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World J Gastroenterol. Jan 14, 2016; 22(2): 681-703
Published online Jan 14, 2016. doi: 10.3748/wjg.v22.i2.681
New obesity classification criteria as a tool for bariatric surgery indication
Antonino De Lorenzo, Laura Soldati, Francesca Sarlo, Menotti Calvani, Nicola Di Lorenzo, Laura Di Renzo
Antonino De Lorenzo, Menotti Calvani, Laura Di Renzo, Division of Clinical Nutrition and Nutrigenomic, Department of Biomedicine and Prevention, University of Tor Vergata, 00133 Rome, Italy
Antonino De Lorenzo, Department of Internal Medicine, UOSD Service of Clinical Nutrition, parenteral therapy and anorexia nervosa, Policlinico Tor Vergata, 00133 Rome, Italy
Laura Soldati, Department of Health Sciences, University of Milan, 20122 Milan, Italy
Francesca Sarlo, Department of Agriculture University of Naples “Federico II”, 80055 Portici (NA), Italy
Nicola Di Lorenzo, Department of Surgical Sciences, University of Tor Vergata, Policlinico Tor Vergata, 00133 Rome, Italy
Author contributions: De Lorenzo A conceived, designed the research, drafted the manuscript, and had primary responsibility for the final content; Soldati L, Sarlo F, Calvani M, Di Lorenzo N and Di Renzo L collected the data; Sarlo F and Di Renzo L wrote the paper; all the author have contributed to the interpretation of the revision of the manuscript.
Conflict-of-interest statement: Antonino De Lorenzo, Laura Soldati, Francesca Sarlo, Menotti Calvani, Nicola Di Lorenzo and Laura Di Renzo have no conflict of interest to disclose.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Antonino De Lorenzo, MD, Division of Clinical Nutrition and Nutrigenomic, Department of Biomedicine and Prevention, University of Tor Vergata, Via Montpellier 1, 00133 Rome, Italy. delorenzo@uniroma2.it
Telephone: +39-6-72596856 Fax: +39-6-72596853
Received: May 28, 2015
Peer-review started: June 1, 2015
First decision: July 14, 2015
Revised: October 5, 2015
Accepted: November 30, 2015
Article in press: December 1, 2015
Published online: January 14, 2016
Processing time: 222 Days and 19.2 Hours
Abstract

Obesity plays relevant pathophysiological role in the development of health problems, arising as result of complex interaction of genetic, nutritional, and metabolic factors. Due to the role of adipose tissue in lipid and glucose metabolism, and low grade inflammation, it is necessary to classify obesity on the basis of body fat composition and distribution, rather than the simply increase of body weight, and the Body Mass Index. The new term of adiposopathy (‘‘sick fat’’) clearly defines the pathogenic role of adipose tissue. Four phenotypes of obese individuals have been described: (1) normal weight obese (NWO); (2) metabolically obese normal weight; (3) metabolically healthy obese; and (4) metabolically unhealthy obese or “at risk” obese. Moreover, sarcopenic obesity has been related to all the phenotypes. The category of normal weight lean, represented by metabolically healthy normal weight has been classified to distinguish from NWO. It is crucial to recommend a bariatric surgery taking into account adiposopathy and sick fat that occurs with the expansion of fat mass, changing the inflammatory and metabolic profile of the patient. Body fat percentage and genetic polymorphism have to be evaluated to personalize the best bariatric surgery intervention.

Keywords: Obesity; Adiposopathy; Normal weight lean; Normal weight obese; Metabolically obese normal weight; Metabolically healthy obese; Metabolically healthy normal weight; Metabolically unhealthy obese; Laparoscopic gastric banding; Fat mass

Core tip: Obesity is a global public health problem due to its association with several diseases and reduced lifespan, as result of complex interaction of genetic, nutritional, and metabolic factors. The term of adiposopathy clearly defines the pathogenic role of adipose tissue. Four phenotypes of obesity have been described, based on body fat composition and distribution: (1) normal weight obese; (2) metabolically obese normal weight; (3) metabolically healthy obese; and (4) metabolically unhealthy obese. Sarcopenic obesity has been characterized, related to all the described phenotypes. Body fat percentage and genetic polymorphism have to be evaluated to personalize the best bariatric surgery intervention.