Chester County Medicine Summer 2021 - 16

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Obesity,
Not so Silent Killer
BY MIAN A. JAN, M.D., F.A.C.C., F.C.S.I.A. AND DANYAL QURAISHI
Introduction
In simple terms, obesity is described
as a state of excess body fat. The effects of
obesity go far beyond cosmetic purposes
and should not be taken lightly due to
its profound effects on the human body.
Currently, obesity stands as one of the
leading preventable causes of death in
the United States. Lancet, the prestigious
international journal, named the U.S. the
most obese nation in the world. With more
than a third of U.S. adults being obese, the
obesity crisis requires attention from our
community. Body Mass Index (BMI) is a
simple screening tool used to assess weight
and obesity. It is important to note that
BMI does not diagnose body fat or overall
health.
body and is vital for maintaining our
body's homeostasis. As further discussed
below, AT is a primary secretor of pertinent
hormones and is a critical regulator in free
fatty acid circulation.
" Except for smoking, obesity is now the
number one preventable cause of death
in this country. Three hundred thousand
people die of obesity every year. "
~Dr. C. Everett Koop, former U.S.
Surgeon General.
Pathophysiology
As the body adjusts to a lifestyle of
increased caloric intake and decreased
energy expenditure, we begin to see
discrepancies in hormonal response and
free fatty acid circulation. These two effects
lead to various health consequences, such
as type 2 diabetes, depicted in Figure 2.
Adipokines
With respect to hormones, AT is
Figure 1 displays the BMI values
associated with various body types.
Obesity occurs over time as a result of the
body gradually reaching a new point of
homeostasis. As the primary goal of our
body is to set and maintain a balance,
obesity occurs to offset the imbalance
between energy expenditure and calorie
intake. In essence, obesity is commonly due
to excess fatty acid deposits in the body.
A typical storage place for such deposits is
Adipose Tissue (AT). Commonly known
as fat tissue, AT is found throughout the
a primary secretor of inflammatory
hormones known as adipokines.
Adipokines primarily produce an
inflammatory state and are responsible for
body-fat regulation. This is done through
a downstream mechanism involving
adipokine-induced cytokines such as
tumor necrosis alpha and interleukin-6.
An increase in these cytokines induces a
vascular endothelial response, resulting
in inflammation. Chronic inflammation
increases the expression of several proteins
that suppress insulin pathways. Over time,
this overproduction of insulin suppressive
proteins makes the human body less
responsive to insulin. Insulin resistance is
16 CHESTER COUNTY Medicine | SUMMER 2021
what gives way to type-2 diabetes.|
Lipotoxicity
When our caloric intake begins to
supersede the storage capacity of AT, we
begin to see an overabundance of free fatty
acids within our bloodstream. Lipotoxicity
refers to the harmful effects of the high
circulation of fatty acids. Similar to chronic
inflammation, increased free fatty acid
circulation levels are also detrimental to
insulin sensitivity.
Pancreatic beta cells are the cells
responsible for synthesizing and producing
insulin for our bodies. Due to their
limited regenerative capacity, these beta
cells are susceptible to damage from a
lipotoxic environment. A high fatty acid
environment leads to beta-cell destruction
through intracellular toxic metabolites and
activation of cell-death pathways. Like
chronic adipokine-induced inflammation,
this lipotoxic environment can also give rise
to type-2 diabetes.
" Obesity affects every aspect of a people's
lives, from health to relationships. "
~Jane Velez-Mitchell, award-winning
journalist
Other Health
Consequences
An additional risk is the development of
metabolic syndrome. Metabolic syndrome
is classified as a cluster of interrelated risk
factors for various cardiovascular diseases.
This includes hypertension, high blood
sugar, abnormal cholesterol levels, and
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