The Southern Medical Journal (SMJ) is the official, peer-reviewed journal of the Southern Medical Association. It has a multidisciplinary and inter-professional focus that covers a broad range of topics relevant to physicians and other healthcare specialists.

SMJ // Article

Expired CME Article

The Prevalence and Etiology of Nongenetic Obesity and Associated Disorders

Authors: Richard N. Redinger, MD

Abstract

The prevalence and etiology of nongenetic causes of obesity are reviewed, along with obesity-associated comorbidities of the metabolic syndrome. The role of nongenetic causes of obesity from environmental affluences, central nervous system developmental effects in adult obesity, and psychosocial disorders affecting obesity through central nervous system dysfunction are discussed. Obesity is now the major underlying cause of the metabolic syndrome and its alarmingly increased prevalence worldwide makes it the most preventable cause of chronic disease burden.


Key Points


* The prevalence of obesity has become the largest worldwide chronic disease burden due to its comorbidities within the metabolic syndrome.


* Environmental effects of increased food intake and decreased energy utilization from sedentary lifestyles are now affecting over 1 billion people, while one third of these are obese.


* Fat adipokines including inflammatory cytokines are the major underlying molecular cause of obesity's comorbidities.

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Tan GD, Goossens GH, Humphreys SM, et al. Upper and lower body adipose tissue function: a direct comparison of fat mobilization in humans. Obes Res 2004;12:114–118.
 
2. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: the evidence report. National Institutes of Health. Obes Res 1998;6:51S–209S.
 
3. James WP. Assessing obesity: are ethnic differences in body mass index and waist clarification criteria justified? Obes Rev 2005;6:179–181.
 
4. McKeigue PM, Shah B, Marmot MG. Relation of central obesity and insulin resistance with high diabetes prevalence and cardiovascular risk in South Asians. Lancet 1991;337:382–386.
 
5. Gallagher D, Kuznia P, Heshka S, et al. Adipose tissue in muscle: a novel depot similar in size to visceral adipose tissue. Am J Clin Nutr 2005;81:903–910.
 
6. Strong K, Mathers C, Leeder S, et al. Preventing chronic diseases: how many lives can we save? Lancet 2005;366:1578–1582.
 
7. Ebbeling CB, Pawlak DB, Ludwig DS. Childhood obesity: public-health crisis, common sense cure. Lancet 2002;360:473–482.
 
8. James WPT, Rigby N, Leach R. The obesity epidemic, metabolic syndrome and future prevention strategies. Eur J Cardiovasc Prev Rehabil 2004;11:3–8.
 
9. Mokdad AH, Marks JS, Stroup DF, et al. Correction: actual causes of death in the United States, 2000. JAMA 2005;293:293–294.
 
10. Flegal KM, Carroll MD, Ogden CL, et al. Prevalence and trends in obesity among US adults: 1999–2000. JAMA 2002;288:1723–1727.
 
11. Popkin BM, Gordon-Larsen P. The nutrition transition: worldwide obesity dynamics and their determinants. Int J Obes 2004;28:S2–S9.
 
12. Grundy SM, Brewer HB Jr, Cleeman JI, et al. Definition of metabolic syndrome: report of the National Heart, Lung, and Blood Institute/American Heart Association conference on scientific issues related to definition. Arterioscler Thromb Vasc Biol 2004;24:e13–e18.
 
13. Paeratakul S, Lovejoy JC, Ryan DH, et al. The relation of gender, race and socioeconomic status to obesity and obesity comorbidities in a sample of US adults. Int J Obes Relat Metab Disord 2002;26:1205–1210.
 
14. Janssen I, Katzmarzyk PT, Ross R. Body mass index, waist circumference, and health risk: evidence in support of current National Institutes of Health guidelines. Arch Intern Med 2002;162:2074–2079.
 
15. Ford ES, Giles WH, Dietz WH. Prevalence of the metabolic syndrome among US adults: findings from the third National Health and Nutrition Examination Survey. JAMA 2002;287:356–359.
 
16. Shirai K. Obesity as the core of the metabolic syndrome and the management of coronary heart disease. Curr Med Res Opin 2004;20:295–304.
 
17. Pladevall M, Singal B, Williams LK, et al. A single factor underlies the metabolic syndrome: a confirmatory factor analysis. Diabetes Care 2006;29:113–22.
 
18. Simard B, Turcotte H, Marceau P, et al. Asthma and sleep apnea in patients with morbid obesity: outcome after bariatric surgery. Obes Surg 2004;14:1381–1388.
 
19. Pagano G, Pacini G, Musso G, et al. Nonalcoholic steatohepatitis, insulin resistance, and metabolic syndrome: further evidence for an etiologic association. Hepatology 2002;35:367–372.
 
