Central obesity associates with cardiovascular pathology and death.
Although it constitutes a component of the metabolic syndrome, there are obese people
without other cardiometabolic risk factors and there are normal weight people with
cardiometabolic risk factor clustering, indicating that the problem may be another
rather than obesity itself. It appears that more than the amount of accumulated fat, large
adipocytes and fat deposition in other tissues, such as the liver, indicate metabolic
disease. There is an impressive overlap between Cushing’s syndrome and metabolic
syndrome. Stress reactions appear in a variety of forms, one of them particularly
serious in its consequences, the defeat reaction, in which there is a marked activation of
the hypothalamus-pituitary-adrenal axis with the production of cortisol. Psychosocial
chronic stress, particularly subordinate stress, promotes an increase of cortisol
production. This excess of cortisol, with time, leads to a clinical status of metabolic
syndrome (central obesity, hypertension, dyslipidemia and insulin resistance). This
chain of reactions and events appears to be an important factor in the association
between social-economic status and health, as unemployed, refugees, ethnic minorities,
homeless people, humiliated workers and a huge proportion of women across countries,
small areas, social classes and income distribution, suffer from this type of chronic
stress and have poor health, namely cardiometabolic diseases and depression. Adverse
effects of central obesity are partly directly attributable to obesity itself, but a large part
of those effects is probably due to cortisol. More important than to reduce obesity will
be, therefore, to prevent stress and cortisol excess.
Keywords: Adipocyte, Adrenaline, Benign obesity, 11beta-hydroxysteroid
dehydrogenase type 1, Cardiovascular diseases, Catecholamines, Catechol-Omethyltransferase,
Central obesity, Cortisol, Cushing’ syndrome, Defeat reaction,
Defense reaction, Hypertrophic adipocytes, Metabolic syndrome, Metanephrine,
Noradrenaline, Obesity, Socio-economic status, Stress, Subordinate stress,
Vigilance reaction.
