subset of individuals, termed the metabolically healthy, but obese (MHO), despite having large amounts of fat mass compared with at risk obese individuals shows a normal metabolic profile, but remarkably normal to high levels of insulin sensitivity. Preliminary evidence suggests that this could be due at least in part to lower visceral fat levels and earlier onset of obesity. A second subset, termed the metabolically obese, but normal weight (MONW), present with normal body mass index, but have significant risk factors for diabetes, metabolic syndrome, and cardiovascular disease, which could be due to higher fat mass and plasma triglycerides as well as higher visceral fat and liver content. We also briefly consider the potential role of adipose and gastrointestinal hormonal profiles in MHO and MONW individuals, which could lead to a better understanding of potential factors that may regulate their body composition. This information will eventually be invaluable in helping us understand factors that predispose to or protect obese individuals from metabolic and cardiovascular disease. Collectively, a greater understanding of the MHO and MONW individual has important implications for therapeutic decision making, the characterization of subjects in research protocols, and medical education.
Topics: Body Composition; Energy Metabolism; Humans; Obesity
PubMed: 15181025
DOI: 10.1210/jc.2004-0165 -
The Medical Clinics of North America Jan 1989The study of obesity from a variety of psychological perspectives has been exciting and inventive, although we still do not understand fully the role of psychological... (Review)
Review
The study of obesity from a variety of psychological perspectives has been exciting and inventive, although we still do not understand fully the role of psychological variables in the etiology of obesity. Many of the factors thought to be of etiologic significance--field dependence, lack of impulse control, inability to delay gratification, or a maladaptive eating style--have not been supported by experimental evidence. Other factors once thought to be of importance as causes of obesity, depression and dysphoria, for example, appear, instead, to be consequences of being obese and may serve to maintain and intensify weight-related problems. Dieting behavior in response to weight concerns appears, perversely, to be implicated in increasing overweight and adiposity. Finally, arousability in response to food cues in the environment may play a causal role in some obesities.
Topics: Eating; Food; Humans; Obesity; Personality
PubMed: 2643008
DOI: 10.1016/s0025-7125(16)30691-5 -
JCI Insight Sep 2023Obesity promotes triple-negative breast cancer (TNBC), and effective interventions are urgently needed to break the obesity-TNBC link. Epidemiologic studies indicate...
Obesity promotes triple-negative breast cancer (TNBC), and effective interventions are urgently needed to break the obesity-TNBC link. Epidemiologic studies indicate that bariatric surgery reduces TNBC risk, while evidence is limited or conflicted for weight loss via low-fat diet (LFD) or calorie restriction (CR). Using a murine model of obesity-driven TNBC, we compared the antitumor effects of vertical sleeve gastrectomy (VSG) with LFD, chronic CR, and intermittent CR. Each intervention generated weight and fat loss and suppressed tumor growth relative to obese mice (greatest suppression with CR). VSG and CR regimens exerted both similar and unique effects, as assessed using multiomics approaches, in reversing obesity-associated transcript, epigenetics, secretome, and microbiota changes and restoring antitumor immunity. Thus, in a murine model of TNBC, bariatric surgery and CR each reverse obesity-driven tumor growth via shared and distinct antitumor mechanisms, and CR is superior to VSG in reversing obesity's procancer effects.
Topics: Humans; Mice; Animals; Triple Negative Breast Neoplasms; Caloric Restriction; Disease Models, Animal; Obesity; Bariatric Surgery
PubMed: 37698918
DOI: 10.1172/jci.insight.172868 -
Digestive Diseases and Sciences Mar 2024
Topics: Humans; Obesity
PubMed: 38184498
DOI: 10.1007/s10620-023-08244-1 -
Puerto Rico Health Sciences Journal Dec 2023The primary aim of this cross-sectional study was to assess, according to previous cancer diagnosis, the knowledge Puerto Rican women have on the link between...
