Overweight is risking fate.
Obesity is the result of ancient evolutionary survival mechanisms in a modern environment of affluence. When pressures from this environment generate a long-term or chronic hypothalamic arousal, neuroendocrine-endocrine and autonomic nervous systems are activated, leading to disease-generating 'risk factors' including the metabolic syndrome, with visceral fat accumulation as a conveniently observable marker. The susceptibility to develop these co-morbidities is probably dependent on a functional defect of the inhibitory feedback control of the hypothalamus-pituitary-adrenal axis by central glucocorticoid receptors, often based on a prevalent polymorphism of the gene locus for this receptor. This means that moderate ('peripheral') obesity is a fairly innocent condition while, when hypothalamic arousal is added, as indicated by the internalization of excess body fat ('central' obesity), a highly malignant condition develops in genetically susceptible individuals. Obesity research would benefit from a distinction between these two types of condition.
Department of Heart and Lung Diseases, Sahlgren's Hospital, University of Göteborg, Sweden.
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Björntorp
D001824:Body Constitution; D004032:Diet / Q000009:adverse effects; D006801:Humans; D007030:Hypothalamo-Hypophyseal System / Q000378:metabolism; D009765:Obesity / Q000145:classification / Q000150:complications / Q000453:epidemiology / Q000209:etiology / Q000235:genetics / Q000378:metabolism; D010913:Pituitary-Adrenal System / Q000378:metabolism; D011965:Receptors, Glucocorticoid / Q000378:metabolism
D011965:Receptors, Glucocorticoid