Obesity is a multifactorial disease that is currently developing a threatening
tendency towards becoming the main cause of chronic disease in the world. Obesity can
induce type 2 diabetes mellitus, dyslipidemia, cardiovascular disease and other chronic
disorders with high social and health costs. Obesity was firstly described in 2000 as a
cardiometabolic disease, even before Metabolic Syndrome, type 2 diabetes mellitus and
coronary disease were considered as such. In this chapter we recover this approach to
obesity, which has remained almost forgotten for the last decade. In obese subjects,
adipokines and miokines interact to promote reticulum stress, insulin resistance,
metabolic inflexibility and endothelial dysfunction. These pathological processes are
amplified when hyperglycemia is present, leading to an increased risk for
atherosclerosis. A number of potential implications for clinical practice are derived
from the cardiometabolic state underlying obesity and its comorbidities. The first step in
the therapeutic strategy against obesity should be the correct diagnosis of its causes and
the promotion of lifestyle changes including physical exercise and a healthy diet. In the
usual case of failing to achieve results, we can still resort to the pharmacological
therapy. While awaiting the release of new drugs, topiramate, alone or combined with
phentermine, has been proposed as a novel anti-obesity drug, showing relevant effects
not only on weight loss but also on cardiometabolic alterations and biomarkers, even
though new studies should clarify the mechanisms of these findings. Finally, our own
experience with topiramate is described, focusing on its effects upon weight loss and
inflammatory markers.
Keywords: Adipokine, adiposity, adiposopathy endoplasmic reticulum stress,
anti-obesity drugs, atherosclerosis, cardiometabolic disease, coronary heart
disease, diet, endothelial dysfunction, inflammation, insulin resistance, lifestyle
changes, metabolic inflexibility, miokine, obesity, physical activity, topiramate,
weight loss.
