The etiopathogenesis and management of obesity: The quintessential quincunx.

This communication uses the quincunx, i.e, a quadruple surrounding a central point, to create a model that describes the etiopathogenesis, as well as informs the management strategy of obesity. With the energy fulcrum (mismatch between energy intake and expenditure) at its centre, the model lists two external influencers-the physical environment and psychosocial environment, and two internal influencers- the hypothalamo-bariatric axis and the endocrine system, to explain the etiopathogenesis of obesity. Genetics factors are included with the hypothalamo-bariatric axis. The same model can be used to explain the five pillars of management: lifestyle and nutritional modification at the centre, along with environmental optimization, behavioural therapy, baro-thalamic modulation, and endocrine optimization.