title: Biological mechanisms that promote weight regain following weight loss in obese humans.
abstract: Weight loss dieting remains the treatment of choice for the vast majority of obese individuals, despite the limited long-term success of behavioral weight loss interventions. The reasons for the near universal unsustainability of behavioral weight loss in [formerly] obese individuals have not been fully elucidated, relegating researchers to making educated guesses about how to improve obesity treatment, as opposed to developing interventions targeting the causes of weight regain. This article discusses research on several factors that may contribute to weight regain following weight loss achieved through behavioral interventions, including adipose cellularity, endocrine function, energy metabolism, neural responsivity, and addiction-like neural mechanisms. All of these mechanisms are engaged prior to weight loss, suggesting that these so called "anti-starvation" mechanisms are activated via reductions in energy intake, rather than depletion of energy stores. Evidence suggests that these mechanisms are not necessarily part of a homeostatic feedback system designed to regulate body weight, or even anti-starvation mechanisms per se. Although they may have evolved to prevent starvation, they appear to be more accurately described as anti-weight loss mechanisms, engaged with caloric restriction irrespective of the adequacy of energy stores. It is hypothesized that these factors may combine to create a biological disposition that fosters the maintenance of an elevated body weight and works to restore the highest sustained body weight, thus precluding the long-term success of behavioral weight loss. It may be necessary to develop interventions that attenuate these biological mechanisms in order to achieve long-term weight reduction in obese individuals.
authors.affiliation: New York Obesity Nutrition Research Center, St. Luke's Roosevelt Hospital, Columbia University College of Physicians and Surgeons, New York, NY, USA; Mount Sinai Adolescent Health Center, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA. Electronic address: christopher.ochner@mountsinai.org.
authors.forename: Christopher N
authors.initials: CN
authors.lastname: Ochner
authors.forename: Dulce M
authors.initials: DM
authors.lastname: Barrios
authors.forename: Clement D
authors.initials: CD
authors.lastname: Lee
authors.forename: F Xavier
authors.initials: FX
authors.lastname: Pi-Sunyer
mesh_terms: D000273:Adipose Tissue / Q000166:cytology / Q000502:physiology; D016739:Behavior, Addictive / Q000523:psychology; D004038:Diet, Reducing; D004702:Endocrine Glands / Q000502:physiology; D004734:Energy Metabolism / Q000502:physiology; D006801:Humans; D009765:Obesity / Q000378:metabolism* / Q000503:physiopathology*; D012008:Recurrence; D015430:Weight Gain / Q000502:physiology*; D015431:Weight Loss / Q000502:physiology*
keywords: Adipose; BMI; Brain; Diet; Endocrine; Metabolic; Metabolism; Neural
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