Obesity and Cardiovascular Diseases: CVIA State-of-the-Art Review

Abstract

Obesity, given its strong association with cardiovascular diseases (CVDs), is a major global public health issue attracting increasing attention. This comprehensive review systematically synthesizes clinical and basic research progress in elucidating the complex relationship between obesity and CVDs. We explore the epidemiology, pathophysiology, clinical manifestations, and management strategies for obesity-related CVDs. Drawing on recent studies, we highlight the effects of obesity on atherosclerotic disease, cardiomyopathy, heart failure, arrhythmias, hypertension, and venous thromboembolism. Understanding these mechanisms is essential for developing effective prevention and treatment strategies to decrease the cardiovascular burden associated with obesity. Furthermore, this review summarizes current therapeutic approaches for obesity-related CVDs, such as lifestyle interventions, pharmacotherapy, and metabolic surgery, and discusses future research directions, including precision medicine, exploration of novel therapeutic targets, and single-cell spatiotemporal omics.

Keywords

Obesity / Cardiovascular diseases / Pathological Mechanisms / Therapeutic interventions / Chronic inflammation

References

[1] Burki T. European Commission classifies obesity as a chronic disease. Lancet Diabetes Endocrinol. 2021. Vol. 9(7):418

[2] Global BMI Mortality Collaboration; Di Angelantonio E, Bhupathiraju ShN, Wormser D, Gao P, Kaptoge S, et al.. Body-mass index and all-cause mortality: individual-participant-data meta-analysis of 239 prospective studies in four continents. Lancet. 2016. Vol. 388(10046):776-86

[3] GBD 2015 Obesity Collaborators; Afshin A, Forouzanfar MH, Reitsma MB, Sur P, Estep K, et al.. Health effects of overweight and obesity in 195 countries over 25 years. N Engl J Med. 2017. Vol. 377(1):13-27

[4] Valenzuela PL, Carrera-Bastos P, Castillo-Garcia A, Lieberman DE, Santos-Lozano A, Lucia A. Obesity and the risk of cardiometabolic diseases. Nat Rev Cardiol. 2023. Vol. 20(7):475-94

[5] WHO Expert Consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004. Vol. 363(9403):157-63

[6] GBD 2021 Adult BMI Collaborators. Global, regional, and national prevalence of adult overweight and obesity, 1990-2021, with forecasts to 2050: a forecasting study for the Global Burden of Disease Study 2021. Lancet. 2025. Vol. 405(10481):813-38

[7] GBD 2017 Diet Collaborators. Health effects of dietary risks in 195 countries, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet2019. Vol. 393(10184):1958-72

[8] Timmis A, Vardas P, Townsend N, Torbica A, Katus H, De Smedt D, et al.. European Society of Cardiology: cardiovascular disease statistics 2021. Eur Heart J. 2022. Vol. 43(8):716-99

[9] Sigit FS, Cho S, Kurniawan F, Jeon HR, Dewi Sartika RA, Tahapary DL, et al.. Hypertriglyceridemic waist phenotype in relation to diabetes mellitus and cardiovascular diseases in the Indonesian and Korean populations: evidence from two national surveys. Diabetol Metab Syndr. 2025. Vol. 17(1):401

[10] Bi X, Tey SL, Leong C, Quek R, Loo YT, Henry CJ. Correlation of adiposity indices with cardiovascular disease risk factors in healthy adults of Singapore: a cross-sectional study. BMC Obes. 2016. Vol. 3(1):33

[11] Bays HE, Kirkpatrick CF, Maki KC, Toth PP, Morgan RT, Tondt J, et al.. Obesity, dyslipidemia, and cardiovascular disease: a joint expert review from the Obesity Medicine Association and the National Lipid Association 2024. J Clin Lipidol. 2024. Vol. 18(3):e320-50

[12] Lin M, Zhou Y, Wu R, Li S, Ni X, Xiao J, et al.. Temporal relationship between visceral fat and inflammation, and their joint effect on cardiometabolic diseases: evidence from the China health and retirement longitudinal study (CHARLS). J Inflamm Res. 2025. Vol. 18(1):14913-26

[13] Kehat I, Molkentin JD. Molecular pathways underlying cardiac remodeling during pathophysiological stimulation. Circulation. 2010. Vol. 122(25):2727-35

[14] Pfeffer MA, Shah AM, Borlaug BA. Heart failure with preserved ejection fraction in perspective. Circ Res. 2019. Vol. 124(11):1598-617

[15] Brown NK, Zhou Z, Zhang J, Zeng R, Wu J, Eitzman DT, et al.. Perivascular adipose tissue in vascular function and disease: a review of current research and animal models. Arterioscler Thromb Vasc Biol. 2014. Vol. 34(8):1621-30

[16] Kralova Lesna I, Kralova A, Cejkova S, Fronek J, Petras M, Sekerkova A, et al.. Characterisation and comparison of adipose tissue macrophages from human subcutaneous, visceral and perivascular adipose tissue. J Transl Med. 2016. Vol. 14(1):208

[17] Filtz A, Lorenzatti D, Scotti A, Bhatia K, Yametti FC, Cossettini FJ, et al.. Epicardial adipose tissue, coronary plaque progression, and major adverse cardiovascular events: a multicenter study. JACC Cardiovasc Imaging. 2026. Vol. 19(6):720-31

[18] Hof A, Landerer M, Peitsmeyer P, Herzog R, Alber J, Ahdab M, et al.. Myeloperoxidase impacts vascular function by altering perivascular adipocytes’ secretome and phenotype in obesity. Cell Rep Med. 2025. Vol. 6(5):102087

[19] Reaven GM. Role of insulin resistance in human disease (syndrome X): an expanded definition. Annu Rev Med. 1993. Vol. 44:121-31

[20] Hotamisligil GS. Inflammation and metabolic disorders. Nature. 2006. Vol. 444(7121):860-7

[21] Hübner MP, de Coninck D, Lenz B, Surendar J, Koschel M, Gandjui NVT, et al.. The role of the IL-9-NLRP3 axis in insulin resistance and adipose tissue inflammation during diet-induced obesity. Cell Mol Immunol. 2025. Vol. 22(11):1478-90

[22] Kim BS, Kim HJ, Moon S, Kim H, Lee J, Shin JH. Association of the triglyceride-glucose index with cardiovascular outcomes across cardiovascular-kidney-metabolic syndrome stages. Korean J Intern Med. 2025. Vol. 40(6):961-74

