Regulation of energy homeostasis and health consequences in obesity.

The growing awareness of the obesity epidemic as a critical matter of health concern has prompted research into the mechanisms underlying energy homeostasis and the pathophysiology of obesity. Food intake, energy expenditure, and fat storage all are regulated by a complex neuroendocrine system. It is now recognized that in addition to central neurohumoral pathways, adipose tissue has an independent endocrine function that contributes to energy homeostasis. Moreover, adipose tissue exerts inflammatory effects that are linked to the most important health problems associated with obesity, including cardiovascular disease and type 2 diabetes mellitus, each of which has the potential to confer long-term morbidity and increased mortality risks. This inflammatory effect of adipose tissue is more pronounced in abdominal obesity, which is reflected by the heightened cardiometabolic risk observed in persons with excess abdominal adiposity. The endocrine impact of adipose tissue on energy homeostasis and inflammation highlights the critical health implications of obesity, particularly abdominal obesity, and the importance of effective prevention and management strategies in clinical practice.

Obesity prevention: recommended strategies and challenges.

Lifelong healthy weight maintenance is an important goal for all Americans to avoid the health problems associated with excessive body weight. In those who are overweight, even modest weight loss can reduce the risk of developing diseases associated with obesity. Federal health agencies, including the Centers for Disease Control and Prevention and the US Department of Agriculture, have recognized the critical nature of the obesity epidemic and the importance of lifelong weight management. As a result, these agencies have published evidence-based dietary and exercise recommendations, as well as analyses of population-based efforts to achieve weight loss that specifically address strategies to maintain a healthy weight. Despite the availability of recommendations and increased public education efforts, however, obesity rates continue to climb. The rising prevalence of obesity in the United States suggests that current efforts to control weight have been inadequate. Large-scale prevention programs that involve interventions targeting individuals as well as the larger community, including initiatives spearheaded through workplaces and schools, are needed to control weight and reduce the risk of long-term health consequences.

When prevention fails: obesity treatment strategies.

The obesity epidemic has resulted in increasingly urgent calls for large-scale prevention strategies. Meanwhile, effective treatment approaches that result in sustainable weight loss are needed to attenuate the cardiometabolic risks that may lead to comorbid illnesses and early mortality. Public education efforts geared toward those afflicted with obesity should emphasize that a relatively modest reduction in body weight dramatically reduces disease risk, thereby improving overall long-term health. Setting realistic weight loss goals with patients should reduce the overwhelming frustration often associated with the belief that large amounts of weight loss are needed for improved health. This misconception often impedes overweight and obese individuals from seeking treatment. Effective strategies are available to help overweight and obese individuals achieve reasonable weight loss goals. Important challenges exist in preventing weight regain following weight loss intervention. Studies are underway to identify new therapeutic strategies to effectively reduce weight, as well as to provide long-term data on successful weight loss maintenance strategies.

Obesity: why be concerned?

The obesity epidemic in the United States represents a critical public health issue that has the potential to incur major healthcare costs because of the substantial risks associated with excess body fat. Whereas many recognize the significant risk of cardiovascular disease and diabetes mellitus associated with excess body fat, a myriad of other health problems can accompany overweight and obesity, potentially leading to early morbidity and mortality. Public recognition of obesity as an important health crisis, and not simply a matter of cosmetics or lifestyle choice, is clearly needed. A greater awareness of the health risks associated with excess weight will facilitate more frequent obesity screenings and discussions about healthy weight management that have the potential to result in a greater commitment of healthcare resources to effective obesity prevention and management strategies.