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West J Med. 1988 Oct; 149(4): 429–441.
PMCID: PMC1026489

Obesity. Part I--Pathogenesis.


Obesity--defined by a body mass index above 30 kg per m2--is a major problem for affluent nations. Its prevalence is higher in North America than in Europe--between 9% and 12% of the population. Reduced energy expenditure from exercise or metabolism or both may be an important contributory factor in the development of obesity because of a failure to reduce food intake sufficiently to maintain energy balance. A high ratio of abdominal circumference relative to gluteal circumference carries a twofold or greater risk of heart attack, stroke, hypertension, diabetes mellitus, gallbladder disease, and death. The effect of increased quantities of abdominal fat is greater than that of a similar increase in total body fat on the risks of ill health associated with obesity. Genetic factors appear to contribute about 25% to its etiology.

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Selected References

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  • Waaler HT. Height, weight and mortality. The Norwegian experience. Acta Med Scand Suppl. 1984;679:1–56. [PubMed]
  • Hannon BM, Lohman TG. The energy cost of overweight in the United States. Am J Public Health. 1978 Aug;68(8):765–767. [PMC free article] [PubMed]
  • Clarys JP, Martin AD, Drinkwater DT. Gross tissue weights in the human body by cadaver dissection. Hum Biol. 1984 Sep;56(3):459–473. [PubMed]
  • Keys A, Fidanza F, Karvonen MJ, Kimura N, Taylor HL. Indices of relative weight and obesity. J Chronic Dis. 1972 Jul 1;25(6):329–343. [PubMed]
  • Bray GA. Overweight is risking fate. Definition, classification, prevalence, and risks. Ann N Y Acad Sci. 1987;499:14–28. [PubMed]
  • Lohman TG. Skinfolds and body density and their relation to body fatness: a review. Hum Biol. 1981 May;53(2):181–225. [PubMed]
  • Lukaski HC. Methods for the assessment of human body composition: traditional and new. Am J Clin Nutr. 1987 Oct;46(4):537–556. [PubMed]
  • Kuczmarski RJ, Fanelli MT, Koch GG. Ultrasonic assessment of body composition in obese adults: overcoming the limitations of the skinfold caliper. Am J Clin Nutr. 1987 Apr;45(4):717–724. [PubMed]
  • Segal KR, Gutin B, Presta E, Wang J, Van Itallie TB. Estimation of human body composition by electrical impedance methods: a comparative study. J Appl Physiol (1985) 1985 May;58(5):1565–1571. [PubMed]
  • Lukaski HC, Johnson PE, Bolonchuk WW, Lykken GI. Assessment of fat-free mass using bioelectrical impedance measurements of the human body. Am J Clin Nutr. 1985 Apr;41(4):810–817. [PubMed]
  • Sjöström L, Kvist H, Cederblad A, Tylén U. Determination of total adipose tissue and body fat in women by computed tomography, 40K, and tritium. Am J Physiol. 1986 Jun;250(6 Pt 1):E736–E745. [PubMed]
  • Wilmore JH. Body composition in sport and exercise: directions for future research. Med Sci Sports Exerc. 1983;15(1):21–31. [PubMed]
  • Van Itallie TB. Health implications of overweight and obesity in the United States. Ann Intern Med. 1985 Dec;103(6 ):983–988. [PubMed]
  • Bray GA. Obesity: definition, diagnosis and disadvantages. Med J Aust. 1985 Apr 1;142(7 Suppl):S2–S8. [PubMed]
  • Kluthe R, Schubert A. Obesity in Europe. Ann Intern Med. 1985 Dec;103(6 ):1037–1042. [PubMed]
  • Baecke JA, van Staveren WA, Burema J. Food consumption, habitual physical activity, and body fatness in young Dutch adults. Am J Clin Nutr. 1983 Feb;37(2):278–286. [PubMed]
  • Bray GA, Zachary B, Dahms WT, Atkinson RL, Oddie TH. Eating patterns of massively obese individuals. J Am Diet Assoc. 1978 Jan;72(1):24–27. [PubMed]
  • Stunkard A, Kaplan D. Eating in public places: a review of reports of the direct observation of eating behavior. Int J Obes. 1977;1(1):89–101. [PubMed]
  • Stunkard AJ, Waxman M. Accuracy of self-reports of food intake. J Am Diet Assoc. 1981 Nov;79(5):547–551. [PubMed]
  • Bray GA. The energetics of obesity. Med Sci Sports Exerc. 1983;15(1):32–40. [PubMed]
  • Jéquier E, Schutz Y. Long-term measurements of energy expenditure in humans using a respiration chamber. Am J Clin Nutr. 1983 Dec;38(6):989–998. [PubMed]
