Obesity

Obesity is a chronic, complex disease characterised by an accumulation of body fat sufficient to impair health, with genetic, environmental, hormonal and metabolic components.

In current medical practice it is no longer regarded as a simple excess of calories or a failure of willpower. It is recognised as a chronic, progressive endocrine and metabolic disorder that arises when the balance among the brain, hormonal signalling, the gut microbiota and adipose tissue is disrupted. Each increase in weight creates a wave of profound hormonal resistance and systemic inflammation in the body.

Major Metabolic and Endocrine Problems of Obesity

Insulin Resistance, Prediabetes and Type 2 Diabetes

Excess adipose tissue, particularly visceral fat surrounding the internal organs, causes cells to become insensitive to insulin. The pancreas secretes excess insulin to overcome this resistance (hyperinsulinaemia). This both makes weight loss more difficult and, over time, exhausts the pancreatic islet cells, setting the stage for type 2 diabetes. Glucose dysregulation and episodes of reactive hypoglycaemia should be identified early so that metabolic damage can be prevented.

Dyslipidemia and Cardiovascular Risks

Metabolically active adipose tissue releases free fatty acids and pro-inflammatory cytokines into the circulation. This disturbs blood lipids (raised triglycerides, raised LDL cholesterol and a fall in protective HDL) and leads to atherosclerosis and hypertension.

Non-Alcoholic Fatty Liver Disease (MAFLD/MASH) and Liver Enzyme Abnormalities

Fat accumulation in the liver (steatosis) is seen in a large proportion of patients with obesity. This is a silent metabolic threat that may progress over time to inflammation (MASH), fibrosis and even cirrhosis.

Neuroendocrine and Appetite Signalling Disorders

Leptin resistance, imbalances of the hunger hormone ghrelin, and regulatory defects in the hypothalamic appetite centre mean that a person may never receive a satiety signal, however much they eat.

Endocrinological Follow-up of Treatments Is Essential

Both the new-generation pharmacological agents used to treat obesity (GLP-1 receptor agonists and multi-hormone analogues) and bariatric or metabolic surgical procedures are powerful therapeutic tools. Their success, and the patient's safety, depend on a strict endocrinological follow-up protocol:

• Monitoring of Metabolic Adaptation: During rapid weight loss, regular monitoring of thyroid hormone balance, pancreatic and renal function, and electrolytes is important.
• Preservation of Muscle Mass and Bone Health: The muscle loss (sarcopenia) and the decline in bone mineral density that occur when weight loss is poorly managed can be prevented only through joint follow-up by endocrinology and nutrition specialists.
• Prevention of the Yo-Yo Effect (Weight Regain): Managing the hormonal resistance mechanisms that may appear after a drug is stopped, or after obesity surgery, is essential for lasting success.

The eKonsey system maps the patient's entire hormonal and metabolic profile and aims to provide a Medical Opinion on a personalised roadmap.