[23] He Y, He J, Chen D, Xiao J. Metabolic score for insulin resistance and the incidence of cardiovascular disease: a meta-analysis of cohort studies. Front Endocrinol (Lausanne). 2025. Vol. 16:1699985

[24] Cahn A, Mor-Shaked H, Rosenberg-Fogler H, Pollack R, Tolhuis B, Sharma G, et al.. Complex rearrangement in TBC1D4 in an individual with diabetes due to severe insulin resistance syndrome. Eur J Hum Genet. 2024. Vol. 32(2):232-7

[25] Coué M, Barquissau V, Morigny P, Louche K, Lefort C, Mairal A, et al.. Natriuretic peptides promote glucose uptake in a cGMP-dependent manner in human adipocytes. Sci Rep. 2018. Vol. 8(1):1097

[26] Cai B, Thorp EB, Doran AC, Subramanian M, Sansbury BE, Lin CS, et al.. MerTK cleavage limits proresolving mediator biosynthesis and exacerbates tissue inflammation. Proc Natl Acad Sci U S A. 2016. Vol. 113(23):6526-31

[27] Abel ED, Ahima RS, Anderson EJ, Berg DD, Berger JS, Das S, et al.. A road map to understanding cardiovascular disease in diabetes: from the AHA Strategically Focused Research Network in Cardiometabolic Health and Type 2 Diabetes. Circ Res. 2026. Vol. 138(2):e325798

[28] Rabiee A, Hossain MA, Poojari A. Adipose tissue insulin resistance: a key driver of metabolic syndrome pathogenesis. Biomedicines. 2025. Vol. 13(10):2376

[29] Hamner JW, Tan CO, Lee K, Cohen MA, Taylor JA. Sympathetic control of the cerebral vasculature in humans. Stroke. 2010. Vol. 41(1):102-9

[30] Chen Y, Budd RC, Kelm RJ Jr, Sobel BE, Schneider DJ. Augmentation of proliferation of vascular smooth muscle cells by plasminogen activator inhibitor type 1. Arterioscler Thromb Vasc Biol. 2006. Vol. 26(8):1777-83

[31] Wang H, Zhang H, Zhang L, Zheng X, Yang M. Combined effects of insulin resistance and dyslipidaemia on cardiometabolic multimorbidity in Chinese middle-age and older adults: a longitudinal cohort study. Sci Rep. 2025. Vol. 15(1):38060

[32] Rabhi N, Farmer SR. Adipose progenitor cells contribute to lipid spillover during obesity. Trends Endocrinol Metab. 2019. Vol. 30(7):416-8

[33] Aroda VR, Aberle J, Bardtrum L, Christiansen E, Knop FK, Gabery S, et al.. Efficacy and safety of once-daily oral semaglutide 25 mg and 50 mg compared with 14 mg in adults with type 2 diabetes (PIONEER PLUS): a multicentre, randomised, phase 3b trial. Lancet. 2023. Vol. 402(10403):693-704

[34] Kersten S. Physiological regulation of lipoprotein lipase. Biochim Biophys Acta. 2014. Vol. 1841(7):919-33

[35] von Eynatten M, Schneider JG, Humpert PM, Rudofsky G, Schmidt N, Barosch P, et al.. Decreased plasma lipoprotein lipase in hypoadiponectinemia: an association independent of systemic inflammation and insulin resistance. Diabetes Care. 2004. Vol. 27(12):2925-9

[36] Drosatos K, Schulze PC. Cardiac lipotoxicity: molecular pathways and therapeutic implications. Curr Heart Fail Rep. 2013. Vol. 10(2):109-21

[37] Parra V, Moraga F, Kuzmicic J, López-Crisosto C, Troncoso R, Torrealba N, et al.. Calcium and mitochondrial metabolism in ceramide-induced cardiomyocyte death. Biochim Biophys Acta. 2013. Vol. 1832(8):1334-44

[38] Hu L, Tang D, Qi B, Guo D, Wang Y, Geng J, et al.. Mfn2/Hsc70 complex mediates the formation of mitochondria-lipid droplets membrane contact and regulates myocardial lipid metabolism. Adv Sci (Weinh). 2024. Vol. 11(14):e2307749

[39] Hori M, Nishida K. Oxidative stress and left ventricular remodelling after myocardial infarction. Cardiovasc Res. 2009. Vol. 81(3):457-64

[40] Lai P, Hille SS, Subramanian H, Wiegmann R, Roser P, Müller OJ, et al.. Remodelling of cAMP dynamics within the SERCA2a microdomain in heart failure with preserved ejection fraction caused by obesity and type 2 diabetes. Cardiovasc Res. 2024. Vol. 120(3):273-85

[41] Hummasti S, Hotamisligil GS. Endoplasmic reticulum stress and inflammation in obesity and diabetes. Circ Res. 2010. Vol. 107(5):579-91

[42] Mlynarska E, Bojdo K, Frankenstein H, Krawiranda K, Kustosik N, Lisińska W, et al.. Endothelial dysfunction as the common pathway linking obesity, hypertension and atherosclerosis. Int J Mol Sci. 2025. Vol. 26(20):10096

[43] Chen Y, Huang W, Zhao S, Ge Z, Liu Y, Huang R, et al.. Predictive value of systemic inflammation response index for atherosclerotic cardiovascular disease risk in patients with hypercholesterolemia: a machine learning study with dual-cohort validation. Lipids Health Dis. 2025. Vol. 24(1):350

[44] Zheng H, Wu K, Zheng H, Chen G, Lan Y, Chen S, et al.. High systemic inflammation response index and increased cardiovascular risk and mortality in MASLD: a prospective cohort study. JHEP Rep. 2025. Vol. 7(12):101602

[45] Han SC, Kang JI, Choi YK, Boo HJ, Yoon WJ, Kang HK, et al.. Intermittent fasting modulates immune response by generating Tregs via TGF-β dependent mechanisms in obese mice with allergic contact dermatitis. Biomol Ther (Seoul). 2024. Vol. 32(1):136-45

[46] Powell-Wiley TM, Poirier P, Burke LE, Després JP, Gordon-Larsen P, Lavie CJ, et al.. Obesity and cardiovascular disease: a scientific statement from the American Heart Association. Circulation. 2021. Vol. 143(21):e984-1010

