Form and Function of Fat in Obesity

Fat ChildEnergy storage? That is the obsolete view about the function of fat tissue that drives much of public health policy on obesity. Energy in, energy out. Eat less, move more. But in reality, fat tissue is an endocrine organ. It is highly active, complex, and essential for health. With exquisite detail, a new review paper in Cell tells us that the problem with adipose tissue in obesity is not that there is too much of it.

No, the problem with fat tissue in obesity is that it has lost its ability to function correctly as an endocrine organ. So try out your willpower for re-wiring that problem.

Plasticity Is the Word to Know

One of the hallmarks of adipose tissue function is plasticity – its ability to adapt and change. Flexibility makes adipose tissue valuable as an endocrine organ. But in obesity, fat tissue can lose this flexibility of function. Thus it opens the door to a whole host of metabolic and inflammatory diseases.

In their new paper, Alexander Sakers and colleagues describe what happens:

Obesity often leads to a decline in adipose-tissue plasticity, which is associated with fibrosis, inflammation, progenitor-cell senescence, and catecholamine resistance. Ultimately, these pathological changes impair the critical nutrient-buffering function of adipose tissue, leading to insulin resistance and metabolic disease.

Targets for Obesity Treatment

To fix a problem, it’s essential to know what it is. Simply understanding that obesity is not a problem of too much energy storage changes everything. In fact, with knowledge that adipose tissue function changes in obesity, scientists can look for ways to repair that dysfunction. Already we know that some drugs for diabetes – called TZDs – have an effect on adipose tissue that helps with insulin sensitivity. But they have other effects that cause problems. So their use has declined. Drugs like liraglutide and empagliflozin gained more favor.

Sakers et al suggest this new science of adipose tissue can open the door for better anti-obesity meds. These would be drugs that can help fat tissue regain its healthy function. That’s hope for the future. But for now, let’s discard the biased mental model of fat tissue as some kind of weirdly expandable gas tank. Because it is plainly wrong.

Click here for the new paper and here for further perspective.

Fat Child, painting by Amedeo Modigliani / WikiArt

Subscribe by email to follow the accumulating evidence and observations that shape our view of health, obesity, and policy.


February 5, 2022

3 Responses to “Form and Function of Fat in Obesity”

  1. February 06, 2022 at 8:48 am, John DiTraglia said:

    Ummm I think a person with a lot of obesity will live longer not eating than a skinny person.

    • February 06, 2022 at 10:27 am, Ted said:

      But starvation is not a good experience for anyone. Also worth noting that severe obesity is not very prevalent where famine is a problem.

  2. February 08, 2022 at 3:55 am, Mary-Jo said:

    Every HCP who has patients with obesity, who wants to really help these folks improve health outcomes, needs to read this paper! It gives insight into the reality of the complexity of the disease and why we are just not seeing success in reducing incidence and prevalence of obesity. Focusing on modifying diets (including various iterations of fasting), levels of exercise, ALONE, certainly with only a couple visits to the GP or dietitian, misses the total reality of what can be done to effectively treat, resulting in not only weight loss, but optimal adipose tissue function. This requires the healthcare system to acknowledge more effective options exist, to give access to people, to provide monitoring and follow up needed until health-care goals sustained.