Approaches to reducing abdominal obesity

Abstract

Excess intra-abdominal adipose tissue accumulation, often termed visceral obesity, is the critical target for medical and public health efforts to reduce the systemic inflammation related to the global epidemic of obesity-associated metabolic disorders. Visceral obesity is characterized by ectopic triglyceride (TG) storage closely related to clustering risk factors for chronic age-related disorders including heart disease, diabetes, liver disease, and common forms of cancer. Hypertriglyceridemia, liver insulin resistance, inflammation of the liver, increased liver VLDL synthesis and secretion, reduced TG-rich lipoprotein clearance, small dense LDL particles, reduced HDL cholesterol, and increased circulating adipocytokines are among the many metabolic alterations that characterize this common condition. Age, gender, genetics, and ethnicity contribute to the observed variations in visceral adipose tissue accumulation in different populations globally. Efforts to bring all obesity under the rubric of body mass index have failed in much of Asia, where there will be a significant expansion of the epidemic of type 2 diabetes mellitus among individuals not classified as either overweight or obese by Western BMI criteria. Attempts to adjust BMI criteria to lower levels have largely been without success since they do not deal with the underlying problem of visceral obesity.