[47] Cornelissen A, Sakamoto A, Sato Y, Kawakami R, Mori M, Kawai K, et al.. COBRA PzF™ coronary stent in clinical and preclinical studies: setting the stage for new antithrombotic strategies? Future Cardiol. 2022. Vol. 18(3):207-17

[48] Levine RB, Ayyala MS, Skarupski KA, Bodurtha JN, Fernández MG, Ishii LE, et al.. “It’s a Little Different for Men”-sponsorship and gender in academic medicine: a qualitative study. J Gen Intern Med. 2021. Vol. 36(1):1-8

[49] Mkubwa B, Angwenyi V, Nzioka B, Newton CR, Sijbrandij M, Abubakar A. Knowledge, attitudes, and practices on child and adolescent mental health among healthcare workers in sub-Saharan Africa: a scoping review. Int J Ment Health Syst. 2024. Vol. 18(1):27

[50] Feng J, Damrauer SM, Lee M, Sellke FW, Ferran C, Abid MR. Endothelium-dependent coronary vasodilatation requires NADPH oxidase-derived reactive oxygen species. Arterioscler Thromb Vasc Biol. 2010. Vol. 30(9):1703-10

[51] Ouchi N, Kihara S, Arita Y, Maeda K, Kuriyama H, Okamoto Y, et al.. Novel modulator for endothelial adhesion molecules: adipocyte-derived plasma protein adiponectin. Circulation. 1999. Vol. 100(25):2473-6

[52] Hasan M, Mutlu O, Islam MS, Shurbaji S, Sulaiman R, Elsharabassi Y, et al.. Oscillatory disturbed flow enhances inflammatory and oxidative stress markers in endothelial cells. Methods Protoc. 2025. Vol. 8(6):130

[53] Yin J, Gao Z, He Q, Zhou D, Guo Z, Ye J. Role of hypoxia in obesity-induced disorders of glucose and lipid metabolism in adipose tissue. Am J Physiol Endocrinol Metab. 2009. Vol. 296(2):E333-42

[54] Packer M. Leptin-aldosterone-neprilysin axis: identification of its distinctive role in the pathogenesis of the three phenotypes of heart failure in people with obesity. Circulation. 2018. Vol. 137(15):1614-31

[55] Mollnau H, Wendt M, Szöcs K, Lassègue B, Schulz E, Oelze M, et al.. Effects of angiotensin II infusion on the expression and function of NAD(P)H oxidase and components of nitric oxide/cGMP signaling. Circ Res. 2002. Vol. 90(4):e58-65

[56] Jones DW, Ferdinand KC, Taler SJ, Johnson HM, Shimbo D, Abdalla M, et al.. 2025 AHA/ACC/AANP/AAPA/ABC/ACCP/ACPM/AGS/AMA/ASPC/NMA/PCNA/SGIM guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2025. Vol. 86(18):1567-678

[57] Hall JE. Pathophysiology of obesity hypertension. Curr Hypertens Rep. 2000. Vol. 2(2):139-47

[58] Kenchaiah S, Evans JC, Levy D, Wilson PW, Benjamin EJ, Larson MG, et al..Obesity and the risk of heart failure. N Engl J Med. 2002. Vol. 347(5):305-13

[59] Peppard PE, Young T, Palta M, Skatrud J. Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med. 2000. Vol. 342(19):1378-84

[60] Reddy YNV, Frantz RP, Hemnes AR, Hassoun PM, Horn E, Leopold JA, et al.. Disentangling the impact of adiposity from insulin resistance in heart failure with preserved ejection fraction. J Am Coll Cardiol. 2025. Vol. 85(18):1774-88

[61] Alpert MA, Karthikeyan K, Abdullah O, Ghadban R. Obesity and cardiac remodeling in adults: mechanisms and clinical implications. Prog Cardiovasc Dis. 2018. Vol. 61(2):114-23

[62] Gan L, Xie D, Liu J, Bond Lau W, Christopher TA, Lopez B, et al.. Small extracellular microvesicles mediated pathological communications between dysfunctional adipocytes and cardiomyocytes as a novel mechanism exacerbating ischemia/reperfusion injury in diabetic mice. Circulation. 2020. Vol. 141(12):968-83

[63] Sun XN, Chen S, Zhao S, Funcke JB, Virostek M, Pedersen L, et al.. Leptin as a key driver for organ fibrogenesis. Sci Adv. 2025. Vol. 11(43):eady7904

[64] Korcarz CE, Peppard PE, Young TB, Chapman CB, Hla KM, Barnet JH, et al.. Effects of obstructive sleep apnea and obesity on cardiac remodeling: the Wisconsin Sleep Cohort study. Sleep. 2016. Vol. 39(6):1187-95

[65] Gutiérrez-Cuevas J, Sandoval-Rodriguez A, Meza-Rios A, Monroy-Ramírez HC, Galicia-Moreno M, García-Bañuelos J, et al.. Molecular mechanisms of obesity-linked cardiac dysfunction: an up-date on current knowledge. Cells. 2021. Vol. 10(3):629

[66] Rosen ED, Spiegelman BM. Adipocytes as regulators of energy balance and glucose homeostasis. Nature. 2006. Vol. 444(7121):847-53

[67] Kershaw EE, Flier JS. Adipose tissue as an endocrine organ. J Clin Endocrinol Metab. 2004. Vol. 89(6):2548-56

[68] Ouchi N, Parker JL, Lugus JJ, Walsh K. Adipokines in inflammation and metabolic disease. Nat Rev Immunol. 2011. Vol. 11(2):85-97

[69] Khan I, Hondros CAB, Hanseth S, Pedersen ER, Hovland S, Larsen TH, et al.. Epicardial adipose tissue volume, compositional plaque progression, and vulnerability in nonobstructive coronary artery disease. Coron Artery Dis. 2025. Vol. 36(7):580-6

[70] Neeland IJ, Ross R, Després JP, Matsuzawa Y, Yamashita S, Shai I, et al.. Visceral and ectopic fat, atherosclerosis, and cardiometabolic disease: a position statement. Lancet Diabetes Endocrinol. 2019. Vol. 7(9):715-25

[71] Turer AT, Hill JA, Elmquist JK, Scherer PE. Adipose tissue biology and cardiomyopathy: translational implications. Circ Res. 2012. Vol. 111(12):1565-77

