Pathophysiology of Obesity Comorbidity: The Effects of Chronically Increased Intraabdominal Pressure

  • Harvey J. Sugerman


Severe obesity is associated with multiple comorbidities that reduce the life expectancy and markedly impair the quality of life. Morbidly obese patients can suffer from central (android) obesity or peripheral (gynoid) obesity or a combination of the two. Gynoid obesity is associated with degenerative joint disease and venous stasis in the lower extremities. Android obesity is associated with the highest risk of mortality related to problems due to the metabolic syndrome or syndrome X, as well as increased intraabdominal pressure (IAP). The metabolic syndrome is associated with insulin resistance, hyperglycemia, and type 2 diabetes mellitus (DM), which in turn are associated with nonalcoholic liver disease (NALD), polycystic ovary syndrome, and systemic hypertension (1–7). Increased IAP is probably responsible in part or totally for obesity hypoventilation, venous stasis disease, pseudotumor cerebri, gastroesophageal reflux disease, stress urinary incontinence, and systemic hypertension. Central obesity is also associated with increased neck circumference and sleep apnea.


Stress Urinary Incontinence Incisional Hernia Plasma Renin Activity Intraabdominal Pressure Pleural Pressure 


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  1. 1.
    Eckel RH, Grundy SM, Zimmet PZ. The metabolic syndrome. Lancet 2005;365(9468):1415–1428.CrossRefPubMedGoogle Scholar
  2. 2.
    Grundy SM, Brewer HB Jr, Cleeman JI, et al. Definition of metabolic syndrome: Report of the National Heart, Lung, and Blood Institute/American Heart Association conference on scientific issues related to definition. Circulation 2004;109(3):433–438.CrossRefPubMedGoogle Scholar
  3. 3.
    Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation 2002;106(25): 3143–3421.Google Scholar
  4. 4.
    Ong JP, Elariny H, Collantes R, et al. Predictors of nonalcoholic steatohepatitis and advanced fibrosis in morbidly obese patients. Obes Surg 2005;15(3):310–315.CrossRefPubMedGoogle Scholar
  5. 5.
    Mattar SG, Velcu LM, Rabinovitz M, et al. Surgicallyinduced weight loss significantly improves nonalcoholic fatty liver disease and the metabolic syndrome. Ann Surg 2005;242(4):610–617; discussion 618–620.PubMedCentralPubMedGoogle Scholar
  6. 6.
    Escobar-Morreale HF, Botella-Carretero JI, Alvarez-Blasco F, et al. The polycystic ovary syndrome associated with morbid obesity may resolve after weight loss induced by bariatric surgery. J Clin Endocrinol Metab 2005; 90(12):6364–6369.CrossRefPubMedGoogle Scholar
  7. 7.
    Johnson D, Prud’homme D, Despres JP, et al. Relation of abdominal obesity to hyperinsulinemia and high blood pressure in men. Int J Obes Relat Metab Disord 1992; 16(11):881–890.PubMedGoogle Scholar
  8. 8.
    Sugerman HJ, Baron PL, Fairman RP, et al. Hemodynamic dysfunction in obesity hypoventilation syndrome and the effects of treatment with surgically induced weight loss. Ann Surg 1988;207(5):604–613.PubMedCentralCrossRefPubMedGoogle Scholar
  9. 9.
    Sugerman HJ, Felton WL 3rd, Salvant JB Jr, et al. Effects of surgically induced weight loss on idiopathic intracranial hypertension in morbid obesity. Neurology 1995;45(9): 1655–1659.CrossRefPubMedGoogle Scholar
  10. 10.
    Bump RC, Sugerman HJ, Fantl JA, McClish DK. Obesity and lower urinary tract function in women: effect of surgically induced weight loss. Am J Obstet Gynecol 1992;167(2):392–397; discussion 397–399.CrossRefPubMedGoogle Scholar
  11. 11.
    Sugerman H, Windsor A, Bessos M, et al. Effects of surgically induced weight loss on urinary bladder pressure, sagittal abdominal diameter and obesity co-morbidity. Int J Obes Relat Metab Disord 1998;22(3):230–235.CrossRefPubMedGoogle Scholar
  12. 12.
    Ertel W, Oberholzer A, Platz A, et al. Incidence and clinical pattern of the abdominal compartment syndrome after “damage-control” laparotomy in 311 patients with severe abdominal and/or pelvic trauma. Crit Care Med 2000; 28(6):1747–1753.CrossRefPubMedGoogle Scholar
  13. 13.
    Ridings PC, Bloomfield GL, Blocher CR, Sugerman HJ. Cardiopulmonary effects of raised intra-abdominal pressure before and after intravascular volume expansion. J Trauma 1995;39(6):1071–1075.CrossRefPubMedGoogle Scholar
