endofocusFOCUS ЭндокринологияFOCUS. Endocrinology2713-01772713-0185ООО "Издательство "Перо"10.62751/2713-0177-2026-7-2-08endofocus-220Research ArticleОБЗОРЫОжирение как глобальная проблема XXI века: механизмы развития и современные стратегии управленияObesity as a global problem of the 21st century: Development mechanisms and modern management strategieshttps://orcid.org/0000-0001-6385-540XДемидоваТ. Ю.DemidovaT. Yu.

Демидова Татьяна Юльевна – д.м.н., профессор, заслуженный врач РФ 

Москва 

Tatiana Yu. Demidova – Dr. Sci. (Med.), professor, Honored Doctor of the Russian Federation 

Moscow 

t.y.demidova@gmail.comhttps://orcid.org/0000-0002-1385-0245ИзмайловаМ. Я.IzmailovaM. Ya.

Измайлова Марьям Ярагиевна – ассистент кафедры эндокринологии ИКМ 

Москва 

Mariam Ya. Izmailova – assistant at the Department of endocrinology 

Moscow 

maremizm@gmail.comhttps://orcid.org/0009-0007-2906-4082ВартпатриковаН. А.VartpatrikovaN. A.

Вартпатрикова Наталья Александровна – студентка 3 курса факультета фундаментальной медицины 

119991, Москва, Ленинские горы, д. 1 

Natalia A. Vartpatrikova – a third-year student, Faculty of Fundamental Medicine

Leninskie Gory, 1, sector «А», room 911, 119991, Moscow 

vartpatrikova@gmail.comРоссийский национальный исследовательский медицинский университет им. Н.И. Пирогова (Пироговский университет)РоссияPirogov Russian National Research Medical University,Russian FederationМедицинский научно-образовательный институт Московского государственного университета им. М.В. ЛомоносоваРоссияMedical Scientific and Educational Institute of Lomonosov Moscow State UniversityRussian Federation202611072026726372Copyright © Демидова Т.Ю., Измайлова М.Я., Вартпатрикова Н.А., 20262026Демидова Т.Ю., Измайлова М.Я., Вартпатрикова Н.А.Demidova T.Y., Izmailova M.Y., Vartpatrikova N.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://endofocus.elpub.ru/jour/article/view/220

 Ожирение – сложное, хроническое полиэтиологическое заболевание, характеризующееся избыточным накоплением жировой ткани, которое приводит к неблагоприятным метаболическим осложнениям (включая сахарный диабет, кардиоваскулярные заболевания, метаболический синдром). С каждым годом ожирение приобретает все бо́льшие масштабы, и, по разным прогнозам, к середине XXI в. это заболевание будет иметь более половины взрослого населения планеты. Такая тенденция вызывает обеспокоенность и требует принятия радикальных мер в системе мирового здравоохранения. На сегодняшний день в арсенале клиницистов появился целый ряд инновационных фармакологических препаратов, позволяющих эффективно управлять массой тела. Цель данного обзора – проанализировать имеющиеся данные об этиологии, патологических процессах, лежащих в основе развития ожирения, современных подходах к диагностике и лечению, сформировать комплексное понимание об этом заболевании и выявить причины его массовой распространенности и трудностей лечения. 

Obesity is a complex chronic polyethological disease characterized by excessive accumulation of adipose tissue, which leads to adverse metabolic complications (diabetes mellitus, cardiovascular diseases, metabolic syndrome). Every year, obesity becomes epidemiological in nature, and according to various forecasts, by the middle of the 21st century, more than half of the adult population of the planet will have this disease. This trend is causing concern and requires drastic measures to be taken in the global health system. To date, a number of innovative pharmacological drugs have appeared in the arsenal of clinicians, allowing them to effectively manage body weight. The purpose of this review is to analyze the available data on the etiology, pathological processes underlying the development of obesity, and modern approaches to the diagnosis and treatment of this disease; to form a comprehensive understanding of this disease and identify the causes of widespread prevalence and treatment difficulties. 