[72] Zhou D, Zhou M, Chen S, Yang C, Wang Y, Zhou Y, et al.. Remnant cholesterol, low-density lipoprotein cholesterol and atherosclerotic cardiovascular disease in metabolic dysfunction-associated steatotic liver disease: a cohort study. Lipids Health Dis. 2025. Vol. 24(1):352

[73] Wu S, Tan J, Zhang H, Hou DX, He J. Tissue-specific mechanisms of fat metabolism that focus on insulin actions. J Adv Res. 2023. Vol. 53:187-98

[74] Jia RY, Lockhart S, Lam BYH, Zhao Y, Kentistou KA, Gardner EJ, et al.. Effects of rare coding variants in severe early-onset obesity genes in the population-based UK Biobank study. J Clin Endocrinol Metab. 2025. Vol. 110(11):e3774-82

[75] Zorn S, Bounds R, Williamson A, Lawler K, Hanssen R, Keogh J, et al.. Obesity due to MC4R deficiency is associated with reduced cholesterol, triglycerides and cardiovascular disease risk. Nat Med. 2025. Vol. 31(12):4180-8

[76] Secondulfo C, Izzo C, Vecchione N, Minelli G, Russo D, Russo D, et al.. Apolipoproteins in chronic kidney disease and kidney transplant: a long unfinished story. Int J Mol Sci. 2025. Vol. 26(19):9664

[77] Ouni M, Schurmann A.Epigenetic contribution to obesity. Mamm Genome. 2020. Vol. 31(5-6):134-45

[78] Patel AP, Wang M, Ruan Y, Koyama S, Clarke SL, Yang X, et al.. A multi-ancestry polygenic risk score improves risk prediction for coronary artery disease. Nat Med. 2023. Vol. 29(7):1793-803

[79] Clément K, Biebermann H, Farooqi IS, et al.. MC4R agonism promotes durable weight loss in patients with leptin receptor deficiency. Nat Med. 2018. Vol. 24(5):551-55

[80] Haqq AM, Chung WK, Dollfus H, Haws RM, Martos-Moreno GÁ, Poitou C, et al.. Efficacy and safety of setmelanotide, a melanocortin-4 receptor agonist, in patients with Bardet-Biedl syndrome and Alström syndrome: a multicentre, randomised, double-blind, placebo-controlled, phase 3 trial with an open-label period. Lancet Diabetes Endocrinol. 2022. Vol. 10(12):859-68

[81] Kozhuharov N, Martin J, Wussler D, Lopez-Ayala P, Belkin M, Strebel I, et al.. Clinical effect of obesity on N-terminal pro-B-type natriuretic peptide cut-off concentrations for the diagnosis of acute heart failure. Eur J Heart Fail. 2022. Vol. 24(9):1545-54

[82] Wang TJ, Larson MG, Levy D, Benjamin EJ, Leip EP, Wilson PW, et al.. Impact of obesity on plasma natriuretic peptide levels. Circulation. 2004. Vol. 109(5):594-600

[83] Zhang J, Begley A, Jackson R, Harrison M, Pellicori P, Clark AL, et al.. Body mass index and all-cause mortality in heart failure patients with normal and reduced ventricular ejection fraction: a dose-response meta-analysis. Clin Res Cardiol. 2019. Vol. 108(2):119-32

[84] Wang TJ. The obesity paradox in heart failure: weighing the evidence. J Am Coll Cardiol. 2014. Vol. 64(25):2750-2

[85] Haass M, Kitzman DW, Anand IS, Miller A, Zile MR, Massie BM, et al.. Body mass index and adverse cardiovascular outcomes in heart failure patients with preserved ejection fraction. Results from the Irbesartan in heart failure with preserved ejection fraction (I-PRESERVE) trial. Circ Heart Fail. 2011. Vol. 4(3):324-31

[86] Chen X, Ruiz-Velasco A, Zou Z, Hille SS, Ross C, Fonseka O, et al.. PAK3 exacerbates cardiac lipotoxicity via SREBP1c in obesity cardiomyopathy. Diabetes. 2024. Vol. 73(11):1805-20

[87] Aune D, Schlesinger S, Norat T, Riboli E. Body mass index, abdominal fatness, and the risk of sudden cardiac death: a systematic review and dose-response meta-analysis of prospective studies. Eur J Epidemiol. 2018. Vol. 33(8):711-22

[88] Bostick B, Habibi J, DeMarco VG, Jia G, Domeier TL, Lambert MD, et al.. Mineralocorticoid receptor blockade prevents Western diet-induced diastolic dysfunction in female mice. Am J Physiol Heart Circ Physiol. 2015. Vol. 308(9):H1126-35

[89] van Hout MJP, Dekkers IA, Westenberg JJM, Schalij MJ, Scholte AJHA, Lamb HJ. The impact of visceral and general obesity on vascular and left ventricular function and geometry: a cross-sectional magnetic resonance imaging study of the UK Biobank. Eur Heart J Cardiovasc Imaging. 2020. Vol. 21(3):273-81

[90] Michalsky M. Improvements in cardiac geometry following bariatric surgery in adolescents help to address important knowledge gaps. Cardiol Young. 2025. Vol. 35(11):2334-2335

[91] Valero-Muñoz M, Li S, Wilson RM, Hulsmans M, Aprahamian T, Fuster JJ, et al.. Heart failure with preserved ejection fraction induces beiging in adipose tissue. Circ Heart Fail. 2016. Vol. 9(1):e002724

[92] Davies MJ, van der Meer P, Verma S, Patel S, Chinnakondepalli KM, Borlaug BA, et al.. Semaglutide in obesity-related heart failure with preserved ejection fraction and type 2 diabetes across baseline HbA_1c levels (STEP-HFpEF DM): a prespecified analysis of heart failure and metabolic outcomes from a randomised, placebo-controlled trial. Lancet Diabetes Endocrinol. 2025. Vol. 13(3):196-209

[93] Melenovsky V, Kotrc M, Borlaug BA, Marek T, Kovar J, Malek I, et al.. Relationships between right ventricular function, body composition, and prognosis in advanced heart failure. J Am Coll Cardiol. 2013. Vol. 62(18):1660-70

[94] Kitzman DW, Shah SJ. The HFpEF obesity phenotype: the elephant in the room. J Am Coll Cardiol. 2016. Vol. 68(2):200-3