  14. 14.
    Bloomfield GL, Ridings PC, Blocher CR, et al. A proposed relationship between increased intra-abdominal, intrathoracic, and intracranial pressure. Crit Care Med 1997; 25(3):496–503.CrossRefPubMedGoogle Scholar
  15. 15.
    Bloomfield GL, Blocher CR, Fakhry IF, et al. Elevated intra-abdominal pressure increases plasma renin activity and aldosterone levels. J Trauma 1997;42(6):997–1004; discussion 1004–1005.CrossRefPubMedGoogle Scholar
  16. 16.
    Dent J, Dodds WJ, Hogan WJ, Toouli J. Factors that influence induction of gastroesophageal reflux in normal human subjects. Dig Dis Sci 1988;33(3):270–275.CrossRefPubMedGoogle Scholar
  17. 17.
    Fantl JA. Genuine stress incontinence: pathophysiology and rationale for its medical management. Obstet Gynecol Clin North Am 1989;16(4):827–840.PubMedGoogle Scholar
  18. 18.
    Nagler R, Spiro HM. Heartburn in late pregnancy. Manometric studies of esophageal motor function. J Clin Invest 1961;40:954–970.PubMedCentralCrossRefPubMedGoogle Scholar
  19. 19.
    Sugerman HJ, Kellum JM Jr, Reines HD, et al. Greater risk of incisional hernia with morbidly obese than steroid-dependent patients and low recurrence with prefascial polypropylene mesh. Am J Surg 1996;171(1):80–84.CrossRefPubMedGoogle Scholar
  20. 20.
    Skudder PA, Farrington DT. Venous conditions associated with pregnancy. Semin Dermatol 1993;12(2):72–77.PubMedGoogle Scholar
  21. 21.
    Sugerman H, Windsor A, Bessos M, Wolfe L. Intra-abdominal pressure, sagittal abdominal diameter and obesity comorbidity. J Intern Med 1997;241(1):71–79.CrossRefPubMedGoogle Scholar
  22. 22.
    Kron IL, Harman PK, Nolan SP. The measurement of intra-abdominal pressure as a criterion for abdominal reexploration. Ann Surg 1984;199(1):28–30.PubMedCentralCrossRefPubMedGoogle Scholar
  23. 23.
    Sugerman HJ, DeMaria EJ, Felton WL 3rd, et al. Increased intra-abdominal pressure and cardiac filling pressures in obesity-associated pseudotumor cerebri. Neurology 1997; 49(2):507–511.CrossRefPubMedGoogle Scholar
  24. 24.
    Harman PK, Kron IL, McLachlan HD, et al. Elevated intra-abdominal pressure and renal function. Ann Surg 1982;196(5):594–597.PubMedCentralCrossRefPubMedGoogle Scholar
  25. 25.
    Scaglione R, Ganguzza A, Corrao S, et al. Central obesity and hypertension: pathophysiologic role of renal haemodynamics and function. Int J Obes Relat Metab Disord 1995; 19(6):403–409.PubMedGoogle Scholar
  26. 26.
    Kvist H, Chowdhury B, Grangard U, et al. Total and visceral adipose-tissue volumes derived from measurements with computed tomography in adult men and women: predictive equations. Am J Clin Nutr 1988;48(6):1351–1361.PubMedGoogle Scholar
  27. 27.
    Kvist H, Chowdhury B, Sjostrom L, et al. Adipose tissue volume determination in males by computed tomography and 40K. Int J Obes 1988;12(3):249–266.PubMedGoogle Scholar
  28. 28.
    Sugerman HJ, Fairman RP, Sood RK, et al. Long-term effects of gastric surgery for treating respiratory insufficiency of obesity. Am J Clin Nutr 1992;55(2 suppl): 597S–601S.PubMedGoogle Scholar
  29. 29.
    Pories WJ, MacDonald KG Jr, Morgan EJ, et al. Surgical treatment of obesity and its effect on diabetes: 10-y followup. Am J Clin Nutr 1992;55(2 suppl):582S–585S.PubMedGoogle Scholar
  30. 30.
    Deitel M, Khanna RK, Hagen J, Ilves R. Vertical banded gastroplasty as an antireflux procedure. Am J Surg 1988; 155(3):512–516.CrossRefPubMedGoogle Scholar
  31. 31.
    Gleysteen JJ, Barboriak JJ, Sasse EA. Sustained coronaryrisk-factor reduction after gastric bypass for morbid obesity. Am J Clin Nutr 1990;51(5):774–778.PubMedGoogle Scholar
  32. 32.
    Deitel M, To TB, Stone E, et al. Sex hormonal changes accompanying loss of massive excess weight. Gastroenterol Clin North Am 1987;16(3):511–515.PubMedGoogle Scholar
  33. 33.
    Foley EF, Benotti PN, Borlase BC, et al. Impact of gastric restrictive surgery on hypertension in the morbidly obese. Am J Surg 1992;163(3):294–297.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Harvey J. Sugerman
    • 1
  1. 1.Department of SurgeryVirginia Commonwealth UniversityRichmondUSA

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