ожирениеэнергетический дисбалансхроническое воспаление жировой тканиорексигенные нейроныанорексигенные нейроныглюкагоноподобный пептид-1семаглутидтирзепатидobesityenergy disbalancechronic inflammation of adipose tissueorexigenic neuronsanorexigenic neuronsglucagon-like peptide-1semaglutidetirzepatideReferencesBanerjee D, Giamouzis G, Marwick TH, von Haehling S. Obesity's systemic impact: Exploring molecular and physiological links to diabetes, cardiovascular disease, and heart failure. Front Endocrinol (Lausanne). 2025;16:1681766. https://doi.org/10.3389/fendo.2025.1681766Banerjee D, Giamouzis G, Marwick TH, von Haehling S. Obesity's systemic impact: Exploring molecular and physiological links to diabetes, cardiovascular disease, and heart failure. Front Endocrinol (Lausanne). 2025;16:1681766. https://doi.org/10.3389/fendo.2025.1681766Gallo G, Desideri G, Savoia C. Update on obesity and cardiovascular risk: from pathophysiology to clinical management. Nutrients. 2024;16(16):2781. https://doi.org/10.3390/nu16162781Gallo G, Desideri G, Savoia C. Update on obesity and cardiovascular risk: from pathophysiology to clinical management. Nutrients. 2024;16(16):2781. https://doi.org/10.3390/nu16162781BD 2021 Adult BMI Collaborators. Global, regional, and national prevalence of adult overweight and obesity, 1990–2021, with forecasts to 2050: A forecasting study for the Global Burden of Disease Study 2021. Lancet. 2025;405(10481):813–38. https://doi.org/10.1016/S0140-6736(25)00355-1BD 2021 Adult BMI Collaborators. Global, regional, and national prevalence of adult overweight and obesity, 1990–2021, with forecasts to 2050: A forecasting study for the Global Burden of Disease Study 2021. Lancet. 2025;405(10481):813–38. https://doi.org/10.1016/S0140-6736(25)00355-1Kaplan LM, Golden A, Jinnett K, Kolotkin RL, Kyle TK, Look M, et al. Perceptions of barriers to effective obesity care: Results from the National ACTION study. Obesity (Silver Spring). 2018;26(1):61–69. https://doi.org/10.1002/oby.22054Kaplan LM, Golden A, Jinnett K, Kolotkin RL, Kyle TK, Look M, et al. Perceptions of barriers to effective obesity care: Results from the National ACTION study. Obesity (Silver Spring). 2018;26(1):61–69. https://doi.org/10.1002/oby.22054McNaught J. Pathophysiology of obesity. J Clin Lipidol. 2026;20(1S):21–25. https://doi.org/10.1016/j.jacl.2025.06.016McNaught J. Pathophysiology of obesity. J Clin Lipidol. 2026;20(1S):21–25. https://doi.org/10.1016/j.jacl.2025.06.016Bray GA, Heisel WE, Afshin A, Jensen MD, Dietz WH, Long M, et al. The science of obesity management: An Endocrine Society Scientific Statement. Endocr Rev. 2018;39(2):79–132. https://doi.org/10.1210/er.2017-00253Bray GA, Heisel WE, Afshin A, Jensen MD, Dietz WH, Long M, et al. The science of obesity management: An Endocrine Society Scientific Statement. Endocr Rev. 2018;39(2):79–132. https://doi.org/10.1210/er.2017-00253Carbone F, Despres JP, Ioannidis JPA, Neeland IJ, Garruti G, Busetto L, et al. Bridging the gap in obesity research: A consensus statement from the European Society for Clinical Investigation. Eur J Clin Invest. 2025;55(8):e70059. https://doi.org/10.1111/eci.70059Carbone F, Despres JP, Ioannidis JPA, Neeland IJ, Garruti G, Busetto L, et al. Bridging the gap in obesity research: A consensus statement from the European Society for Clinical Investigation. Eur J Clin Invest. 2025;55(8):e70059. https://doi.org/10.1111/eci.70059Muller TD, Bluher M, Tschop MH, DiMarchi RD. Anti-obesity drug discovery: Advances and challenges. Nat Rev Drug Discov. 2022;21(3):201–23. https://doi.org/10.1038/s41573-021-00337-8Muller TD, Bluher M, Tschop MH, DiMarchi RD. Anti-obesity drug discovery: Advances and challenges. Nat Rev Drug Discov. 