[95] Abdelrahman EM, Ghali MS, Mohamed AG, Elhady F, Habib SA, Ali AA, et al.. Outcome of sleeve gastrectomy versus single anastomosis sleeve ileal bypass on the cardiac functions and rhythm disturbance. Obes Surg. 2025. Vol. 35(8):2905-14

[96] Bibi F, Aslam A, Naseem H, Khurshid H, Haider A, Ashraf H, et al..Adipokines pathogenesis in heart failure. Cardiovasc Innov Appl. 2025. Vol. 10(1):e995

[97] Ming C, Xu X, Yao Y, Li X, Sun Y, Jawaid Z, et al.. MicroRNAs Have an Immunomodulatory Role in Diabetes Mellitus and Diabetic Cardiomyopathy. Cardiovasc Innov Appl. 2025. Vol. 10(1):e983

[98] Morawska A, Frankowski R, Grabarczyk M, Kosmalski M, Różycka-Kosmalska M. Crosstalk between metabolic dysfunction-associated steatotic liver disease and atrial fibrillation: shared mechanism, diagnostic integration, and management implications. Life (Basel). 2025. Vol. 15(11):1713

[99] Shaihov-Teper O, Ram E, Ballan N, Brzezinski RY, Naftali-Shani N, Masoud R, et al.. Extracellular vesicles from epicardial fat facilitate atrial fibrillation. Circulation. 2021. Vol. 143(25):2475-93

[100] Sridhar A, DeSantiago J, Chen H, Pavel MA, Ly O, Owais A, et al.. Modulation of NOX2 causes obesity-mediated atrial fibrillation. J Clin Invest. 2024. Vol. 134(18):e175447

[101] Gawałko M, Saljic A, Li N, Abu-Taha I, Jespersen T, Linz D, et al.. Adiposity-associated atrial fibrillation: molecular determinants, mechanisms, and clinical significance. Cardiovasc Res. 2023. Vol. 119(3):614-30

[102] Shu H, Cheng J, Li N, Zhang Z, Nie J, Peng Y, et al.. Obesity and atrial fibrillation: a narrative review from arrhythmogenic mechanisms to clinical significance. Cardiovasc Diabetol. 2023. Vol. 22(1):192

[103] Medina-Inojosa BJ, Lopez-Jimenez F. Are body mass index changes related to incident atrial fibrillation?-Results of the Danish Diet, Cancer, and Health Cohort. Eur J Prev Cardiol. 2024. Vol. 31(2):214-5

[104] Holmstrom L, Junttila J, Chugh SS. Sudden death in obesity: mechanisms and management. J Am Coll Cardiol. 2024. Vol. 84(23):2308-24

[105] Martínez-Martínez E, Jurado-López R, Valero-Muñoz M, Bartolomé MV, Ballesteros S, Luaces M, et al.. Leptin induces cardiac fibrosis through galectin-3, mTOR and oxidative stress: potential role in obesity. J Hypertens. 2014. Vol. 32(5):1104-14

[106] Wu R, Xing B, Zhou Z, Yu L, Wang H. Effect of semaglutide on arrhythmic, major cardiovascular, and renal outcomes in patients with overweight or obesity: a systematic review and meta-analysis. Eur J Med Res. 2025. Vol. 30(1):835

[107] Jamaly S, Carlsson L, Peltonen M, Jacobson P, Sjöström L, Karason K. Bariatric surgery and the risk of new-onset atrial fibrillation in Swedish Obese Subjects. J Am Coll Cardiol. 2016. Vol. 68(23):2497-504

[108] Thompson P, Logan I, Tomson C, Sheerin N, Ellam T. Obesity, sex, race, and early onset hypertension: implications for a refined investigation strategy. Hypertension. 2020. Vol. 76(3):859-65

[109] Mitsuno R, Kaneko K, Nakamura T, Kojima D, Mizutani Y, Azegami T, et al.. Association between renal sinus fat and cardiometabolic and renin-angiotensin system parameters in primary aldosteronism. J Endocr Soc. 2024. Vol. 8(1):bvad154

[110] Li P, Liu B, Wu X, Lu Y, Qiu M, Shen Y, et al.. Perirenal adipose afferent nerves sustain pathological high blood pressure in rats. Nat Commun. 2022. Vol. 13(1):3130

[111] Li B, Fan H, Wu H, Zhang Y, Ding N, Liu P, et al.. Targeting FXR in hepatocytes: a promising approach to enhance fibrinolysis and reduce deep vein thrombosis risk. Blood. 2025. Vol. 146(20):2464-78

[112] Okada K, Hibi K, Honda Y, Fitzgerald PJ, Tamura K, Kimura K. Association between abdominal fat distribution and coronary plaque instability in patients with acute coronary syndrome. Nutr Metab Cardiovasc Dis. 2020. Vol. 30(7):1169-78

[113] Raya-Benitez J, Heredia-Ciuro A, Calvache-Mateo A, Martín-Núñez J, Valenza-Peña G, López-López L, et al.. Effectiveness of non-instrumental early mobilization to reduce the incidence of deep vein thrombosis in hospitalized patients: a systematic review and meta-analysis. Int J Nurs Stud. 2025. Vol. 161:104917

[114] Ikesaka R, Kaur B, Crowther M, Rajasekhar A. Efficacy and safety of pre-operative insertion of inferior vena cava filter in patients undergoing bariatric surgery: a systematic review. J Thromb Thrombolysis. 2022. Vol. 54(3):502-23

[115] Segrestin B, Cherifi BG. Obesity and its treatment: toward new approaches. Ann Endocrinol (Paris). 2025. Vol. 86(2):101712

[116] Wharton S, Aronne LJ, Stefanski A, Alfaris NF, Ciudin A, Yokote K, et al.. Orforglipron, an oral small-molecule GLP-1 receptor agonist for obesity treatment. N Engl J Med. 2025. Vol. 393(18):1796-806

[117] Kushner RF, Jastreboff AM, Ryan DH. Current and future medications for obesity treatment. JAMA. 2025. Vol. 334(17):1551-2

[118] Lewis KH, Moore JB, Ard JD. Game changers: do new medications make lifestyle-based treatment of obesity obsolete? Obesity (Silver Spring). 2024. Vol. 32(2):237-9

[119] Younossi ZM, Ratziu V, Loomba R, Rinella M, Anstee QM, Goodman Z, et al.. Obeticholic acid for the treatment of non-alcoholic steatohepatitis: interim analysis from a multicentre, randomised, placebo-controlled phase 3 trial. Lancet. 2019. Vol. 394(10215):2184-96

