Barocrinology: The Endocrinology of Obesity from Bench to Bedside

Abstract

Obesity has reached pandemic proportions. Hormonal and metabolic imbalances are the key factors that lead to obesity. South Asian populations have a unique phenotype, peculiar dietary practices, and a high prevalence of consanguinity. Moreover, many lower middle-income countries lack appropriate resources, super-specialists, and affordability to manage this complex disorder. Of late, there has been a substantial increase in both obesity and diabesity in India. Thus, many more patients are being managed by different types of bariatric procedures today than ever before. These patients have many types of endocrine and metabolic disturbances before and after bariatric surgery. Therefore, these patients should be managed by experts who have knowledge of both bariatric surgery and endocrinology. The authors propose “Barocrinology”, a novel terminology in medical literature, to comprehensively describe the field of obesity medicine highlighting the role of knowing endocrine physiology for understating its evolution, insights into its complications and appreciating the changes in the hormonal milieu following weight loss therapies including bariatric surgery. Barocrinology, coined as a portmanteau of “baro” (weight) and endocrinology, focuses upon the endocrine and metabolic domains of weight physiology and pathology. This review summarizes the key pointers of bariatric management from an endocrine perspective.

Gender disparities in people living with obesity - An unchartered territory

“…[ 19 ] Although obesity is associated with significant alterations in the hormonal, metabolic, and inflammatory milieu of a given patient, the key mechanisms that alter the risk between men and women include the differences in the insulin/insulin-like growth factor-1 axis, the impact of gonadal hormones, and the emerging role of adipocytokines. [ 20 21 22 ] Overall, the obesity-related malignancies are more common in women and include endometrial, ovarian, and postmenopausal breast cancers. Among the malignancies that affect both genders, esophageal cancers are more prevalent in men.…”

Subclinical Kwashiorkor in Adults

“…[ 62 ] Secondary endocrine causes such as endogenous Cushing’s syndrome, chronic adrenal insufficiency, chronic steroid use, uncontrolled diabetes, hyperthyroidism and hypogonadism should be ruled out in patients where no other obvious cause can be identified. [ 48 ]…”

“…Conditions, such as infections, trauma, burns, surgery and hyperthyroidism, that increase metabolic demands, can precipitate PEU. [ 47 48 ]…”

ESI Clinical Practice Guidelines for the Evaluation and Management of Obesity In India

“…The treating physician should also rule out secondary causes of obesity and associated endocrinopathies. [ 43 ] These have been summarized in the Table 6 .…”