What

Is the Disease of
Obesity?
Obesity, the Chronic
Disease
 Chronic Disease Management as Applied to
Obesity
Intervention phase Definition and goals Method
Primary Prevention Prevent development of • Educate the public
overweight and obesity • Modify obesogenic built
environment
• Promote healthy eating and
regular physical activity
Secondary Prevent future weight gain and • Screen using BMI
Prevention development of weight-related • Diagnose using BMI and evaluation
complications in patients with for complications
overweight or obesity • Treat with lifestyle/behavioral
interventions ± weight loss
medications
Tertiary Prevention Treat with weight-loss therapy • Treat with lifestyle/behavioral
to eliminate or ameliorate interventions plus weight loss
weight-related complications medications
and prevent disease • Consider bariatric surgery
progression

Garvey TW, et al. Endocr Pract. 2016;22(suppl 3):1-205.

 Obesity Meets AMA Criteria for a Disease

Impairment of Characteristic Signs

Harm or Morbidity
Normal Function or Symptoms

• Physical impairments • Increased body fat • Cardiovascular disease

• Altered physiologic mass • Type 2 diabetes
function • Joint pain • Metabolic syndrome
(inflammation, insulin • Impaired mobility • Cancer
resistance, • Low self-esteem • Death
dyslipidemia, etc) • Sleep apnea
• Altered regulation of • Altered metabolism
satiety in the
hypothalamus

AMA = American Medical Association.

Mechanick JI, et al. Endocr Pract. 2012;18:642-648.
3
 Medical Complications of Obesity
Obesity

Biomechanical Cardiometabolic Other

Dismotility/disability Dyslipidemia Hypertension Androgen
GERD deficiency
Prediabetic states
Lung function Cancer
defects NAFLD PCOS Gallstone
Osteoarthritis disease
Diabetes Psychological
Sleep apnea
Cardiovascular Disease disorders
Urinary
incontinence

GERD = gastroesophageal reflux disease; NAFLD = nonalcoholic fatty liver disease; PCOS = polycystic ovary syndrome.
Pi-Sunyer X. Postgrad Med. 2009;121:21-33.
4
 Obesity-Related Abnormalities: Mechanical
Problems

§ Breathing disorders (sleep apnea, asthma)

§ Osteoarthritis
§ Urinary stress incontinence
§ GERD

GERD = gastroesophageal reflux disease.

Garvey TW, et al. Endocr Pract. 2016;22(suppl 3):1-205.
5
 Obesity-Related Abnormalities:
Metabolic and Organ Dysfunction
§ Appetite dysregulation § Hypertension
§ Abnormal energy § Infertility
balance § Nonalcoholic fatty liver
§ Endocrine dysfunction disease (NAFLD)
§ Elevated leptin levels § Dyslipidemia
§ Insulin resistance
§ Systemic inflammation
§ Dysregulated adipokine
signaling § Adipose tissue
inflammation
§ Abnormal endothelial
function
GERD = gastroesophageal reflux disease.
Garvey TW, et al. Endocr Pract. 2016;22(suppl 3):1-205.
6
 Obesity Has Multiple Pathophysiologic
Origins

Epigenetic

Environmental Genetic

Obesity

Sociocultural Physiologic

Behavioral

Bray GA, et al. Lancet. 2016;387:1947-1956.

7
Obesity, the Chronic Disease

AACE Obesity Algorithm

Summary

• Obesity is a disease
• Genetic, environmental, and behavioral factors all
contribute to its pathogenesis
• The pathophysiology involves neuroendocrine factors
involved in regulating both appetite and energy balance
• Impairments in physical and physiologic functioning
contribute to high rates of morbidity and mortality

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