2 Pathophysiology of Obesity Comorbidity: The Effects of Chronically Increased Intra-abdominal Pressure

Abstract

Severe obesity is associated with multiple comorbidities that reduce the life expectancy and markedly impair the quality of life. Morbidly obese patients can suffer from central (android) obesity or peripheral (gynoid) obesity or a combination of the two. Gynoid obesity is associated with degenerative joint disease and venous stasis in the lower extremities. Android obesity is associated with the highest risk of mortality related to problems due to the metabolic syndrome or syndrome X, as well as increased intraabdominal pressure (IAP). The metabolic syndrome is associated with insulin resistance, hyperglycemia, and type 2 diabetes mellitus (DM), which in turn are associated with nonalcoholic liver disease (NALD), polycystic ovary syndrome, and systemic hypertension (1–7). Increased IAP is probably responsible in part or totally for obesity hypoventilation, venous stasis disease, pseudotumor cerebri, gastroesophageal reflux disease, stress urinary incontinence, and systemic hypertension. Central obesity is also associated with increased neck circumference and sleep apnea.