Medical and Psychological Problems
1 December 1985

Complications of Obesity

Publication: Annals of Internal Medicine
Volume 103, Number 6_Part_2

Abstract

The major diseases associated with obesity are hypertension, atherosclerosis, and diabetes, as well as certain types of cancer. Less well-known complications include hepatic steatosis, gallbladder disease, pulmonary function impairment, endocrine abnormalities, obstetric complications, trauma to the weight-bearing joints, gout, cutaneous disease, proteinuria, increased hemoglobin concentration, and possibly immunologic impairment. A U- or J-shaped curve illustrates the relation between body mass index and the degree of these various complications. This relationship can be used to provide guidelines for assessing treatment of obesity.

Get full access to this article

View all available purchase options and get full access to this article.

References

1.
BRAY G. The Obese Patient. Philadelphia: W. B. Saunders Company; 1976. (Major Problems in Internal Medicine, vol. 9).
2.
LEIJD B. Cholesterol and bile acid metabolism in obesity. Clin Sci. 1980;59:203-6.
3.
Build Study 1979. Chicago: Society of Actuaries and Association of Life Insurance Medical Directors of America; 1980.
4.
LEW E and GARFINKEL L. Variations in mortality by weight among 750,000 men and women. J Chronic Dis. 1979;32:563-76.
5.
STURDEVANT RPEARCE M, and DAYTON S. Increased prevalence of cholelithiasis in men ingesting a serum-cholesterol-lowering diet. N Engl J Med. 1973;288:24-7.
6.
BERNSTEIN RGIEFER EVIEIRA JWERNER L, and RIMM A. Gallbladder disease—II. Utilization of the life table method in obtaining clinically useful information: a study of 62,739 weight-conscious women. J Chronic Dis. 1977;30:529-41.
7.
RIMM AWERNER LVAN YSERLOO B, and BERNSTEIN R. Relationship of obesity and disease in 73,532 weight-conscious women. Public Health Rep. 1975;90:44-51.
8.
FRIEDMAN GKANNEL W, and DAWBER J. The epidemiology of gallbladder disease: observations in the Framingham Study. J Chronic Dis. 1966;19:273-92.
9.
GARN SBAILEY S, and BLOCK W. Relationships between fatness and lipid levels in adults [Letter]. Am J Clin Nutr. 1979;32:733-5.
10.
NESTEL PSCHREIBMAN P, and AHRENS E. Cholesterol metabolism in human obesity. J Clin Invest. 1973;52:2389-97.
11.
MIETTINEN T. Cholesterol production in obesity. Circulation. 1971;44:842-50.
12.
BENNION L and GRUNDY S. Risk factors for the development of cholelithiasis in man (part 2). N Engl J Med. 1978;229:1221-7.
13.
O'BRIEN T. Lower esophageal sphincter pressure (LESP) and esophageal function in obese humans. J Clin Gastroenterol. 1980;2:145-8.
14.
BACKMAN LGRANSTROM LLINDAHL J, and MELCHER A. Manometric studies of lower esophageal sphincter in extreme obesity. Acta Chir Scand. 1983;149:193-7.
15.
BRAILLON A and CAPRON J. Foie et l'obésité. Gastroenterol Clin Biol. 1983;7:627-34.
16.
MAVRELIS PAMMON HGLEYSTEEN JKOMOROWSKI R, and CHARAF U. Hepatic free fatty acids in alcoholic liver disease and morbid obesity. Hepatology. 1983;3:226-31.
17.
ROCHESTER D and ENSON Y. Current concepts in the pathogenesis of the obesity-hypoventilation syndrome: mechanical and circulatory factors. Am J Med. 1974;57:402-20.
18.
SHARP JBARROCAS M, and CHOKROVERTY S. The cardiorespiratory effects of obesity. Clin Chest Med. 1980;1:103-18.
19.
LUCE J. Respiratory complications of obesity. Chest. 1980;78:626-31.
20.
RAY CSUE DBRAY GHANSEN J, and WASSERMAN K. Effects of obesity on respiratory function. Am Rev Respir Dis. 1983;128:501-6.
21.
BURWELL CROBIN EWHALEY R, and BICKELMAN A. Extreme obesity associated with alveolar hypoventilation: a Pickwickian syndrome. Am J Med. 1956;21:811-8.
22.
DOUGLAS F and CHANG P. Influence of obesity on peripheral airways patency. J Appl Physiol. 1972;33:559-63.
23.
DEMPSEY JREDDAN WBALKE B, and RANKIN J. Work capacity determinants and physiologic cost of weight-supported work in obesity. J Appl Physiol. 1966;21:1815-20.
24.
NAIMARK A and CHERNIACK R. Compliance of the respiratory system and its components in health and obesity. J Appl Physiol. 1960;15:377-82.
25.
SHARP JHENRY JSWEANY SMEADOWS W, and PIETRAS R. Effects of mass loading the respiratory system in man. J Appl Physiol. 1965;19:959-66.
26.
LOURENCO R. Diaphragm activity in obesity. J Clin Invest. 1969;48:1609-14.
27.
LOPATA M and ONAL E. Mass loading, sleep apnea, and the pathogenesis of obesity hypoventilation. Am Rev Respir Dis. 1982;126:640-5.
