White adipose tissue is a secretory endocrine organ.

White adipose tissue secretes cytokines called adipokines.

Adipokines are proteins that send signals to other parts of the body. Adipokines like c-reactive protein, interleukin-6, TNFα and others creates a pro-inflammatory state in the body which leads to metabolic syndrome.

Further, when fat cells die or lyse, they spill their contents into surrounding tissue. This increases macrophage activity in those areas to clean up the mess, which then signals more macrophage activity.

In healthy mice adpiose tissue is made up of 10% macrophages. In obese mice that number rises to 50-60%. This high level of macrophage activity mimics an immune response to bacteria. It creates the same kind of inflammation that a bacterial infection causes, except this inflammation never goes away. The more adipose tissue you have, the more inflammation you’ll have due to cell death and macrophage activity.

In summary, obesity itself is inflammatory in two ways: through adipokines secreted by the adipose tissue and through the inflammation due to macrophage activity.

Encourage your obese clients to lose weight! Have some weight loss offerings in your practice. This will improve the health of your clients and boost your own income.

Studies:

Biochemistry of adipose tissue: an endocrine organ
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3648822/

Adipose tissue macrophages, low grade inflammation and insulin resistance in human obesity.
https://www.ncbi.nlm.nih.gov/pubmed/18473870

Table of adipokines and their description / function:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3648822/table/T0001/