The Ominous Octet of Obesity: A framework for obesity pathophysiology.

The pathogenesis of obesity is complex and is beyond the simple equation of excess calorie intake and inadequate calorie expenditure. It involves the role of multiple organ systems and these complex interactions are often challenging to address in a busy clinical practice. We propose a simplified framework akin to the ominous octet of diabetes, to help understand the role of these different organ systems in relation to obesity. The Ominous Octet of obesity includes the hypothalamus, islet cells of Langerhans, gastrointestinal tract, adipose tissue, adrenal gland, gonads, thyroid gland and the muscle. This framework would also help to understand the use of different therapeutic targets in patients with obesity and improve the care of these patients.