[120] Patel K, Harrison SA, Elkhashab M, Trotter JF, Herring R, Rojter SE, et al.. Cilofexor, a nonsteroidal FXR agonist, in patients with noncirrhotic NASH: a phase 2 randomized controlled trial. Hepatology. 2020. Vol. 72(1):58-71

[121] Nadolsky K, Garvey WT, Agarwal M, Bonnecaze A, Burguera B, Chaplin MD, et al.. American Association of Clinical Endocrinology consensus statement: algorithm for the evaluation and treatment of adults with obesity/adiposity-based chronic disease - 2025 update. Endocr Pract. 2025. Vol. 31(11):1351-94

[122] Ryan L, Quigley F, Birney S, Crotty M, Conlan O, Walsh JC. ‘Beyond the Scale’: a qualitative exploration of the impact of weight stigma experienced by patients with obesity in general practice. Health Expect. 2024. Vol. 27(3):e14098

[123] Marshall S, Mackay H, Matthews C, Maimone IR, Isenring E. Does intensive multidisciplinary intervention for adults who elect bariatric surgery improve post-operative weight loss, co-morbidities, and quality of life? A systematic review and meta-analysis. Obes Rev. 2020. Vol. 21(7):e13012

[124] Schladitz K, Buß A, Pabst A, Welzel FD, Blüher M, Stumvoll M, et al.. Effectiveness of an internet-based self-help intervention for improving mental health in individuals with obesity: study protocol for a randomised controlled trial. BMJ Open. 2025. Vol. 15(11):e107131

[125] Hall KD, Kahan S. Maintenance of lost weight and long-term management of obesity. Med Clin North Am. 2018. Vol. 102(1):183-97

[126] Vora AA, Marchalik D, Kowalczyk KJ, Nissim H, Bandi G, McGeagh KG, et al.. Robotic-assisted prostatectomy and open radical retropubic prostatectomy for locally-advanced prostate cancer: multi-institution comparison of oncologic outcomes. Prostate Int. 2013. Vol. 1(1):31-6

[127] Estruch R, Ros E, Salas-Salvadó J, Covas MI, Corella D, Arós F, et al.. Primary prevention of cardiovascular disease with a Mediterranean diet supplemented with extra-virgin olive oil or nuts. N Engl J Med. 2018. Vol. 378(25):e34

[128] Yanes T, Sullivan A, Barbaro P, Brion K, Hollway G, Peake J, et al.. Evaluation and pilot testing of a multidisciplinary model of care to mainstream genomic testing for paediatric inborn errors of immunity. Eur J Hum Genet. 2023. Vol. 31(10):1125-32

[129] Sung JE, Lee HA, Kim JE, Yun WB, An BS, Yang SY, et al.. Saponin-enriched extract of Asparagus cochinchinensis alleviates airway inflammation and remodeling in ovalbumin-induced asthma model. Int J Mol Med. 2017. Vol. 40(5):1365-76

[130] US Preventive Services Task Force; Curry SJ, Krist AH, Owens DK, Barry MJ, Caughey AB, et al.. Behavioral weight loss interventions to prevent obesity-relatedmorbidity and mortality in adults US preventive services task force recommendation statement. JAMA. 2018. Vol. 320(11):1163-71

[131] Spring B, Pfammatter AF, Scanlan L, Daly E, Reading J, Battalio S, et al.. An adaptive behavioral intervention for weight loss management: a randomized clinical trial. JAMA. 2024. Vol. 332(1):21-30

[132] Grunvald E, Shah R, Hernaez R, Chandar AK, Pickett-Blakely O, Teigen LM, et al.. AGA clinical practice guideline on pharmacological interventions for adults with obesity. Gastroenterology. 2022. Vol. 163(5):1198-225

[133] Yanovski SZ, Yanovski JA. Long-term drug treatment for obesity: a systematic and clinical review. JAMA. 2014. Vol. 311(1):74-86

[134] Apovian CM, Aronne LJ, Bessesen DH, McDonnell ME, Murad MH, Pagotto U, et al.. Pharmacological management of obesity: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2015. Vol. 100(2):342-62

[135] Pi-Sunyer X, Astrup A, Fujioka K, Greenway F, Halpern A, Krempf M, et al.. A randomized, controlled trial of 3.0 mg of liraglutide in weight management. N Engl J Med. 2015. Vol. 373(1):11-22

[136] Wilding JPH, Batterham RL, Calanna S, Davies M, Van Gaal LF, Lingvay I, et al.. Once-weekly semaglutide in adults with overweight or obesity. N Engl J Med. 2021. Vol. 384(11):989-1002

[137] Jastreboff AM, Aronne LJ, Ahmad NN, Wharton S, Connery L, Alves B, et al.. Tirzepatide once weekly for the treatment of obesity. N Engl J Med. 2022. Vol. 387(3):205-16

[138] Jastreboff AM, Kaplan LM, Frias JP, Wu Q, Du Y, Gurbuz S, et al.. Triple-hormone-receptor agonist retatrutide for obesity -a phase 2 trial. N Engl J Med. 2023. Vol. 389(6):514-26

[139] Garvey WT, Blüher M, Osorto Contreras CK, Davies MJ, Winning Lehmann E, Pietiläinen KH, et al.. Coadministered cagrilintide and semaglutide in adults with overweight or obesity. N Engl J Med. 2025. Vol. 393(7):635-47

[140] Lincoff AM, Brown-Frandsen K, Colhoun HM, Deanfield J, Emerson SS, Esbjerg S, et al.. Semaglutide and cardiovascular outcomes in obesity without diabetes. N Engl J Med. 2023. Vol. 389(24):2221-32

[141] Mann JFE, Ørsted DD, Brown-Frandsen K, Marso SP, Poulter NR, Rasmussen S, et al.. Liraglutide and renal outcomes in type 2 diabetes. N Engl J Med. 2017. Vol. 377(9):839-48

[142] Preda A, Montecucco F, Carbone F, Camici GG, Lüscher TF, Kraler S, et al.. SGLT2 inhibitors: from glucose-lowering to cardiovascular benefits. Cardiovasc Res. 2024. Vol. 120(5):443-60

[143] Packer M. Critical reanalysis of the mechanisms underlying the cardiorenal benefits of SGLT 2 inhibitors and reaffirmation of the nutrient deprivation signaling/autophagy hypothesis. Circulation. 2022. Vol. 146(18):1383-405

