Obesity: Pathophysiology and Management

J Am Coll Cardiol. 2018 Jan 2;71(1):69-84. doi: 10.1016/j.jacc.2017.11.011.


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.

Keywords: adipose tissue; antiobesity drugs; bariatric surgery; obesity; overweight; weight loss.

Publication types

  • Review

MeSH terms

  • Anti-Obesity Agents / pharmacology*
  • Bariatric Surgery / methods*
  • Cardiovascular Diseases* / epidemiology
  • Cardiovascular Diseases* / prevention & control
  • Humans
  • Obesity* / epidemiology
  • Obesity* / physiopathology
  • Obesity* / therapy
  • Risk Assessment
  • Risk Factors
  • Risk Reduction Behavior


  • Anti-Obesity Agents