28.
TUCKER D and SIEKER H. The effects of change in body position on lung volumes and intrapulmonary gas mixing in patients with obesity, heart failure and emphysema. J Clin Invest. 1960;39:787-91.
29.
HOLLEY HMILIC-EMILI JBECKLAKE M, and BATES D. Regional distribution, pulmonary ventilation and perfusion in obesity. J Clin Invest. 1967;46:475-81.
30.
KAUFMAN BFERGUSON M, and CHERNIACK R. Hypoventilation in obesity. J Clin Invest. 1956;21:811-8.
31.
ZWILLICH CSUTTON FPIERSON DCREAGH E, and WEIL J. Decreased hypoxic ventilatory drive in the obesity-hypoventilation syndrome. Am J Med. 1975;59:343-8.
32.
LYONS H and HUANG C. Therapeutic use of progesterone in alveolar hypoventilation associated with obesity. Am J Med. 1968;44:881-8.
33.
SUTTON FZWILLICH CCREAGH CPIERSON D, and WEIL J. Progesterone for outpatient treatment of Pickwickian syndrome. Ann Intern Med. 1975;83:476-9.
34.
STROHL KSAUNDERS NFELDMAN N, and HALLETT M. Obstructive sleep apnea in family members. N Engl J Med. 1978;299:969-73.
35.
WHITCOMB MALTMAN NCLARK R, and RALSTIN J. Central and obstructive sleep apnea: pulmonary disease conference at the Ohio State University, Columbus. Chest. 1978;73:857-60.
36.
ORLOWSKI JHERRELL D, and MOODIE D. Narcotic antagonist therapy of the obesity hypoventilation syndrome. Crit Care Med. 1982;10:604-7.
37.
GLASS ABURMAN KDAHMS W, and BOEHM T. Endocrine function in human obesity. Metabolism. 1981;30:89-104.
38.
KLEY HEDELMAN P, and KRUSKEMPER H. Relationships of plasma sex hormones to different parameters of obesity in male subjects. Metabolism. 1980;29:1041-5.
39.
EDMAN C and MACDONALD P. Effect of obesity on conversion of plasma androstenedione to estrone in ovulatory and anovulatory young women. Am J Obstet Gynecol. 1978;130:456-61.
40.
FRISCH R and MCARTHUR J. Menstrual cycles: fatness as a determinant of minimum weight for height necessary for their maintenance or onset. Science. 1974;185:949-51.
41.
CRAWFORD J and OSLER D. Body composition at ménarche: the Frisch-Revelle hypothesis revisited. Pediatrics. 1975;56:449-58.
42.
ROGERS J and MITCHELL G. The relation of obesity to menstrual disturbances. N Engl J Med. 1952;247:53-5.
43.
MITCHELL G and ROGERS J. The influence of weight reduction on obese women. N Engl J Med. 1953;249:835-6.
44.
HARTZ ABARBORIAK PWONG AKATAYAMA K, and RIMM A. The association of obesity with infertility and related menstrual abnormalities in women. Int J Obesity. 1979;3:57-73.
45.
SHERMAN B and KORENMAN S. Measurement of serum LH, FSH, estradiol and progesterone in disorders of the human menstrual cycle. The inadequate luteal phase. J Clin Endocrinol Metab. 1974;39:145-9.
46.
GLASS ADAHMS WABRAHAM GATKINSON RBRAY G, and SWERDLOFF R. Secondary amenorrhea in obesity: etiologic role of weight-related androgen excess. Fertil Steril. 1978;30:243-4.
47.
KOPELMAN PWHITE NPILKINGTON T, and JEFFCOATE S. The effect of weight loss on sex steroid secretion and binding in massively obese women. Clin Endocrinol (Oxf). 1981;15:113-6.
48.
SCHINDLER AEBERT A, and FRIEDRICH E. Conversion of androstenedione to estrone by human tissue. J Clin Endocrinol Metab. 1972;35:627-30.
49.
VERMEULEN A and VERDONCK L. Sex hormone concentrations in post-menopausal women: relation to obesity, fat mass, age and years post menopause. Clin Endocrinol (Oxf). 1979;9:59-66.
50.
LONGCOPE CPRATT JSCHNEIDER S, and FINEBERG S. Aromatization of androgens by muscle and adipose tissue in vivo. J Clin Endocrinol Metab. 1978;46:146-52.
51.
CLELAND WMENDELSON C, and SIMPSON E. Aromatase activity of membrane fractions of human adipose tissue stromal cells and adipocytes. Endocrinology. 1983;113:2155-60.
52.
ZUMOFF B. Relationship of obesity to blood estrogens. Cancer Res. 1982;42(8 suppl):3289s-94s.
53.
LOBO RMARCH CGOEBELSMANN U, and MISHELL D. The modulating role of obesity and 17 beta-estradiol (E2) on bound and unbound E2 and adrenal androgens in oophorectomized women. J Clin Endocrinol Metab. 1982;54:320-4.
54.
SCHNEIDER JBRADLOW HSTRAIN GLEVIN JANDERSON K, and FISHMAN J. Effects of obesity on estradiol metabolism: decreased formation to nonuterotropic metabolites. J Clin Endocrinol Metab. 1983;56:973-8.
55.
KLINGA KVON HOLST T, and RUNNEBAUM B. Influence of severe obesity on peripheral hormone concentrations in pre- and postmenopausal women. Eur J Obstet Gynecol Reprod Biol. 1983;15:103-12.
56.
