Excess adiposity and obesity are the root cause of at least 27 diseases that cause considerable lifelong morbidity and, in many scenarios, eventual cardiovascular mortality. The human body has the ability to increase the number and size of its adipocytes by approximately 10-fold over the course of a lifetime. As fat mass increases, its blood supply, supporting cells, tissue structure, and local and systemic hormonal control also increase. This results in excess adiposity, leading to progressive obesity and the resistance to weight-loss attempts. There have been numerous trials of food diets combined with exercise that, in general, have a 50% dropout rate at 1 year and lead to very modest (∼ 5%) reductions in body weight. Thus, many with obesity require interventions beyond casual diet and exercise advice. Meal replacement diets and bariatric surgery offer considerably greater degrees of weight loss, but both can be plagued by weight regain. Because the ability to control food urges has been shown to be a key psychological factor for success, medicinal approaches that work in this domain are attractive adjuncts to diet, exercise, and weight-loss surgery. This article reviews the emerging role of medical therapy in the treatment of excess adiposity with the goal of reducing comorbidities and possibly improving cardiovascular survival.
"Thus, strategies and policies for prevention and treatment of obesity have been deemed global priorities to reverse the trend of the global obesity epidemic . Numerous anti-obesity interventions have been studied including lifestyle modification, behavioral therapy, pharmacological treatments, and surgery  . However, the limited efficacy and high incidence of adverse events with side effects observed in conventional therapies have motivated practitioners to investigate complementary and alternative medicine therapies for weight loss such as dietary supplements, herbal products, and acupuncture  . "
[Show abstract][Hide abstract] ABSTRACT: Almost 20 years ago, the protein encoded by the ob locus in mice was identified as an adipocyte-secreted hormone, now termed leptin, which functions as a peripheral signal to communicate the organism's energy reserve-and thereby protects against starvation due to insufficient caloric resources. Additional peripheral factors have since been identified that coordinate interorgan crosstalk to manage energy resources. The heart is included in this network through its regulated release of natriuretic peptides A and B-cardiac hormones originally identified as important in blood pressure control. Emerging evidence that natriuretic peptide receptors are expressed in adipose tissue, and that circulating levels of these peptides are decreased in animals and humans with obesity, could imply that natriuretic peptides are also involved in the regulation of energy metabolism. The natriuretic peptides stimulate triglyceride lipolysis in adipocytes, a process also regulated by the sympathetic nervous system. In addition, these two pathways promote uncoupling of mitochondrial respiration and thermogenesis in brown adipocytes. This Review focuses on the roles of the natriuretic peptides and the sympathetic nervous system in regulating adipocyte metabolism. The potential for manipulating the natriuretic peptide pathway to increase energy expenditure in obesity and manage the complications of cardiometabolic disease is also discussed.
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