2022;21(3):201–23. https://doi.org/10.1038/s41573-021-00337-8Golden A. Obesity's impact. Nurs Clin North Am. 2021;56(4):xiii–xiv. https://doi.org/10.1016/j.cnur.2021.08.004Golden A. Obesity's impact. Nurs Clin North Am. 2021;56(4):xiii–xiv. https://doi.org/10.1016/j.cnur.2021.08.004Gjermeni E, Kirstein AS, Kolbig F, Kirchhof M, Bundalian L, Katzmann JL, et al. Obesity – an update on the basic pathophysiology and review of recent therapeutic advances. Biomolecules. 2021;11(10):1426. https://doi.org/10.3390/biom11101426Gjermeni E, Kirstein AS, Kolbig F, Kirchhof M, Bundalian L, Katzmann JL, et al. Obesity – an update on the basic pathophysiology and review of recent therapeutic advances. Biomolecules. 2021;11(10):1426. https://doi.org/10.3390/biom11101426Fruhbeck G, Busetto L, Dicker D, Yumuk V, Goossens GH, Hebebrand J, et al. The ABCD of obesity: An EASO position statement on a diagnostic term with clinical and scientific implications. Obes Facts. 2019;12(2):131–36. https://doi.org/10.1159/000497124Fruhbeck G, Busetto L, Dicker D, Yumuk V, Goossens GH, Hebebrand J, et al. The ABCD of obesity: An EASO position statement on a diagnostic term with clinical and scientific implications. Obes Facts. 2019;12(2):131–36. https://doi.org/10.1159/000497124Tahrani AA, Panova-Noeva M, Schloot NC, Hennige AM, Soderberg J, Nadglowski J, et al. Stratification of obesity phenotypes to optimize future therapy (SOPHIA). Expert Rev Gastroenterol Hepatol. 2023;17(10):1031–39. https://doi.org/10.1080/17474124.2023.2264783Tahrani AA, Panova-Noeva M, Schloot NC, Hennige AM, Soderberg J, Nadglowski J, et al. Stratification of obesity phenotypes to optimize future therapy (SOPHIA). Expert Rev Gastroenterol Hepatol. 2023;17(10):1031–39. https://doi.org/10.1080/17474124.2023.2264783Lin X, Li H. Obesity: Epidemiology, pathophysiology, and therapeutics. Front Endocrinol (Lausanne). 2021;12:706978. https://doi.org/10.3389/fendo.2021.706978Lin X, Li H. Obesity: Epidemiology, pathophysiology, and therapeutics. Front Endocrinol (Lausanne). 2021;12:706978. https://doi.org/10.3389/fendo.2021.706978Fraiman J, Baver S, Henneberg M. Microevolutionary hypothesis of the obesity epidemic. PLoS One. 2024;19(8):e0305255. https://doi.org/10.1371/journal.pone.0305255Fraiman J, Baver S, Henneberg M. Microevolutionary hypothesis of the obesity epidemic. PLoS One. 2024;19(8):e0305255. https://doi.org/10.1371/journal.pone.0305255From the American Association of Neurological Surgeons (AANS), American Society of Neuroradiology (ASNR), Cardiovascular and Interventional Radiology Society of Europe (CIRSE), Canadian Interventional Radiology Association (CIRA), Congress of Neurological Surgeons (CNS), European Society of Minimally Invasive Neurological Therapy (ESMINT), European Society of Neuroradiology (ESNR), European Stroke Organization (ESO), Society for Cardiovascular Angiography and Interventions (SCAI), Society of Interventional Radiology (SIR), Society of NeuroInterventional Surgery (SNIS), and World Stroke Organization (WSO); Sacks D, Baxter B, Campbell BCV, Carpenter JS, Cognard C, Dippel D, et al. Multisociety Consensus Quality Improvement Revised Consensus Statement for Endovascular Therapy of Acute Ischemic Stroke. Int J Stroke. 