Hormonal
Human obesity is characterized by tissue-specific dysregulation of cortisol metabolism, specifically involving increased 11beta-hydroxysteroid dehydrogenase type 1 (11beta-HSD1) activity in adipose tissue and skeletal muscle, leading to elevated intracellular cortisol levels despite normal circulating cortisol.
Standard blood tests for cortisol may appear normal in obesity, masking tissue-specific metabolic stress. The problem lies in how fat and muscle cells convert inactive cortisone into active cortisol via the enzyme 11beta-HSD1. Managing obesity requires addressing this local tissue dysregulation, not just systemic stress markers.
We have shown that 11beta-HSD1 activity is increased in adipose tissue and skeletal muscle in human obesity, leading to increased intracellular cortisol concentrations.
Why this rating
The study uses rigorous biochemical assays (microsomal fractions) and direct tissue biopsies in humans, though it is a cross-sectional observation rather than a long-term intervention.
Source
Tissue-Specific Dysregulation of Cortisol Metabolism in Human Obesity
Eva Rask et al. · The Journal of Clinical Endocrinology & Metabolism · 2001
DOI 10.1210/jcem.86.3.7453
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