Obesity: regulation of appetite and energy homeostasis; treatment

Big picture

Obesity is a chronic, relapsing metabolic disease caused by long-term imbalance between energy intake, energy expenditure, appetite regulation, genetic susceptibility, environment, and neuroendocrine adaptation.

For the exam, do not explain obesity only as “eating too much.” The high-yield concept is:

Brain appetite centers + gut hormones + adipose hormones + reward system
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Control hunger, satiety, energy expenditure, and body-weight set point
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In obesity: leptin resistance, insulin resistance, hedonic overeating, low energy expenditure, adaptive metabolic slowing
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Weight gain becomes biologically defended

Treatment is stepwise:

Lifestyle therapy for all
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Treat complications and weight-promoting drugs
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Anti-obesity pharmacotherapy if indicated
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Bariatric/metabolic surgery in selected patients
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Long-term follow-up because relapse is common

Current obesity treatment guidelines generally use pharmacotherapy as an adjunct to lifestyle therapy in adults with body mass index ≥30 kg/m², or ≥27 kg/m² with obesity-related complications, and modern metabolic/bariatric surgery guidelines recommend surgery for BMI ≥35 kg/m² regardless of comorbidity, and consideration for BMI 30–34.9 kg/m² with metabolic disease. ([jomes.org][1])

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