The problem of classifying obesity

Abstract

The numerous attempts to classify obesity demonstrate the difficulty of grouping the obesity syndrome into a single schema. The criteria can be subdivided into 3 groups: the first based on etiology and pathogenesis; the second based on clinical observation, anthropomorphic measurements and adipose tissue histology; and the third based on psychological and nutritional behavior, and environmental elements. The etiological classification subdividing obesity into genetic, hypothalamic, nutritional, physical inactivity, and endocrine groups is important because it best approximates the clinical reality of obesity.Recently acquired knowledge about adipose tissue cellularity and its metabolism has become important for clinical classification of the different types of obesity. Now we can divide obesity into hypertrophic (the weight of the adipocite increases), hyperplastic (only the number of adipose cells increases), and combined (number and weight of adipocite increase). Pure hyperplastic obesity is rarely found, while combined obesity is more frequent; the hypertrophic form is associated with obesity arising in adult life.Considerable information is gained from the study of anomalous nutritional behavior. The excess of food intake has psychologically disparate motivations that are caused by emotional reaction to anxiety‐provoking events or to a developing modification of personality. The first is reactive obesity, the second developmental obesity. However, among the obese there are individuals who have no specific psychological problems and are prompted to hyperfeed by environmental factors. In this case, the term “environmental obesity” is used. As regards a proper therapeutic approach, these distinctions are very important.