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The Heterogeneity of Obesity



In the same manner in that there is not one predisposing factor for the development of obesity, the phenotypic clinical presentation of obesity is likewise extraordinarily heterogenous. (This has some authors speaking of “obesities” rather than “obesity”).

While it is now well established that BMI is a measure of size rather than health, it is perhaps less well recognised how the different types of body fat and their storage in various fat depots and organs can contribute to cardiometabolic disease (location, location, location!).

Now, a comprehensive review by Ian Neeland from theĀ University of Texas Southwestern Medical Center, Dallas, together with my colleagues Paul Poirier and JP Despres from Laval University in Quebec, published in Circulation discusses the cardiovascular and metabolic heterogeneity of obesity.

As the authors point out,

“Although the BMI has been a convenient and simple index to monitor the growth in obesity prevalence at the population level, many metabolic and clinical studies have revealed that obesity, when defined on the basis of the BMI alone, is a remarkably heterogeneous condition. For instance, patients with similar body weight or BMI values have been shown to display markedly different comorbidities and levels of health risk.”

Not only has BMI never emerged as a significant component in risk engines such as the Framingham risk score, there are many individuals with obesity who never develop metabolic complications or heart disease during the course of their life.

The paper offers a good review of what the author describe as adipose dysfunction or “adiposopathy” = “sick fat”. Thus, in some individuals, there is an accumulation of “unhealthy” fat (particularly visceral and ectopic fat), whereas in others, excess fat predominantly consists of “healthy” fat (predominantly in subcutaneous depots such as the hips and thighs).

The authors thus emphasise the importance of measuring fat location with methods ranging from simple anthropometric measures (e.g. waist circumference) to comprehensive imaging techniques (e.g. MRI).

The authors also provide a succinct overview of exactly how this “sick fat” contributes to cardiometabolic risk and briefly touches on the behavioural, medical, and surgical management of patients with obesity and elevated cardiometabolic risk.

I, for one, was also happy to see the inclusion of the Edmonton Obesity Staging System in their reflections on this complex issue.

This paper is certainly suggested reading for anyone interested in the link between obesity and cardiovascular disease.

@DrSharma
Edmonton, AB

4 Comments

  1. Yes? How about a link or pdf to the FULL article then. Thank you.

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  2. I wish that my doctor would take the time to learn and understand the many factors contributing to my obesity.

    He tells me that it is strictly my diet ( the amount of food intake ) that is the real cause of my obesity. He does not want to discuss or provide guidance as to why I have such uncontrollable cravings for food and literately eating my self to death.

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  3. Very good information this matter helps many people who are in this process of obesity are information that we need to thank Dr. Arya Sharma.

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