Hormonal
Obesity causes supersaturated cholesterol bile primarily through excessive hepatic cholesterol secretion, not by a deficiency in bile acids or phospholipids.
If you are obese, your liver is likely secreting excess cholesterol into your bile, making you prone to gallstones. This is a metabolic consequence of obesity itself, not just what you eat. While weight loss reduces this risk, the underlying tendency is driven by the excess body fat altering liver secretion rates.
Supersaturated bile in the obese could therefore be attributed to a single defect in lipid secretion, namely, an excessive output of cholesterol.
Why this rating
The study uses rigorous controlled metabolic ward protocols with matched controls and direct measurement of hepatic outputs, though it is an older study (1975).
Source
Effects of obesity and caloric intake on biliary lipid metabolism in man.
Lynn J. Bennion et al. · Journal of Clinical Investigation · 1975
DOI 10.1172/jci108180
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