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Obesity is a chronic, relapsing neurochemical disease


The debate about whether obesity should be called a disease continues. From a clinical perspective, it meets the criteria needed to call it a disease. It has an etiology—an imbalance between energy intake and expenditure. It has a pathogenesis in the feedback systems involving leptin, neurochemicals in the brain, and the neural and endocrine messages that respond to the intake of food. The pathology of obesity lies in its enlarged fat cells, and the pathophysiology lies in the changes in the secretion of products from these enlarged fat cells, including cytokines, procoagulants, inflammatory peptides, and angiotensinogen. These secretory products of fat cells and the increased mass of fat are responsible for the associated metabolic diseases, such as diabetes, hypertension, heart disease, sleep apnea, and some sorts of cancer. Treatments consist of techniques to alter the balance between energy intake and energy expenditure. This constellation of factors leads to the conclusion that obesity should be called a disease.

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  1. Heshka S, Allison DB . Is obesity a disease? Int J Obes Relat Metab Disord 2001; 25: 1401–1404.

    CAS  Article  PubMed  Google Scholar 

  2. Downey M . Obesity as a disease entity. Am Heart J 2001; 142: 1091–1094.

    CAS  Article  PubMed  Google Scholar 

  3. Fine JT, Colditz GA, Coakley EH, Moseley G, Manson JE, Willett WC, Kawachi I . A prospective study of weight change and health-related quality of life in women. JAMA 1999; 282: 2136–2142.

    CAS  Article  PubMed  Google Scholar 

  4. Coakley EH, Rimm EB, Colditz G, Kawachi I, Willett W . Predictors of weight change in men: results from the Health Professionals Follow-up Study. Int J Obes Relat Metab Disord 1998; 22: 89–96.

    CAS  Article  PubMed  Google Scholar 

  5. Bray GA . Obesity: Historical development of scientific and cultural ideas. Int J Obes Relat Metab Disord 1990; 14: 909–926.

    CAS  Google Scholar 

  6. Flemyng M . A discourse on the nature, causes, and cure of corpulency, [illustrated by a remarkable case, read before the Royal Society, November 1757]. L. Davis and C. Reymers: London; 1760.

    Google Scholar 

  7. Wadd W . Cursory remarks on CORPULENCE; by a member of the Royal College of Surgeons [William Wadd, Surgeon]. J. Callow, Medical Bookseller: London; 1810.

    Google Scholar 

  8. Babinski JFF . Tumeur du corps pituitaire sans acromegalie et avec arret de developpement des organes genitaux. Rev Neurol 1900; 8: 531–533.

    Google Scholar 

  9. Frohlich A . Ein Fall von Tumor der Hypophysis cerebri ohne Akromegalie. Wien klin Rundschau 1901; 15: 883–886, 906–908.

    Google Scholar 

  10. Duffin J . History of medicine. University of Toronto Press: Toronto; 1999.

    Google Scholar 

  11. Faber K . Nosography in modern internal medicine. Paul B. Hoeber Inc.: New York; 1923.

    Google Scholar 

  12. Bray GA . Drug treatment of obesity: don't throw the baby out with the bath water. Am J Clin Nutr 1998; 67: 1–4, [editorial].

    CAS  Article  PubMed  Google Scholar 

  13. von Helmholtz H . Uber die Erhaltung der Kraft. G. Reimer: Berlin; 1847.

    Google Scholar 

  14. Atwater WO, Benedict FG . Experiments on the metabolism of matter and energy in the human body, 1899–1900. Government Printing Office: Washington; 1902. U.S. Department of Agriculture, Office of Experiment Stations Bulletin No. 109.

    Book  Google Scholar 

  15. Zhang Y, Proenca R, Maffei M, Barone M, Leopold L, Friedman JM . Positional cloning of the mouse obese gene and its human homologue. Nature 1994; 372: 425–432.

    CAS  Article  PubMed  Google Scholar 

  16. Guy-Grand B, Apfelbaum M, Crepaldi G, Gries A, Lefebvre P, Turner P . International trial of long-term dexfenfluramine in obesity. Lancet 1989; 2: 1142–1145.

    CAS  Article  PubMed  Google Scholar 

  17. Schwartz MW, Woods SC, Porte Jr D, Seeley RJ, Baskin DG . Central nervous system control of food intake. Nature 2000; 404: 661–671.