OBJECTIVE
The primary aim of this cross-sectional study was to assess, according to previous cancer diagnosis, the knowledge Puerto Rican women have on the link between obesity-endometrial, -breast, and colon cancer, and determine women's most common source for medical information.
METHODS
In this cross-sectional study, eligible female patients (n=234) from the Gynecology and Gynecology-Oncology Clinics completed a self-administered survey from October 2014 to March 2016. Participants were evaluated on sociodemographic, body mass index, knowledge of the obesity-cancer link, and source of medical information.
RESULTS
About 49% and 31% of women in the study were obese and overweight, respectively. Less than 52% of the women knew about the link between obesity-breast,-colon, and/or -endometrial cancers. Women with previous cancer diagnoses were more likely aware of the association between obesity-colon cancer than women without previous cancer diagnoses (58% vs. 44%, p0.05). Higher incomes showed increased odds for the knowledge obesity-cancer link among women with a cancer history, but the odds decreased for women without previous cancer diagnoses (p>0.05). Higher education showed a trend towards a better knowledge of the obesity-cancer association. The most common sources of information were the primary doctor (80%) and the internet (54%).
CONCLUSION
Counseling about preventable cancer risk factors through primary care to all women must be encouraged especially in young healthy females. Further studies should address qualitative aspects of the odds differences in the obesity-cancer link knowledge observed between income categories for women with/without previous cancer diagnoses.
Topics: Female; Humans; Colonic Neoplasms; Cross-Sectional Studies; Hispanic or Latino; Obesity; Puerto Rico; Health Knowledge, Attitudes, Practice
PubMed: 38104285
DOI: No ID Found -
PharmacoEconomics Sep 1998The purpose of this article is to review the data from pharmacotherapeutic and surgical intervention studies for the management of obesity. Clinical outcomes assessed... (Review)
Review
The purpose of this article is to review the data from pharmacotherapeutic and surgical intervention studies for the management of obesity. Clinical outcomes assessed include weight changes over time and the effects of weight loss on blood pressure, serum lipid profiles and blood glucose control. Quality of life and economic data have been incorporated where available. Double-blind, randomised controlled trials were used preferentially over shorter term open studies. The literature evaluation was based on a Medline search of published data between January 1990 and January 1998. Obesity affects 65 million adults in the US. Estimates based on 1990 data suggest that obesity and comorbid illness contributed to $US46 billion in direct costs and $US23 billion in indirect costs in the US. Obesity is a chronic condition which requires long term management. The risk of developing cardiovascular disease, hypertension, type 2 (non-insulin-dependent) diabetes mellitus, osteoarthritis, Pickwickian syndrome and cancer is increased in the obese population, resulting in excess morbidity and mortality. There are no long term prospective studies that have demonstrated that weight reduction in obese patients improves survival. However, on the basis of epidemiological data using the prevalence of disease and associated body mass index, it is generally accepted that weight reduction of 5 to 10% in obese patients is associated with significant health benefits. Current treatment modalities include diet and behaviour modification, exercise and, where indicated, pharmacological intervention. Surgical intervention is reserved for the clinically severe obese patient [body mass index (BMI) > 40 kg/m2]. Many studies have demonstrated weight loss and improved metabolic fitness over 6 to 12 months. Few studies have been conducted over a longer period. Limited data are available regarding reduced morbidity and mortality, improved quality of life and functional or employment status and even fewer have incorporated any economic assessments of the impact of medical or surgical intervention. Although prospective data have demonstrated reduced morbidity following surgical intervention, only retrospective data have demonstrated reduced mortality. Studies of new drugs and interventions under development should demonstrate long term safety and efficacy in terms of sustained weight loss and subsequent weight maintenance. Future studies should incorporate assessment of patient perceived satisfaction with weight loss, health status and quality-of-life evaluations and pharmacoeconomic data to aid clinicians in the decision-making process in terms of weight management of their obese patients.
Topics: Humans; Obesity; Quality of Life; Treatment Outcome
PubMed: 10186466
DOI: 10.2165/00019053-199814030-00004