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• W2029732373 abstract "Many clinicians are not adequately aware of the reasons that individuals with obesity struggle to achieve and maintain weight loss, 1 Colbert JA Sushrut J Training clinicians to manage obesity—back to the drawing board. N Engl J Med. 2013; 369: 1389-1391 Crossref PubMed Scopus (26) Google Scholar and this poor awareness precludes the provision of effective intervention. 2 Puhl RM Heuer CA Obesity stigma: important considerations for public health. Am J Public Health. 2010; 100: 1019-1028 Crossref PubMed Scopus (984) Google Scholar Irrespective of starting weight, caloric restriction triggers several biological adaptations designed to prevent starvation. 3 Ochner CN Barrios DM Lee CD Pi-Sunyer FX Biological mechanisms that promote weight regain following weight loss in obese humans. Physiol Behav. 2013; 120: 106-113 Crossref PubMed Scopus (107) Google Scholar These adaptations might be potent enough to undermine the long-term effectiveness of lifestyle modification in most individuals with obesity, particularly in an environment that promotes energy overconsumption. However, they are not the only biological pressures that must be overcome for successful treatment. Additional biological adaptations occur with the development of obesity and these function to preserve, or even increase, an individual's highest sustained lifetime bodyweight. For example, preadipocyte proliferation occurs, increasing fat storage capacity. In addition, habituation to rewarding neural dopamine signalling develops with the chronic overconsumption of palatable foods, leading to a perceived reward deficit and compensatory increases in consumption. 4 Kenny PJ Reward mechanisms in obesity: new insights and future directions. Neuron. 2011; 69: 664-679 Summary Full Text Full Text PDF PubMed Scopus (469) Google Scholar Importantly, these latter adaptations are not typically observed in individuals who are overweight, but occur only after obesity has been maintained for some time. 3 Ochner CN Barrios DM Lee CD Pi-Sunyer FX Biological mechanisms that promote weight regain following weight loss in obese humans. Physiol Behav. 2013; 120: 106-113 Crossref PubMed Scopus (107) Google Scholar Thus, improved lifestyle choices might be sufficient for lasting reductions in bodyweight prior to sustained obesity. Once obesity is established, however, bodyweight seems to become biologically stamped in and defended. Therefore, the mere recommendation to avoid calorically dense foods might be no more effective for the typical patient seeking weight reduction than would be a recommendation to avoid sharp objects for someone bleeding profusely. Reversible biological adaptations in obesityChristopher Ochner and colleagues address the very important issue of whether reversal of the neurohormonal adaptations associated with obesity is physiologically possible. They suggest that these changes are irreversible and thus prevent the possibility of designing successful strategies using lifestyle interventions. They argue that any treatment of obesity should include direct biological intervention.1 Full-Text PDF Reversible biological adaptations in obesity – Authors' replyWe thank Per Södersten and colleagues for their thoughtful commentary, and appreciate the contribution of their research.1 However, its description primarily argues against contentions that were not made in our Comment,2 which necessitates some clarification. We state that the neurohormonal adaptations to sustained obesity often persist indefinitely, but we do not suggest that is it not physiologically possible to reverse them. Further, the increased ghrelin following low-calorie diet described by Södersten and colleagues is an example of an adaptation to caloric restriction, which differs from biological adaptations to sustained obesity that serve to maintain or even increase an individual's adipose storage capacity. Full-Text PDF" @default.
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• W2029732373 date "2015-04-01" @default.
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• W2029732373 title "Treating obesity seriously: when recommendations for lifestyle change confront biological adaptations" @default.
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