title: Making sense of metabolic obesity and hedonic obesity.
abstract: Body weight is neither stationary nor does it change unidirectionally. Rather, body weight usually oscillates up and down around a set point. Two types of forces determine the direction of weight changes. Forces that push body weight away from the set point are defined as non-homeostatic and are governed by multiple mechanisms, including, but not limited to, hedonic regulation of food intake. Forces that restore the set point weight are defined as homeostatic, and they operate through mechanisms that regulate short-term energy balance driven by hunger and satiation and long-term energy balance driven by changes in adiposity. In the normal physiological state, the deviation of body weight from the set point is usually small and temporary, and is constantly corrected by homeostatic forces. Metabolic obesity develops when body weight set point is shifted to an abnormally high level and the obese body weight becomes metabolically defended. In hedonic obesity, the obese body weight is maintained by consistent overeating due to impairments in the reward system, although the set point is not elevated. Adaptive increases in energy expenditure are elicited in hedonic obesity because body weight is elevated above the set point. Neither subtype of obesity undergoes spontaneous resolution unless the underlying disorders are corrected. In this review, the need for both appropriate patient stratification and tailored treatments is discussed in the context of the new framework of metabolic and hedonic obesity.
authors.affiliation: Department of Endocrinology, Greenwich Hospital and Northeast Medical Group, Yale-New Haven Health System, Greenwich, Connecticut, USA.
authors.forename: Yi-Hao
authors.initials: YH
authors.lastname: Yu
mesh_terms: D050154:Adiposity / Q000502:physiology; D001069:Appetite Regulation / Q000502:physiology; D001835:Body Weight; D004435:Eating / Q000502:physiology; D004734:Energy Metabolism / Q000502:physiology*; D006706:Homeostasis / Q000502:physiology*; D006801:Humans; D009765:Obesity / Q000378:metabolism / Q000503:physiopathology*
keywords: body weight changes; energy metabolism; food intake regulation; obesity; weight loss; 体重变化; 减重; 肥胖; 能量代谢; 餐食调控