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I've always been drawn to pathophysiology, and reviewing it helps me better understand the complications my patients face. That's what struck me most about the Obesity Medicine Association's , that it ties the complex issues my patients deal with into a clearer picture.
Inflammation resulting from adiposopathy, often referred to as "sick fat disease," leads to immune dysfunction, chronic inflammation, endocrine abnormalities, and increased free fatty acid circulation, contributing to insulin resistance and beta-cell dysfunction.
- This condition is influenced by the interaction of various organs and has multiple underlying causes.
- Adiposopathy is associated with chronic low-grade inflammation, with elevated levels of tumor necrosis factor-alpha and interleukin-6.
- As adipose tissue expands and becomes dysfunctional, the enlarged adipocytes are more prone to hypoxia and cell death, which triggers the release of cytokines and further inflammation.
- Dysfunctional fat tissue becomes infiltrated by macrophages, which heighten the inflammatory response.
- Excess free fatty acids cause lipotoxicity in muscle and liver, impairing insulin signaling, leading to beta-cell dysfunction and insulin resistance -- culminating in type 2 diabetes.
- This condition can also cause leptin resistance, where the body no longer effectively regulates hunger.
- Excess fat deposits in the liver can result in non-alcoholic fatty liver disease.
- Dysfunctional fat releases angiotensinogen, which raises blood pressure and leads to vascular endothelial dysfunction.
- High levels of adipose tissue also decrease adiponectin, worsening insulin sensitivity.
All these complications make adiposopathy/"sick fat disease" highly detrimental to overall health. Fortunately, we now have management options such as GLP-1 receptor agonists and SGLT-2 inhibitors, which aid in weight loss, improve blood sugar control, and lower cardiovascular risk.
However, medication alone is not enough. Addressing obesity requires comprehensive management. It's essential to approach the topic with sensitivity -- ask for permission, use people-first language, and engage patients in meaningful conversations about their behaviors, diet, and exercise.
Our goal should be to help patients make long-term, sustainable lifestyle changes. Obesity management can't rely on just one pillar, like medication or surgery. It requires a multifaceted approach.
Raghuveer Vedala, MD, FAAFP, DABOM, a Family Medicine and Obesity Medicine Specialist, is a clinical physician (outpatient) at Norman Regional Health (South OKC) in Oklahoma City.
Read the study here and an interview about it here.
Primary Source
Obesity Pillars
Bays HE, et al "Obesity, diabetes mellitus, and cardiometabolic risk: An Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) 2023" 2023; 5: 100056.