Fueling the Fire: Obesity's Role in Acute Pancreatitis

This is the authors' abstract. We don't add key points for this paper.

Background Amid a global obesity epidemic, the incidence of acute pancreatitis (AP) continues to rise steadily worldwide. Obesity is increasingly recognized as an important risk factor for the development of AP and its progression to severe disease. Accumulating evidence links excess adiposity to higher rates of local and systemic complications, greater intensive care needs, and increased mortality. Objective This narrative review provides a clinical overview of the relationship between obesity and AP. It summarizes the epidemiologic association between obesity and AP incidence, examines the mechanisms by which adiposity aggravates pancreatic and systemic injury, and discusses implications for prognostication, intensive care management, long-term outcomes, and health-care burden. Findings Obesity contributes to AP risk by promoting gallstone disease, hypertriglyceridemia, type 2 diabetes, and adverse lifestyle patterns. Once AP occurs, excess visceral, peripancreatic, and intrapancreatic fat enhances lipotoxicity and inflammatory signaling, fueling pancreatic necrosis, infected collections, and systemic organ failure. Patients living with obesity are more likely to develop respiratory, renal, and circulatory complications, require mechanical ventilation or renal replacement therapy. They experience abdominal compartment syndrome, prolonged hospitalization, and increased resource utilization. Mortality is also higher in AP populations living with obesity. Current prognostic scores do not adequately capture obesity-related risk, and body mass index alone appears insufficient for precise stratification. Visceral adipose tissue and waist-based measures may better reflect clinically relevant adiposity. Although no obesity-specific causal treatment is currently established, approaches targeting lipolysis, and metabolic pathways (including GLP-1 receptor agonists) warrant further study. Obesity also influences the post-pancreatitis phase, including the risk of new-onset diabetes, emphasizing the need for obesity-aware management and structured follow-up.