Pathophysiology and Obesity-related Complications
As illustrated in the former OER section, obesity is a chronic, relapsing, multifactorial disease characterised not only by excess adiposity. The development of obesity is influenced by complex interactions among genetic, neurologic, metabolic, enteric and behavioural factors. Central to obesity's pathophysiology is adipose tissue dysfunction, in which impaired adipocyte expandability, altered adipokine secretion, chronic low-grade inflammation, ectopic lipid deposition and insulin resistance contribute to systemic metabolic disturbances. As adipose tissue loses its capacity to store energy safely, lipids accumulate in non-adipose organs, promoting cardiometabolic complications.
Consequently, obesity remains a major modifiable risk factor for multiple comorbidities, including cardiovascular disease, diabetes mellitus, and cancer. Although significant advances have been made
in obesity treatment including dietary interventions, lifestyle modification, pharmacotherapy, endoscopic procedures and bariatric surgery, there remains a critical need to better understand the heterogeneity
of obesity’s underlying pathophysiology and clinical outcomes.
In this section, information is provided on the pathophysiological mechanisms contributing to obesity and its related comorbidities, with particular attention to adipose tissue dysfunction. Moreover, the risk and manifestation of these complications can vary depending on factors such as environmental influences, ethnicity and sex, the latter being visualised in this OER section.​​​​​​
EASO ECN Masterclass Lecture - Adipose tissue dysfunction in obesity: a driver for cardiometabolic complications
This lecture from the 2025 EASO Early Career Network Masterclass, delivered by Professor Gijs Goossens in November 2025, is shared by PROMINENCE OER with permission of EASO and the speaker.
Obesity-associated Comorbidities
Epidemiological research from large-scale electronic health record data, measured prospectively over
10 years, has shown a clear relationship between BMI and the incidence (new development) of 6 major comorbidities:
-
Coronary Artery Disease,
-
Hyperlipidemia,
-
Hypertension,
-
Obstructive Sleep Apnoea,
-
Osteoarthritis, and
-
Type 2 Diabetes Mellitus.
This is illustrated in the graphic below, which also demonstrates the BMI cut points (kg/m2) associated with a rise in 1 year incidence.
EASO Health Impacts of Obesity in Males and Females Infographic
The disease of obesity has extensive health impacts, with associated comorbidities in multiple body systems.
The European Association for the Study of Obesity (EASO) has developed the infographics, displayed below, as visual resources to demonstrate how obesity is associated with neurological, cardiovascular, metabolic, respiratory, reproductive and musculoskeletal complications. This emphasises type 2 diabetes, coronary artery disease, obstructive sleep apnoea, endocrine disorders and certain cancers. It also highlights less commonly recognised consequences of obesity, such as chronic kidney disease, cognitive decline and skin disorders. Illustrations for both males and females are shown.
Click here for reading on obesity and its impacts on health.
This resource was developed by the European Association for the Study of Obesity (EASO) and is shared with permission
for inclusion in the PROMINENCE Open Education Resource (OER). For more information, visit easo.org.