Obesity is an acknowledged health hazard and risk factor for cardiovascular disease (CVD) and type 2 diabetes, yet physicians have been perplexed by the remarkable heterogeneity of obese patients in clinical practice. Some obese patients display no CVD risk factors whereas others have type 2 diabetes, clinical signs of coronary heart disease, and are characterized by insulin resistance, atherogenic dyslipidemia, and a whole constellation of risk factors. Though we know that obesity is a health hazard, it is still unclear why this condition is so heterogeneous in its clinical manifestations.
The fact that obesity is so multifaceted means it must be redefined as a clinical entity. Evidence published over the last 25 years has proven that the subgroup of overweight or obese patients with excess abdominal fat—intra-abdominal or visceral fat in particular—has the highest risk of developing type 2 diabetes and CVD. Many factors influence the accumulation of intra-abdominal fat.

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