Obesity and stress

Obesity is a complex, diffuse premorbid condition, characterized by an array of alterations in regulatory mechanisms, that have been associated with a higher risk for metabolic and cardiovascular diseases. Given the high prevalence of the condition we could accept the concept of 'obese epidemics'. However, in spite of a critical focus both of the medical profession and of mass media, coupled with extremely elevated costs of obesity, some experts state that 'therapy could be more dangerous than the disease'. Obesity derives from a long standing interaction between genetics and environment. Long years of maladaptive life styles (overeating and sedentary habits) are the consequence of an ill-regulated 'reward system'. Altered regulation of alimentary behavior seems critically dependent upon an unbalanced neurohormonal central receptor function. From a practical point of view it might be useful to introduce the concept of stress, as a way to provide quantitative parameters of the environmental effects on individual patients. Spectral analysis of cardiovascular variability provides quantitative indices of the interaction between efferent vagal and sympathetic modulatory activity, and of the influence of obesity. This condition produces autonomic alterations that appear related to attendant hormonal disturbances. From a therapeutical point of view new habits, not diets; an integrated multidisciplinary approach to healthy eating, not simply drugs or ideal weight; an equilibrium between theoretical principles and complex, tailored individual treatments.