    CAS  Article  PubMed  Google Scholar 

  18. Tecott LH, Sun LM, Akana SF, Strack AM, Lowenstein DH, Dallman MF, Julius D . Eating disorder and epilepsy in mice lacking 5-HT2c serotonin receptors. Nature 1995; 374: 542–546.

    CAS  Article  PubMed  Google Scholar 

  19. Bray GA, Greenway FL . Current and potential drugs for treatment for obesity. Endocr Rev 1999; 20: 805–875.

    CAS  Article  PubMed  Google Scholar 

  20. Morgagni JB . De sedibus, et causis morborum per anatomen indagatis Libri Quinque. Dissectiones, et animadversiones, nunc primum editas complectuntur propenodum innumeras, medicis, chirurgis, anatomicia profuturas. Multiplex praefixus est index rerum and nominum accuratissimus. Typographia Remodiniana: Venetiis; 1761.

    Google Scholar 

  21. Schwann T . Mikroscopische Untersuchungen uber die Uebereinstimmung in der Struktur un dem Wachsthum der Thiere und Pflanzen. Sander: Berlin; 1839.

    Google Scholar 

  22. Virchow R . Die Cellularpathologie in inrer Begrundung auf physiologische and pathologische Gewebelehre. August Hirschwald: Berlin; 1858.

    Google Scholar 

  23. Bjurlf P . Atherosclerosis and body build with special reference to size and number of subcutaneous fat cells. Acta Med Scand 1959; 166: 99.

    Google Scholar 

  24. Bjorntorp P . Obesity at the cellular level. Nord Med 1991; 106: 191–194, [Review].

    CAS  PubMed  Google Scholar 

  25. Hirsch J, Gallian E . Methods for the determination of adipose cell size in man and animals. J Lipid Res 1968; 9: 110–119.

    CAS  PubMed  Google Scholar 

  26. Bray GA . An atlas of obesity and weight control. Parthenon Publishing: London; 2003.

    Google Scholar 

  27. Dresner A, Laurent D, Marcucci M, Griffin ME, Dufour S, Cline GW, Slezak LA, Andersen DK, Hundal RS, Rothman DL, Petersen KF, Shulman GI . Effects of free fatty acids on glucose transport and IRS-1-associated phosphatidylinositol 3-kinase activity. J Clin Invest 1999; 103: 253–259.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  28. Randle PJ, Garland PB, Hales CN, Newsholme EA . The glucose fatty-acid cycle: its role in insulin sensitivity and the metabolic disturbances of diabetes mellitus. Lancet 1963; i: 785–789.

    Article  Google Scholar 

  29. Smith SR, Lovejoy JC, Greenway F, Ryan D, deJonge L, de la Bretonne J, Volafova J, Bray GA . Contributions of total body fat, abdominal subcutaneous adipose tissue compartments, and visceral adipose tissue to the metabolic complications of obesity. Metabolism 2001; 50: 425–435.

    CAS  Article  PubMed  Google Scholar 

  30. Hegarty BD, Furler SM, Ye J, Cooney GJ, Kraegen EW . The role of intramuscular lipid in insulin resistance. Acta Physiol Scand 2003; 178: 373–383.

    CAS  Article  PubMed  Google Scholar 

  31. Ridker PM, Rifai N, Rose L, Buring JE, Cook NR . Comparison of C-reactive protein and low-density lipoprotein cholesterol levels in the prediction of first cardiovascular events. N Engl J Med 2002; 347: 1557–1565.

    CAS  Article  PubMed  Google Scholar 

  32. Quetelet A . Sur l'homme et le developpement de ses facultes, ou essai de physique sociale. Bachelier: Paris; 1835.

    Google Scholar 

  33. Bray GA . Contemporary diagnosis and management of obesity and the metabolic syndrome, 2nd edn Handbooks in Health Care: Newtown, PA; 2003.

    Google Scholar 

  34. National Cholesterol Education Program. Executive summary of the third report of The National Cholesterol Education Program (NCEP) Expert Panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). JAMA 2001; 285: 2486–2497.

  35. 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.

    Article  PubMed  Google Scholar 

  36. Rankinen T, Perusse L, Weisnagel SJ, Snyder EE, Chagnon YC, Bouchard C . The human obesity gene map: the 2001 update. Obes Res 2002; 10: 196–243, [Review].

    CAS  Article  PubMed  Google Scholar 

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Correspondence to G A Bray.

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Bray, G. Obesity is a chronic, relapsing neurochemical disease. Int J Obes 28, 34–38 (2004).

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  • leptin
  • treatments
  • etiology

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