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The epidemic of obesity-associated diabetes is a major crisisin modern societies, in which food is plentiful and exerciseis optional. The biological basis of this problem has been exploredfrom evolutionary and mechanistic perspectives. Evolutionarytheories, focusing on the potential survival advantages of "thrifty"genes that are now maladaptive, are of great interest but areinherently speculative and difficult to prove. Mechanistic studieshave revealed numerous fat-derived molecules and a link to inflammationthat, together, are hypothesized to underlie the obesity-diabetesconnection and thereby represent prospective targets for therapeuticintervention.
Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, and The Penn Diabetes Center, University of Pennsylvania School of Medicine, Philadelphia, PA 19104–6149, USA.
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