[144] McMurray JJV, Solomon SD, Inzucchi SE, Køber L, Kosiborod MN, Martinez FA, et al.. Dapagliflozin in patients with heart failure and reduced ejection fraction. N Engl J Med. 2019. Vol. 381(21):1995-2008

[145] Packer M, Anker SD, Butler J, Filippatos G, Pocock SJ, Carson P, et al.. Cardiovascular and renal outcomes with empagliflozin in heart failure. N Engl J Med. 2020. Vol. 383(15):1413-24

[146] Anker SD, Butler J, Filippatos G, Ferreira JP, Bocchi E, Böhm M, et al.. Empagliflozin in heart failure with a preserved ejection fraction. N Engl J Med. 2021. Vol. 385(16):1451-61

[147] Solomon SD, McMurray JJV, Claggett B, de Boer RA, DeMets D, Hernandez AF, et al.. Dapagliflozin in heart failure with mildly reduced or preserved ejection fraction. N Engl J Med. 2022. Vol. 387(12):1089-98

[148] Apperloo EM, Neuen BL, Fletcher RA, Jongs N, Anker SD, Bhatt DL, et al..Efficacy and safety of SGLT2 inhibitors with and without glucagon-like peptide 1 receptor agonists: a SMART-C collaborative meta-analysis of randomised controlled trials. Lancet Diabetes Endocrinol. 2024. Vol. 12(8):545-57

[149] James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, et al.. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee ( JNC 8). JAMA. 2014. Vol. 311(5):507-20

[150] Cholesterol Treatment Trialists Collaboration; Baigent C, Blackwell L, Emberson J, Holland LE, Reith C, et al.. Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170,000 participants in 26 randomised trials. Lancet. 2010. Vol. 376(9753):1670-81

[151] Cholesterol Treatment Trialists’ (CTT) Collaboration. Effects of statin therapy on diagnoses of new-onset diabetes and worsening glycaemia in large-scale randomised blinded statin trials: an individual participant data meta-analysis. Lancet Diabetes Endocrinol. 2024. Vol. 12(5):306-19

[152] Albawa’neh AS, Alqasrawi MN, Al-Mahayri ZN, Albawaana A, Ahmed G, Al-Rifai RH, et al.. Ezetimibe and the risk of new-onset type 2 diabetes: a systematic review and meta-analysis. Ann Med. 2025. Vol. 57(1):2594355

[153] Kim BK, Hong SJ, Lee YJ, Hong SJ, Yun KH, Hong BK, et al.. Long-term efficacy and safety of moderate-intensity statin with ezetimibe combination therapy versus high-intensity statin monotherapy in patients with atherosclerotic cardiovascular disease (RACING): a randomised, open-label, non-inferiority trial. Lancet. 2022. Vol. 400(10349):380-90

[154] Schauer PR, Bhatt DL, Kirwan JP, Wolski K, Aminian A, Brethauer SA, et al.. Bariatric surgery versus intensive medical therapy for diabetes -5-year outcomes. N Engl J Med. 2017. Vol. 376(7):641-51

[155] Carlsson LMS, Sjoholm K, Jacobson P, Andersson-Assarsson JC, Svensson PA, Taube M, et al..Life expectancy after bariatric surgery in the Swedish obese subjects study. N Engl J Med. 2020. Vol. 383(16):1535-43

[156] le Roux CW, Aylwin SJ, Batterham RL, Borg CM, Coyle F, Prasad V, et al.. Gut hormone profiles following bariatric surgery favor an anorectic state, facilitate weight loss, and improve metabolic parameters. Ann Surg. 2006. Vol. 243(1):108-14

[157] Courcoulas AP, Yanovski SZ, Bonds D, Eggerman TL, Horlick M, Staten MA, et al.. Long-term outcomes of bariatric surgery: a National Institutes of Health symposium. JAMA Surg. 2014. Vol. 149(12):1323-9

[158] Mechanick JI, Apovian C, Brethauer S, Timothy Garvey W, Joffe AM, et al.. Clinical practice guidelines for the perioperative nutrition, metabolic, and nonsurgical support of patients undergoing bariatric procedures - 2019 update: cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, The Obesity Society, American Society for Metabolic and Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists. Obesity (Silver Spring). 2020. Vol. 28(4):O1-58

[159] Li C, Zhou Z, Liu Z, Fang Q, Han G. From attitude to behavior: the effect of residents’ food waste attitudes on their food waste behaviors in Shanghai. Foods. 2024. Vol. 13(14):2201

[160] Acosta A, Camilleri M, Abu Dayyeh B, Calderon G, Gonzalez D, McRae A, et al.. Selection of antiobesity medications based on phenotypes enhances weight loss: a pragmatic trial in an obesity clinic. Obesity (Silver Spring). 2021. Vol. 29(4):662-71

[161] Espinosa MA, Rivera Gutierrez RJ, Villamarin J, Acosta A.Precision medicine for obesity treatment. J Endocr Soc. 2025. Vol. 9(9):bvaf102

[162] Desmarais F, Maltais R, Sancéau JY, Marcotte B, Guèvremont G, Trottier J, et al.. A new synthetic analogue of protectin DX with enhanced therapeutic potential against metabolic-associated steatotic liver disease. FASEB J. 2025. Vol. 39(20):e71172

[163] Jara M, Norlin J, Kjær MS, Almholt K, Bendtsen KM, Bugianesi E, et al.. Modulation of metabolic, inflammatory and fibrotic pathways by semaglutide in metabolic dysfunction-associated steatohepatitis. Nat Med. 2025. Vol. 31(9):3128-40

[164] Marcinkowska M, Sniecikowska J, Głuch-Lutwin M, Mordyl B, Bednarski M, Bucki A, et al..JP-14: a trace amine-associated receptor 1 agonist with anti-metabolic disorder potential. Int J Mol Sci. 2025. Vol. 26(20):10033

[165] Lourie J, Goraltchouk A, Hollander JM, Berger NJ, Rosen HG, Fujishiro AA, et al.. A novel gene therapy platform for the treatment of type 2 diabetes and obesity. Mol Ther Nucleic Acids. 2025. Vol. 36(4):102739

[166] Sjöström L, Peltonen M, Jacobson P, Sjöström CD, Karason K, Wedel H, et al.. Bariatric surgery and long-term cardiovascular events. JAMA. 2012. Vol. 307(1):56-65

