The Present and Future
State-of-the-Art Review
Obesity: Pathophysiology and Management

https://doi.org/10.1016/j.jacc.2017.11.011Get rights and content
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Abstract

Obesity continues to be among the top health concerns across the globe. Despite our failure to contain the high prevalence of obesity, we now have a better understanding of its pathophysiology, and how excess adiposity leads to type 2 diabetes, hypertension, and cardiovascular disease. Lifestyle modification is recommended as the cornerstone of obesity management, but many patients do not achieve long-lasting benefits due to difficulty with adherence as well as physiological and neurohormonal adaptation of the body in response to weight loss. Fortunately, 5 drug therapies—orlistat, lorcaserin, liraglutide, phentermine/topiramate, and naltrexone/bupropion—are available for long-term weight management. Additionally, several medical devices are available for short-term and long-term use. Bariatric surgery yields substantial and sustained weight loss with resolution of type 2 diabetes, although due to the high cost and a small risk of serious complications, it is generally recommended for patients with severe obesity. Benefit-to-risk balance should guide treatment decisions.

Key Words

adipose tissue
antiobesity drugs
bariatric surgery
obesity
overweight
weight loss

Abbreviations and Acronyms

BMI
body mass index
CI
confidence interval
CVD
cardiovascular disease
CVOT
cardiovascular outcomes trial
FDA
Food and Drug Administration
HF
heart failure
HgA1c
glycosylated hemoglobin
ILI
intensive lifestyle intervention
LAGB
laparoscopic adjustable gastric band
LV
left ventricular
MACE
major adverse cardiovascular events
MRI
magnetic resonance imaging
NB
naltrexone/bupropion
PHEN/TPM
phentermine/topiramate
RCT
randomized controlled trial
RYGB
Roux-en-Y gastric bypass
SG
sleeve gastrectomy
T2D
type 2 diabetes

Cited by (0)

Dr. Gadde is an advisor to AstraZeneca with payments made to his employer, Pennington Biomedical Research Center; has received research support from the National Institutes of Health (NIH) and AstraZeneca; and has received speaking honoraria from the American Diabetes Association. Dr. Martin has served as an advisor for ACAP Health, Zafgen, Gila Therapeutics, Weight Watchers, Florida Hospital and Kitchry; has received research funding from the NIH, Centers for Disease Control, U.S. Department of Agriculture, Ohio State University, Elizabeth Blackwell Institute for Health Research, Patient-Centered Outcomes Research Institute, Egg Board, University of Pennsylvania, Louisiana LIFT Fund, Weight Watchers, and Regents of Georgia State University, and Access Business Group International; and has received royalties from his institution licensing smartphone-based technology he invented. Dr. Berthoud has received research funding from the NIH. Dr. Heymsfield has received fees for serving on advisory boards from Janssen Pharmaceuticals, Tanita, Merck, and Medifast.

Listen to this manuscript's audio summary by JACC Editor-in-Chief Dr. Valentin Fuster.