Nathan Denton - Waisted: The Biology of Body Fat

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First Edition published in 2022

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Library of Congress Control Number: 2021944588

ISBN 9780198865278

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DOI: 10.1093/med/9780198865278.001.0001

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For Meredith,

For always being there for me

Many people played an instrumental role in making this book possible, although not everyone may be aware of their contribution. First, I wish to thank Professor Fredrik Karpe for sharing his inspiring fascination with and knowledge of adipose tissue as it opened my eyes to a biological world to which I had previously little exposure. Those formative years spent in the laboratory for my postgraduate studies with him, Dr Katherine Pinnick, and the many, many brilliant people at the Oxford Centre for Diabetes, Endocrinology, and Metabolism laid the groundwork for this book.

I would like to thank my undergraduate mentors, Dr Richard Boyd, Dr Paul Dennis, Professor William James, and Dr Piers Nye who provided a wonderful, unique learning environment that cultivated a life-long scientific curiosity. I also appreciate the words of encouragement from Professor Russell Foster and Professor Frances Ashcroft to pursue this project and whose science communication efforts act as great sources of inspiration. I also wish to thank my parents, Sue and George, for their support during this substantial task. Finally, I want to thank Meredith, my wonderful wife, for her tireless cheerleading, unending patience, and insightful feedback on multiple drafts.

Fat, and its associated negative health consequences, garners significant media attention and is a frequent topic of conversation with our doctors, partners, children, friends, and colleagues. The frequency and intensity of such discussions has only grown in recent decades in tandem with the substantial increase in obesity over a breathtakingly short period of time. The global prevalence of adult and childhood obesity has nearly tripled since 1975 and shows little sign of slowing. Major contributing factors in this growing crisis include our increasingly sedentary lifestyles and changing dietary habits, aided in large part by ineffective preventative policies, increasingly industrialized food manufacturing practices, and unhelpful social attitudes and norms. With the global obesity crisis unfolding before our very eyes, wreaking ever-increasing amounts of havoc on individuals, communities, healthcare systems, and economies, now, more than ever, is the time to understand what fat is, what it does, and why.

The current prevalence of overweight and obesity around the world is staggering. In their most recent statistics,

Being overweight or obese puts an immense strain on ones body and can accelerate the path to ill health or an untimely demise. What is not so clear, however, is whether obesity itself is a disease; has anyone died as a direct result of being obese? This heated debate boiled over in 2013, when the American Medical Association moved to classify obesity as a disease, However, not all overweight or obese people get diabetes, and not all people with diabetes are overweight or obese. This curious situation is an example of the fact that