[167] Gilbert N, Dudfield O, Bull F. Embracing community sport to promote global health. Lancet Diabetes Endocrinol. 2024. Vol. 12(9):616-7

[168] Patel S, Alvarez-Guaita A, Melvin A, Rimmington D, Dattilo A, Miedzybrodzka EL, et al.. GDF15 provides an endocrine signal of nutritional stress in mice and humans. Cell Metab. 2019. Vol. 29(3):707-18.e8

[169] Marino S, Bellido T. PTH receptor signalling, osteocytes and bone disease induced by diabetes mellitus. Nat Rev Endocrinol. 2024. Vol. 20(11):661-72

[170] Klingelhuber F, Frendo-Cumbo S, Omar-Hmeadi M, Massier L, Kakimoto P, Taylor AJ, et al.. A spatiotemporal proteomic map of human adipogenesis. Nat Metab. 2024. Vol. 6(5):861-79

[171] Wells JCK. Natural selection and human adiposity: crafty genotype, thrifty phenotype. Philos Trans R Soc Lond B Biol Sci. 2023. Vol. 378( 1885):20220224

[172] Nayak N, Mukherjee T, Pattnaik A. Comprehensive role of GDF 15 in inhibiting adipogenesis and hyperlipidemia, enhancing cardiovascular health and alleviating inflammation in metabolic disorders. Curr Pharm Des. 2024. Vol. 30(30):2387-99

[173] van den Hoek AM, van Heijningen C, Schröder-van der Elst JP, Ouwens DM, Havekes LM, Romijn JA, et al.. Intracerebroventricular administration of neuropeptide Y induces hepatic insulin resistance via sympathetic innervation. Diabetes. 2008. Vol. 57(9):2304-10

[174] Neufer PD, Bamman MM, Muoio DM, Bouchard C, Cooper DM, Goodpaster BH, et al.. Understanding the cellular and molecular mechanisms of physical activity-induced health benefits. Cell Metab. 2015. Vol. 22(1):4-11

[175] Zimmermann GR, Lehár J, Keith CT. Multi-target therapeutics: when the whole is greater than the sum of the parts. Drug Discov Today. 2007. Vol. 12(1-2):34-42

[176] Wan Q, Huang B, Li T, Xiao Y, He Y, Du W, et al.. Selective targeting of visceral adiposity by polycation nanomedicine. Nat Nanotechnol. 2022. Vol. 17(12):1311-21

[177] Juguilon C, Khosravi R, Radisic M, Wu JC. In vitro modeling of interorgan crosstalk: multi-organ-on-a-chip for studying cardiovascular-kidney-metabolic syndrome. Circ Res. 2025. Vol. 136(11):1476-93

[178] Yan S, Zhou X, Wu C, Gao Y, Qian Y, Hou J, et al.. Adipocyte YTH N(6)-methyladenosine RNA-binding protein 1 protects against obesity by promoting white adipose tissue beiging in male mice. Nat Commun. 2023. Vol. 14(1):1379

[179] Yang Loureiro Z, Joyce S, DeSouza T, Solivan-Rivera J, Desai A, Skritakis P, et al.. Wnt signaling preserves progenitor cell multipotency during adipose tissue development. Nat Metab. 2023. Vol. 5(6):1014-28

[180] Qiu J, Guo Y, Guo X, Liu Z, Li Z, Zhang J, et al.. Ucp1 Ablation improves skeletal muscle glycolytic function in aging mice. Adv Sci (Weinh). 2025. Vol. 12(2):e2411015

[181] Emont MP, Jacobs C, Essene AL, Pant D, Tenen D, Colleluori G, et al.. A single-cell atlas of human and mouse white adipose tissue. Nature. 2022. Vol. 603(7903):926-33

[182] Miller RJH, Yi J, Shanbhag A, Marcinkiewicz A, Patel KK, Lemley M, et al.. Deep learning-quantified body composition from positron emission tomography/computed tomography and cardiovascular outcomes: a multicentre study. Eur Heart J. 2025. Vol. 46(24):2336-47

[183] Hamel-Sellman DJ, Prescott BR, Korzinski TJ, Xanthakis V, Cooper LL, Hamburg NM, et al.. Relations of artificial intelligence vascular age with cardiometabolic disease progression: the Framingham Heart Study. J Am Heart Assoc. 2025. Vol. 14(24):e044872

[184] Wang Y, Aivalioti E, Stamatelopoulos K, Zervas G, Mortensen MB, Zeller M, et al.. Machine learning in cardiovascular risk assessment: towards a precision medicine approach. Eur J Clin Invest. 2025. Vol. 55 Suppl 1:e70017

[185] Kim C, Ross JS, Jastreboff AM, Meeker D, Freedman H, Krumholz HM, et al.. Uptake of and disparities in semaglutide and tirzepatide prescribing for obesity in the US. JAMA. 2025. Vol. 333(24):2203-6

[186] Gasoyan H, Pfoh ER, Schulte R, Sullivan E, Le P, Rothberg MB. Association of patient characteristics and insurance type with anti-obesity medications prescribing and fills. Diabetes Obes Metab. 2024. Vol. 26(5):1687-96

[187] National Science and Technology Information System of China. Semaglutide 2.4 mg Approved for Chronic Weight Management in China on 25 June 2024.

[188] Hernandez I, Sullivan SD. Net prices of new antiobesity medications. Obesity (Silver Spring). 2024. Vol. 32(3):472-5

[189] Bray GA, Kim KK, Wilding JPH; World Obesity Federation. Obesity: a chronic relapsing progressive disease process. A position statement of the World Obesity Federation. Obes Rev. 2017. Vol. 18(7):715-23

[190] Sumithran P, Prendergast LA, Delbridge E, Purcell K, Shulkes A, Kriketos A, et al.. Long-term persistence of hormonal adaptations to weight loss. N Engl J Med. 2011. Vol. 365(17):1597-604

[191] Lake A, Townshend T. Obesogenic environments: exploring the built and food environments. J R Soc Promot Health. 2006. Vol. 126(6):262-7

[192] Blüher M. Obesity: global epidemiology and pathogenesis. Nat Rev Endocrinol. 2019. Vol. 15(5):288-98

[193] Seidell JC, Halberstadt J. The global burden of obesity and the challenges of prevention. Ann Nutr Metab. 2015. Vol. 66 Suppl 2:7-12