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Abstract
Recent research has indicated that visceral obesity is associated with multiple endocrine
disturbances. Insulin resistance, as well as visceral fat accumulation, may be consequences
of these abnormalities. The complex endocrine aberrations are probably of central
origin, and suggest a neuroendocrine background with a “hypothalamic arousal” syndrome.
Such a syndrome has been found after excess alcohol intake, tobacco smoking, and certain
types of stress reactions. Subjects with visceral obesity might be characterized by
a high prevalence of such factors, although only indirect evidence is available for
the stress component, maybe caused by a poor socioeconomic and psychosocial situation.
In primate experiments, a submissive stress reaction is followed by a syndrome essentially
identical to that seen in humans with visceral obesity, including visceral fat accumulation.
These observations strongly support a similar chain of events in humans. Recent studies
have indicated several abnormalities in cerebrospinal fluid (CSF) concentrations of
catecholamines and neuropeptides. In particular, serotonin metabolites and corticotropin-releasing
factor (CRF) concentrations are apparently lower than normal. In women with visceral
obesity, these low concentrations are associated with food choices that indicate a
preference for carbohydrates. This finding emphasizes the importance of serotonin
agonists in the treatment of human obesity. It seems possible that such drugs may
have effects on metabolic and other symptoms particularly prevalent in abdominal obesity,
and that these effects might be independent of the decrease in energy intake. It would
seem highly desirable to explore these possibilities further. Such observations may
also provide a link between the abnormalities of low serotonin and CRF concentrations
in the central nervous system on one hand and peripheral metabolic and other abnormalities
on the other.
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© 1995 Published by Elsevier Inc.