GOLDZIEHER J. Polycystic ovarian disease. Fertil Steril. 1981;35:371-94.
57.
LAATIKAINEN TTULENHEIMO AANDERSSON B, and KARKKAINEN J. Obesity, serum steroid levels, and pulsatile gonadotropin secretion in polycystic ovarian disease. Eur J Obstet Gynecol Reprod Biol. 1983;15:45-53.
58.
PASQUALI RVENTUROLI SPARADIS RCAPELLI MPARENTI M, and MELCHIONDA N. Insulin and C-peptide levels in obese patients with polycystic ovaries. Horm Metab Res. 1982;14:284-7.
59.
PECKHAM C and CHRISTIANSON R. The relationship between prepregnancy weight and certain obstetric factors. Am J Obstet Gynecol. 1971;111:1-7.
60.
GROSS TSOKOL R, and KING K. Obesity in pregnancy: risks and outcome. Obstet Gynecol. 1980;56:446-50.
61.
SICURANZA B and TISDALL L. Cesarean section in the massively obese. J Reprod Med. 1975;14:10-1.
62.
HODGKINSON R and HUSAIN F. Caesarean section associated with gross obesity. Br J Anaesth. 1980;52:919-23.
63.
GARN S. Some consequences of being obese. In: HANSEN BC, ed. Controversies in Obesity. New York: Praeger Publishers; 1983:287-300.
64.
MCKEOWN T and RECORD R. The influence of body weight on reproductive function in women. J Endocrinol. 1957;5:410-22.
65.
NAEYE R. Weight gain and the outcome of pregnancy. Am J Obstet Gynecol. 1979;135:3-9.
66.
SAVILLE P and DICKSON J. Age and weight in osteoarthritis of the hip. Arthritis Rheum. 1968;11:635-44.
67.
GOLDIN RMCADAM LLOUIE JGOLD R, and BLUESTONE R. Clinical and radiological survey of the incidence of osteoarthrosis among obese patients. Ann Rheum Dis. 1976;35:349-53.
68.
WEBER M. Clinical and roentgenological analysis of 150 cases of chronic nonspecific arthritis. Med Bull Vet Admin. 1939;2:43-60.
69.
HERRELL W. Osteoarthritis and symptomatic arthritis. J Ky Med Assoc. 1961;59:241-5.
70.
ENGEL A. Osteoarthritis and body measurements. Vital Health Stat. 1968;11:1-37.
71.
SILBERBERG R. Obesity and osteoarthritis. In: Medical Complications of Obesity. MANCINI M, LEWIS B, CONTALDO F, eds. London: Academic Press; 1979:301-15.
72.
KANNEL W and GORDON T. Physiological and medical concomitants of obesity: the Framingham Study. In: BRAY GA, ed: Obesity in America. Bethesda, Maryland: National Institutes of Health; 1979. DHEW publication no. (NIH) 79-359.
73.
GANOR S and EVEN-PAZ Z. Fragilitas cutis inguinalis: a phenomenon associated with obesity. Dermatologia. 1967;134:113-24.
74.
BROWN J and WINKELMANN R. Acanthosis nigricans: a study of 90 cases. Medicine (Baltimore). 1968;47:33-51.
75.
KAHN RBAIRD K, and FLIER J. Insulin receptors, receptor antibodies, and the mechanism of insulin action. Recent Prog Horm Res. 1981;37:477-538.
76.
KAHN CFLIER J, and BAR R. The syndromes of insulin resistance and acanthosis nigricans: insulin-receptor disorders in man. N Engl J Med. 1976;294:739-45.
77.
SCHEER J and GUTHRIE H. Hemoglobin criteria with respect to obesity. Am J Clin Nutr. 1979;34:2748-51.
78.
GARN S and RYAN A. Relationship between fatness and hemoglobin levels in the national health and nutrition examinations of the USA. Ecol Food Nutr. 1982;12:211-5.
79.
SELTZER C and MAYER J. A simple criterion of obesity. Postgrad Med. 1965;38A:101-7.
80.
GARN S and PETZOLD A. Fatness and hematological levels during pregnancy [Letter]. Am J Clin Nutr. 1982;36:729-30.
81.
KRISHNAN ETROST LAARONS S, and JEWELL W. Study of function and maturation of monocytes in morbidly obese individuals. J Surg Res. 1982;33:89-97.
82.
KOLTERMAN OOLEFSKY JKURAHARA C, and TAYLOR K. A defect in cell-mediated immune function in insulin-resistant diabetic and obese subjects. J Lab Clin Med. 1980;96:535-43.
83.
CHANDRA R and KUTTY K. Immunocompetence in obesity. Acta Paediatr Scand. 1980;69:25-30.
84.
WEISINGER JKEMPSON RELDRIDGE F, and SWENSON R. The nephrotic syndrome: a complication of massive obesity. Ann Intern Med. 1974;81:440-7.
85.
LARSSON BSVARDSUDD KWELIN LWILHELMSEN LBJORNTORP P, and TIBBLIN G. Abdominal adipose tissue distribution, obesity, and risk of cardiovascular disease and death: 13 year follow up of participants in the study of men born in 1913. Br Med J [Clin Res]. 1984;288:1401-4.
86.
LAPIDUS LBENGTSSON CLARSSON BPENNERT KRYBO E, and SJOSTROM L. Distribution of adipose tissue and risk of cardiovascular disease and death: a 12 year follow up of participants in the population study of women in Gothenburg, Sweden. Br Med J [Clin Res]. 1984;289:1257-61.
87.
GARROW J. Treat Obesity Seriously: A Clinical Manual. London: Churchill Livingstone; 1981.