  • de Boer JO, van Es AJ, van Raaij JM, Hautvast JG. Energy requirements and energy expenditure of lean and overweight women, measured by indirect calorimetry. Am J Clin Nutr. 1987 Jul;46(1):13–21. [PubMed]
  • Bogardus C, Lillioja S, Ravussin E, Abbott W, Zawadzki JK, Young A, Knowler WC, Jacobowitz R, Moll PP. Familial dependence of the resting metabolic rate. N Engl J Med. 1986 Jul 10;315(2):96–100. [PubMed]
  • Ravussin E, Lillioja S, Knowler WC, Christin L, Freymond D, Abbott WG, Boyce V, Howard BV, Bogardus C. Reduced rate of energy expenditure as a risk factor for body-weight gain. N Engl J Med. 1988 Feb 25;318(8):467–472. [PubMed]
  • Brownell KD, Stunkard AJ, Albaum JM. Evaluation and modification of exercise patterns in the natural environment. Am J Psychiatry. 1980 Dec;137(12):1540–1545. [PubMed]
  • Waxman M, Stunkard AJ. Caloric intake and expenditure of obese boys. J Pediatr. 1980 Feb;96(2):187–193. [PubMed]
  • Woo R, Daniels-Kush R, Horton ES. Regulation of energy balance. Annu Rev Nutr. 1985;5:411–433. [PubMed]
  • Glick Z, Teague RJ, Bray GA. Brown adipose tissue: thermic response increased by a single low protein, high carbohydrate meal. Science. 1981 Sep 4;213(4512):1125–1127. [PubMed]
  • Astrup A, Bülow J, Madsen J, Christensen NJ. Contribution of BAT and skeletal muscle to thermogenesis induced by ephedrine in man. Am J Physiol. 1985 May;248(5 Pt 1):E507–E515. [PubMed]
  • LeBlanc J, Brondel L. Role of palatability on meal-induced thermogenesis in human subjects. Am J Physiol. 1985 Mar;248(3 Pt 1):E333–E336. [PubMed]
  • Golay A, Schutz Y, Meyer HU, Thiébaud D, Curchod B, Maeder E, Felber JP, Jéquier E. Glucose-induced thermogenesis in nondiabetic and diabetic obese subjects. Diabetes. 1982 Nov;31(11):1023–1028. [PubMed]
  • Björntorp P, Ostman J. Human adipose tissue dynamics and regulation. Adv Metab Disord. 1971;5:277–327. [PubMed]
  • Knittle JL, Timmers K, Ginsberg-Fellner F, Brown RE, Katz DP. The growth of adipose tissue in children and adolescents. Cross-sectional and longitudinal studies of adipose cell number and size. J Clin Invest. 1979 Feb;63(2):239–246. [PMC free article] [PubMed]
  • Sjöström L, William-Olsson T. Prospective studies on adipose tissue development in man. Int J Obes. 1981;5(6):597–604. [PubMed]
  • Krotkiewski M, Sjöström L, Björntorp P, Carlgren G, Garellick G, Smith U. Adipose tissue cellularity in relation to prognosis for weight reduction. Int J Obes. 1977;1(4):395–416. [PubMed]
  • Lew EA, Garfinkel L. Variations in mortality by weight among 750,000 men and women. J Chronic Dis. 1979;32(8):563–576. [PubMed]
  • Manson JE, Stampfer MJ, Hennekens CH, Willett WC. Body weight and longevity. A reassessment. JAMA. 1987 Jan 16;257(3):353–358. [PubMed]
  • Garn SM, Hawthorne VM, Pilkington JJ, Pesick SD. Fatness and mortality in the West of Scotland. Am J Clin Nutr. 1983 Aug;38(2):313–319. [PubMed]
  • VAGUE J. The degree of masculine differentiation of obesities: a factor determining predisposition to diabetes, atherosclerosis, gout, and uric calculous disease. Am J Clin Nutr. 1956 Jan-Feb;4(1):20–34. [PubMed]
  • Lapidus L, Bengtsson C, Larsson B, Pennert K, Rybo E, Sjöström L. Distribution of adipose tissue and risk of cardiovascular disease and death: a 12 year follow up of participants in the population study of women in Gothenburg, Sweden. Br Med J (Clin Res Ed) 1984 Nov 10;289(6454):1257–1261. [PMC free article] [PubMed]
  • Larsson B, Svärdsudd K, Welin L, Wilhelmsen L, Björntorp P, Tibblin G. Abdominal adipose tissue distribution, obesity, and risk of cardiovascular disease and death: 13 year follow up of participants in the study of men born in 1913. Br Med J (Clin Res Ed) 1984 May 12;288(6428):1401–1404. [PMC free article] [PubMed]
  • Ducimetiere P, Richard J, Cambien F. The pattern of subcutaneous fat distribution in middle-aged men and the risk of coronary heart disease: the Paris Prospective Study. Int J Obes. 1986;10(3):229–240. [PubMed]
  • Donahue RP, Abbott RD, Bloom E, Reed DM, Yano K. Central obesity and coronary heart disease in men. Lancet. 1987 Apr 11;1(8537):821–824. [PubMed]
