Pathogenesis of Obesity Related Type Diabetes

Philip McTernan and Sudhesh Kumar Introduction

The profound changes in eating habits, agricultural capabilities and pattern of physical activity has fuelled today's epidemic of obesity, bringing with it a host of long-term complications. However, obesity has not always been regarded as a disadvantage. Statues dating from the Stone Age period appear to provide the earliest depictions of obesity. These Stone Age sculptures demonstrate not only the social importance attached to it, but also the survival advantage conferred by the ability to store energy (Bray, 1990). The most famous of these, the Venus of Willendorf, a 12-cm limestone figurine, demonstrates a woman with excessive body fat stores (Figure 4.1) whose habitus has been ascribed to a diet rich in fat and marrow and a sedentary lifestyle secondary to confinement in caves during the glacial period. These early depictions, however, not only highlight obesity as a phenomenon but also draw attention to the importance of body fat distribution. Whilst the lower body fat distribution of the Venus of Willendorf may have been symbolic of power and efficient fuel storage (Kissebah et al., 1994) the concomitant hazards of obesity were, in fact, recognized as early as ~ 400 bc by Hippocrates who noted that 'sudden death is more common in those who are naturally fat than in the lean' (Bray, 1990). It is, however, only since the later half of the 20th century, that clinical obesity has emerged from the realm of sociology and a philosophical talking point to be recognized as a scientific discipline. This transformation can be most significantly attributed to the changing perception of adipose tissue as more than a mere site of lipid

Obesity and Diabetes. Edited by Anthony H. Barnett and Sudhesh Kumar © 2004 John Wiley & Sons, Ltd ISBN: 0-470-84898-7

PATHOGENESIS OF OBESITY-RELATED TYPE 2 DIABETES

PATHOGENESIS OF OBESITY-RELATED TYPE 2 DIABETES

Figure 4.1 Venus of Willendorf.

storage and a recognition from epidemiological studies that fat distribution and accumulation alters the associated risk of disease (Vague, 1956).

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