2018;13(6):612–32. https://doi.org/10.1016/j.eprac.2025.07.017From the American Association of Neurological Surgeons (AANS), American Society of Neuroradiology (ASNR), Cardiovascular and Interventional Radiology Society of Europe (CIRSE), Canadian Interventional Radiology Association (CIRA), Congress of Neurological Surgeons (CNS), European Society of Minimally Invasive Neurological Therapy (ESMINT), European Society of Neuroradiology (ESNR), European Stroke Organization (ESO), Society for Cardiovascular Angiography and Interventions (SCAI), Society of Interventional Radiology (SIR), Society of NeuroInterventional Surgery (SNIS), and World Stroke Organization (WSO); Sacks D, Baxter B, Campbell BCV, Carpenter JS, Cognard C, Dippel D, et al. Multisociety Consensus Quality Improvement Revised Consensus Statement for Endovascular Therapy of Acute Ischemic Stroke. Int J Stroke. 2018;13(6):612–32. https://doi.org/10.1016/j.eprac.2025.07.017Marassi M, Fadini GP. The cardio-renal-metabolic connection: A review of the evidence. Cardiovasc Diabetol. 2023;22(1):195.https://doi.org/10.1186/s12933-023-01937-xMarassi M, Fadini GP. The cardio-renal-metabolic connection: A review of the evidence. Cardiovasc Diabetol. 2023;22(1):195.https://doi.org/10.1186/s12933-023-01937-xRyan DH, Lingvay I, Deanfield J, Kahn SE, Barros E, Burguera B, et al. Long-term weight loss effects of semaglutide in obesity without diabetes in the SELECT trial. Nat Med. 2024;30(7):2049–57. https://doi.org/10.1038/s41591-024-02996-7Ryan DH, Lingvay I, Deanfield J, Kahn SE, Barros E, Burguera B, et al. Long-term weight loss effects of semaglutide in obesity without diabetes in the SELECT trial. Nat Med. 2024;30(7):2049–57. https://doi.org/10.1038/s41591-024-02996-7Marso SP, Daniels GH, Brown-Frandsen K, Kristensen P, Mann JF, et al; LEADER Steering Committee; LEADER Trial Investigators. Liraglutide and cardiovascular outcomes in type 2 diabetes. N Engl J Med. 2016;375(4):311–22. https://doi.org/10.1056/NEJMoa1603827Marso SP, Daniels GH, Brown-Frandsen K, Kristensen P, Mann JF, et al; LEADER Steering Committee; LEADER Trial Investigators. Liraglutide and cardiovascular outcomes in type 2 diabetes. N Engl J Med. 2016;375(4):311–22. https://doi.org/10.1056/NEJMoa1603827Jastreboff AM, Aronne LJ, Ahmad NN, Wharton S, Connery L, Alves B, et al; SURMOUNT-1 Investigators. Tirzepatide once weekly for the treatment of obesity. N Engl J Med. 2022;387(3):205–16. https://doi.org/10.1056/NEJMoa2206038Jastreboff AM, Aronne LJ, Ahmad NN, Wharton S, Connery L, Alves B, et al; SURMOUNT-1 Investigators. Tirzepatide once weekly for the treatment of obesity. N Engl J Med. 2022;387(3):205–16. https://doi.org/10.1056/NEJMoa2206038Kanu C, Shinde S, Chakladar S, Dennehy EB, Weaver TE, Poon JL, Malhotra A. Effect of tirzepatide treatment on patient-reported outcomes among SURMOUNT-OSA participants with obstructive sleep apnea and obesity. Sleep Med. 2025;134:106719. https://doi.org/10.1016/j.sleep.2025.106719Kanu C, Shinde S, Chakladar S, Dennehy EB, Weaver TE, Poon JL, Malhotra A. Effect of tirzepatide treatment on patient-reported outcomes among SURMOUNT-OSA participants with obstructive sleep apnea and obesity. Sleep Med. 2025;134:106719. https://doi.org/10.1016/j.sleep.2025.106719Lugovik IA, Babina AV, Arutyunyan SS, Ermolaeva DO, Saparova VB, Kobeleva TN et al. The first generic tirzepatide GP30931: physicochemical and biological similarity to the reference drug. Razrabotka i registratsiya lekarstvennykh sredstv = Drug Development & Registration. 2025;14(2):54–74 (In Russ.). https://doi.org/10.33380/2305-2066-2025-14-2-2084Луговик И.А., Бабина А.В., Арутюнян С.С., Ермолаева Д.О., Сапарова В.Б., Кобелева Т.Н. с соавт. Первый дженерик тирзепатида GP30931: физико-химическое и биологическое сходство с референтным лекарственным средством. Разработка и регистрация лекарственных средств. 2025;14(2):54–74. https://doi.org/10.33380/2305-2066-2025-14-2-2084

The authors declare that there are no conflicts of interest present.