20. Franks S. Polycystic ovary syndrome. N Engl J Med 1995;333:1435.
 
21. Bodnar LM, Ness RB, Harger GF, et al. Inflammation and triglycerides partially mediate the effect of prepregnancy body mass index on the risk of preeclampsia. Am J Epidemiol 2005;162:1198–1206.
 
22. Barden A. Pre-eclampsia: contribution of maternal constitutional factors and the consequences for cardiovascular health. Clin Exp Pharmacol Physiol 2006;33:826–830.
 
23. Luke A, Roizen NJ, Sutton M, et al. Energy expenditure in children with Down syndrome: correcting metabolic rate for movement. J Pediatr 1994;125:829–838.
 
24. Redinger RN, Small DM. Bile composition, bile salt metabolism and gallstones. Arch Intern Med 1972;130:618–630.
 
25. Schoen RE, Tangen CM, Kuller LH, et al. Increased blood glucose and insulin, body size, and incident colorectal cancer. J Natl Cancer Inst 1999;91:1147–1154.
 
26. Bianchini F, Kaaks R, Vainio H. Weight control and physical activity in cancer prevention. Obesity Reviews (2002)3:5–8.
 
27. Carroll KK. Obesity as a risk factor for certain types of cancer. Lipids 1998;33:1055–1059.
 
28. Alberti KG, Zimmet PZ. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1. Diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med 1998;15:539–553.
 
29. Chen J, Muntner P, Hamm LL, et al. The metabolic syndrome and chronic kidney disease in U.S. adults. Ann Intern Med 2004;140:167–174.
 
30. Scott CL. Diagnosis, prevention, and intervention for the metabolic syndrome. Am J Cardiol 2003;92:35i–42i.
 
31. Diet, nutrition and the prevention of chronic diseases. World Health Organ Tech Rep Ser 2003;916:1–149.
 
32. Ravussin E. Physiology: a NEAT way to control weight? Science 2005;307:530–531.
 
33. Coakley EH, Rimm EB, Colditz G, et al. Predictors of weight change in men: results from Health Professionals follow-up study. Int J Obes Relat Metab Disord 1998;22:89–96.
 
34. Erlanson-Albertsson C. How palatable food disrupts appetite regulation. Basic Clin Pharmacol Toxicol 2005;97:61–73.
 
35. Ludwig DS, Pereira MA, Kroenke CH, et al. Dietary fiber, weight gain, and cardiovascular disease risk factors in young adults. JAMA 1999;282:1539–1546.
 
36. Allison DB, Kaprio J, Korkeila M, et al. The heritability of body mass index among an international sample of monozygotic twins reared apart. Int J Obes Relat Metab Dis 1996;20:501–506.
 
37. Olden K, Wilson S. Environmental health and genomics: visions and implications. Nat Rev Genet 2000;1:149–153.
 
38. Ravelli GP, Stein ZA, Susser MW. Obesity in young men after famine exposure in utero and early infancy. N Engl J Med 1976;295:349–353.
 
39. Forsen T, Eriksson J, Tuomilehto J, et al. The fetal and childhood growth of persons who develop type 2 diabetes. Ann Intern Med 2000;133:176–182.
 
40. Monteiro POA, Victora CG. Rapid growth in infancy and childhood and obesity later in life—a systematic review. Obes Rev 2005;6:143.
 
41. Crowell MD, Cheskin LJ, Musial F. Prevalence of gastrointestinal symptoms in obese and normal weight binge eaters. Am J Gastroenterol 1994;89:387–391.
 
42. Drossman DA, Whitehead WE, Camilleri M. Irritable bowel syndrome: a technical review for practice guideline development. Gastroenterology 1997;112:2120–2137.
 
43. Huang XF, Xin X, McLennan P, et al. Role of fat amount and type in ameliorating diet-induced obesity: insights at the level of hypothalamic arcuate nucleus leptin receptor, neuropeptide Y and pro-opiomelanocortin mRNA expression. Diabetes Obes Metab 2004;6:35–44.
 
44. Schwartz GJ. The role of gastrointestinal vagal afferents in the control of food intake: current prospects. Nutrition 2000;16:866–873.
 
45. Broberger C. Brain regulation of food intake and appetite: Molecules and networks. J Intern Med 2005;258:301–327.
 
46. Thompson RH, Swanson LW. Structural characterization of a hypothalamic visceromotor pattern generator network. Brain Res Brain Res Rev 2003;41:153–202.
 
47. Hoyer D, Hannon JP, Martin GR. Molecular, pharmacological and functional diversity of 5-HT receptors. Pharmacol Biochem Behav 2002;71:533–554.
 
48. Matsuzawa Y. Therapy insight: adipocytokines in metabolic syndrome and related cardiovascular disease. Nat Clin Pract Cardiovasc Med 2006;3:35–42.