PRIMEVIEW

OBESITY
For the Primer, visit doi:10.1038/nrdp.2017.34

Approximately 40% of the world Metabolic imprinting DIAGNOSIS

EPIDEMIOLOGY Microbiota is the programming
population is overweight or
obese. Obesity is associated with the of metabolism at the
genetic and epigenetic Various methods are available to determine
development of type 2 diabetes mellitus,
level by prenatal and adiposity. Although the body mass index (BMI)
cardiovascular diseases and some types
Visceral obesity Metabolic neonatal factors, such is not a perfect index of adiposity, it is often
of cancer. Some of these comorbidities imprinting
is more common as excessive maternal used in clinical practice because of its simplicity
are considered features of the gestational weight gain,
in men than in and good correlation with cardiometabolic risk.
metabolic syndrome. women and poses rapid neonatal weight The BMI should be complemented by measuring
a higher risk gain or breastfeeding. the ratio of waist-to-hip circumferences to
of developing discriminate between subcutaneous obesity
MECHANISMS complications and visceral obesity.
than subcutaneous Genetics
The pathogenesis of obesity is complex and obesity.
More than Underweight Extreme obese
determined by the interaction of genetic, 2.1 billion
environmental and psychosocial factors acting Reduced adults are Normal Obese
energy
through several physiological mediators (such as expenditure estimated to be
hormones, cytokines and the nervous system) to overweight or obese, Overweight
regulate food intake, energy expenditure and fat of which 1.5 billion
accumulation. Pathological changes in adipocytes are overweight and
might explain some of the complications Excess 640 million BMI (kg/m2)
associated with obesity. Subcutaneous fat tissue energy are obese.
accommodates the energy surplus through intake
adipocyte hyperplasia, acting as a metabolic 18.5 25 30 40
‘sink’. By contrast, visceral adipocytes often
undergo hypertrophy, resulting in hypoxia, The worldwide
excess secretion of pro-inflammatory adipokines number of
and an inability to store excess lipids, which children and MANAGEMENT
causes low-grade systemic inflammation, insulin adolescents with
resistance and deposition of triglycerides obesity has doubled Management of obesity is aimed at weight loss.
Obesity
in non-adipose tissues. since 1980, and is now Lifestyle interventions, dietary changes and
Social and prevention
estimated to be physical activity are the first-line approach,
cultural factors should focus on
FTO 110 million. followed by medical treatment and bariatric
controlling excessive
weight gain and maintaining surgery in selected patients. Drugs approved
MC4R weight loss. Interventions for use include lipase inhibitors and agonists
should start as early as of the glucagon‑like peptide receptor,
LEPR
QUALITY OF LIFE possible, even during serotonin receptor and adrenergic receptor.
pregnancy. Criteria for surgery are a BMI of >40 kg/m2 or
Obesity is associated with atherosclerosis and myocardial extent of a BMI of >35 kg/m2 with comorbidities such as
Subcutaneous Visceral several comorbidities, including infarction) and cancers weight loss hypertension or dyslipidaemia.
fat fat
endocrine disorders (such (endometrial, liver and kidney needed remains Personalized precision nutrition
as type 2 diabetes mellitus), cancer, among others). Obesity unclear. Global health based on phenotypical and
LEP respiratory problems (for also has a substantial impact costs associated with obesity and genotypical characteristics holds
POMC
example, sleep apnoea), on quality of life. Weight loss its complications are estimated promise for the prevention and
cardiovascular diseases (such as improves quality of life, but the to be ~US$2 trillion. management of obesity.

Written by Liesbet Lieben; designed by Laura Marshall Article number: 17035; doi:10.1038/nrdp.2017.35; published online 15 Jun 2017
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