  • Krotkiewski M, Björntorp P, Sjöström L, Smith U. Impact of obesity on metabolism in men and women. Importance of regional adipose tissue distribution. J Clin Invest. 1983 Sep;72(3):1150–1162. [PMC free article] [PubMed]
  • Kissebah AH, Vydelingum N, Murray R, Evans DJ, Hartz AJ, Kalkhoff RK, Adams PW. Relation of body fat distribution to metabolic complications of obesity. J Clin Endocrinol Metab. 1982 Feb;54(2):254–260. [PubMed]
  • Fujioka S, Matsuzawa Y, Tokunaga K, Tarui S. Contribution of intra-abdominal fat accumulation to the impairment of glucose and lipid metabolism in human obesity. Metabolism. 1987 Jan;36(1):54–59. [PubMed]
  • Blair D, Habicht JP, Sims EA, Sylwester D, Abraham S. Evidence for an increased risk for hypertension with centrally located body fat and the effect of race and sex on this risk. Am J Epidemiol. 1984 Apr;119(4):526–540. [PubMed]
  • Hartz AJ, Rupley DC, Rimm AA. The association of girth measurements with disease in 32,856 women. Am J Epidemiol. 1984 Jan;119(1):71–80. [PubMed]
  • MacMahon SW, Wilcken DE, Macdonald GJ. The effect of weight reduction on left ventricular mass. A randomized controlled trial in young, overweight hypertensive patients. N Engl J Med. 1986 Feb 6;314(6):334–339. [PubMed]
  • Drenick EJ. Definition and health consequences of morbid obesity. Surg Clin North Am. 1979 Dec;59(6):963–976. [PubMed]
  • Toeller M, Gries FA, Dannehl K. Natural history of glucose intolerance in obesity. A ten year observation. Int J Obes. 1982;6 (Suppl 1):145–149. [PubMed]
  • Henry RR, Wiest-Kent TA, Scheaffer L, Kolterman OG, Olefsky JM. Metabolic consequences of very-low-calorie diet therapy in obese non-insulin-dependent diabetic and nondiabetic subjects. Diabetes. 1986 Feb;35(2):155–164. [PubMed]
  • Sharp JT, Barrocas M, Chokroverty S. The cardiorespiratory effects of obesity. Clin Chest Med. 1980 Jan;1(1):103–118. [PubMed]
  • Ray CS, Sue DY, Bray G, Hansen JE, Wasserman K. Effects of obesity on respiratory function. Am Rev Respir Dis. 1983 Sep;128(3):501–506. [PubMed]
  • Meistas MT, Foster GV, Margolis S, Kowarski AA. Integrated concentrations of growth hormone, insulin, C-peptide and prolactin in human obesity. Metabolism. 1982 Dec;31(12):1224–1228. [PubMed]
  • Danforth E, Jr, Horton ES, O'Connell M, Sims EA, Burger AG, Ingbar SH, Braverman L, Vagenakis AG. Dietary-induced alterations in thyroid hormone metabolism during overnutrition. J Clin Invest. 1979 Nov;64(5):1336–1347. [PMC free article] [PubMed]
  • Glass AR, Burman KD, Dahms WT, Boehm TM. Endocrine function in human obesity. Metabolism. 1981 Jan;30(1):89–104. [PubMed]
  • Kley HK, Solbach HG, McKinnan JC, Krüskemper HL. Testosterone decrease and oestrogen increase in male patients with obesity. Acta Endocrinol (Copenh) 1979 Jul;91(3):553–563. [PubMed]
  • Hartz AJ, Barboriak PN, Wong A, Katayama KP, Rimm AA. The association of obesity with infertility and related menstural abnormalities in women. Int J Obes. 1979;3(1):57–73. [PubMed]
  • Ashley FW, Jr, Kannel WB. Relation of weight change to changes in atherogenic traits: the Framingham Study. J Chronic Dis. 1974 Mar;27(3):103–114. [PubMed]
  • Bray GA, Dahms WT, Swerdloff RS, Fiser RH, Atkinson RL, Carrel RE. The Prader-Willi syndrome: a study of 40 patients and a review of the literature. Medicine (Baltimore) 1983 Mar;62(2):59–80. [PubMed]
  • Stunkard AJ, Sørensen TI, Hanis C, Teasdale TW, Chakraborty R, Schull WJ, Schulsinger F. An adoption study of human obesity. N Engl J Med. 1986 Jan 23;314(4):193–198. [PubMed]
  • Price RA, Cadoret RJ, Stunkard AJ, Troughton E. Genetic contributions to human fatness: an adoption study. Am J Psychiatry. 1987 Aug;144(8):1003–1008. [PubMed]
  • Stunkard AJ, Foch TT, Hrubec Z. A twin study of human obesity. JAMA. 1986 Jul 4;256(1):51–54. [PubMed]
  • Bouchard C, Pérusse L, Leblanc C, Tremblay A, Thériault G. Inheritance of the amount and distribution of human body fat. Int J Obes. 1988;12(3):205–215. [PubMed]
  • Bray GA. Syndromes of hypothalamic obesity in man. Pediatr Ann. 1984 Jul;13(7):525–536. [PubMed]

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