Trimming the Fat, Do We Know Where to Begin?

The worldwide prevalence of obese and overweight individuals has increased ≈3-fold during the past 30 years, from 857 million in 1980 to 2.1 billion in 2014.1 Once thought to be a rich world problem, rates have increased dramatically even in low- and middle-income countries with 1 in 7 obese individuals residing in China and India. As global demographic trends continue to shift toward urbanization, typified by sedentary lifestyles with easy accessibility to calorie-dense foods, rates are only expected to increase. Particularly alarming is the rapid rise in childhood obesity, portending poorly for the anticipated burdens on future healthcare systems. Obesity-related diseases have already surpassed tobacco as the largest noncommunicable cause of death worldwide.2See Article by Graner et al But what makes obesity such a potent risk factor for the development of so called lifestyle diseases? Advances in imaging technology have improved our understanding of the relationship between body weight and health and has helped highlight the metabolic consequences of fat mass in relation to total body mass. Although body mass index is a cost-effective and simple screening tool, the sensitivity for detecting individuals with poor metabolic health and increased risk of mortality can be imprecise.3 In normal weight individuals, body fat percentage may be a better predictor of poor metabolic health and cardiovascular mortality.4 With the advent of dual-energy x-ray absorptiometry and MRI, the ability to compartmentalize fat depots …