Information & Authors

Information

Published In

cover image Annals of Internal Medicine
Annals of Internal Medicine
Volume 103Number 6_Part_21 December 1985
Pages: 1052 - 1062

History

Published in issue: 1 December 1985
Published online: 1 December 2008

Keywords

Authors

Affiliations

GEORGE A. BRAY, M.D.
▸From the Section of Diabetes and Clinical Nutrition, University of Southern California School of Medicine; Los Angeles, California.

Metrics & Citations

Metrics

Citations

If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. For an editable text file, please select Medlars format which will download as a .txt file. Simply select your manager software from the list below and click Download.

For more information or tips please see 'Downloading to a citation manager' in the Help menu.

Format





Download article citation data for:
GEORGE A. BRAY. Complications of Obesity. Ann Intern Med.1985;103:1052-1062. doi:10.7326/0003-4819-103-6-1052

View More

Get Access

Login Options:
Purchase

You will be redirected to acponline.org to sign-in to Annals to complete your purchase.

Access to EPUBs and PDFs for FREE Annals content requires users to be registered and logged in. A subscription is not required. You can create a free account below or from the following link. You will be redirected to acponline.org to create an account that will provide access to Annals. If you are accessing the Free Annals content via your institution's access, registration is not required.

Create your Free Account

You will be redirected to acponline.org to create an account that will provide access to Annals.

View options

PDF/ePub

View PDF/ePub

Related in ACP Journals

Media

Figures

Other

Tables

Share

Share

Copy the content Link

Share on social media