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Factors affecting energy balance and thus steady-state weight. There are three main groups of factors—homoeostatic, environmental and behavioural processes—that interact and influence steady-state body weight. Alterations in any of these factors will result in changes to this steady-state and could result in obesity. AgRP, agout-related peptide; GIP, gastric inhibitory polypeptide; GLP-1, glucagon-like peptide-1; CART, cocaine- and amphetamine-regulated transcript; CCK, cholecystokinin; PYY, peptide YY; NPY, neuropeptide Y; POMC, pro-opiomelanocortin; PP, pancreatic polypeptide; REE, resting energy expenditure; NREE, non-resting energy expenditure. ‘Central’ and ‘peripheral’ refer to the site where the molecules are produced, rather than where they necessarily act. In gthe brain, insulin acts as an anorexigenic hormone.13, 104, 105 However, in the periphery, insulin lowers blood sugar, which potently stimulates food intake.106
Source publication
Obesity is a major global health problem and predisposes individuals to several comorbidities that can affect life expectancy. Interventions based on lifestyle modification (e.g., improved diet and exercise) are integral components in the management of obesity. However, although weight loss can be achieved through dietary restriction and/or increas...
Citations
... Additionally, acute and chronic exercise modulate appetite-regulating hormones, including ghrelin, in both lean and obese individuals. These physiological adaptations may contribute to the success of exercise interventions in promoting weight loss and long-term weight maintenance after bariatric surgery [20]. ...
Introduction: Leptin and ghrelin are two hormones that play a role in weight homeostasis. Leptin, which is produced primarily by adipocytes and is dependent on body fat mass, suppresses appetite and increases energy expenditure. Conversely, ghrelin is the “hunger hormone”, it stimulates appetite and promotes fat storage. Bariatric surgery significantly alters the levels and activity of these hormones, contributing to weight loss and metabolic improvements. Clarifying the interplay between bariatric surgery, weight loss, physical exercise, leptin, and ghrelin is essential in developing comprehensive strategies for optimizing the long-term outcomes for candidates who have undergone bariatric surgery, especially for sarcopenic patients. Methods: This was a randomized controlled study with two groups (n = 22). The patients in both groups had obesity and sarcopenia. A Roux-en-Y-gastric bypass (RYGB) procedure was performed on all patients. The intervention group participated in a structured exercise program three times per week, beginning one month after surgery and lasting 16 weeks. Patient assessment was performed before surgery (baseline) and after the completion of the exercise program. The control group received the usual standard of care and was assessed similarly. Results: After surgery, weight, BMI, and lean mass decreased significantly in both groups between the baseline and the second assessment. Leptin levels were not significantly different between baseline and the second assessment in the physical exercise group, but were significantly lower in the control group (p = 0.05). Ghrelin levels increased over time in both groups, but the differences were not significant. When we associated leptin (the dependent variable) with weight (the independent variable), we found that lower weight was associated with lower leptin levels. A similar relationship was also observed between the leptin and sarcopenia parameters (muscle strength and mass), as well as in the bone health parameters (bone mineral density and t-score). Higher ghrelin levels were significantly associated with higher t-scores and z-scores (p < 0.05). Conclusion: Exercise has been shown to have a significant effect on leptin and ghrelin levels after bariatric surgery. By incorporating regular physical activity into their lifestyle, bariatric patients can optimize their weight loss outcomes and improve their overall health. After the physical exercise protocol, patients in the intervention group revealed more established leptin levels, which may indicate a protected pattern concerning decreased leptin levels. An unfavorable profile was evidenced, according to which greater weight loss, sarcopenia, and osteoporosis were associated with lower leptin levels.
... Furthermore, a greater decrease in energy expenditure is observed during weight loss than would be expected based on changes in body mass and body composition [7]. This phenomenon has been termed metabolic adaptation [8,9]. Collectively, these factors are hypothesized to contribute to the challenge of maintaining a weight-reduced state and present key factors underlying the weight plateau and subsequent weight recidivism following bariatric surgery. ...
Objective
Bariatric surgery remains the most effective treatment to achieve substantial weight loss; however, total daily energy expenditure and physical activity changes in response to such interventions have been seldom explored.
Methods
In this prospective observational study, total daily energy expenditure (TDEE) using doubly labeled water and physical activity (SenseWear armband) was assessed in 17 females (mean ± SD: 48.6 ± 9.7 kg/m2, 43 ± 12 years) at baseline and 8 and 52 weeks following either bariatric surgery (BSG, N = 9) or a low-calorie diet (LCD, N = 8). Energy intake was assessed using the intake-balance method.
Results
After 8 weeks, weight loss was 16.0 ± 3.5 kg and TDEE decreased by 552 ± 319 kcal/d in BSG (P < 0.001) compared to 8.8 ± 3.4 kg and 256 ± 239 kcal/d in LCD (P < 0.05). After 52 weeks, weight loss was 44.3 ± 16.4 kg and TDEE decreased by 583 ± 418 kcal/d (P < 0.001), compared to 4.3 ± 6.7 kg and 84 ± 285 kcal/d in LCD (P > 0.05). TDEE was lower than predicted in BSG at 8 (P = 0.03) but not 52 weeks (P = 0.77). There was no evidence of metabolic adaptation in LCD. Average daily energy intake in BSG was 1403 ± 245 kcal/d compared to 2545 ± 398 kcal/d in LCD (P < 0.001). In BSG, step count and physical activity minutes were increased at 52 weeks compared to baseline (P = 0.03), whereas no significant changes were observed in LCD.
Conclusion
Bariatric surgery-induced weight loss decreased TDEE at 8 weeks and 1 year, resulting in metabolic adaptation after 8 weeks that was reversed at 1 year. These changes were accompanied by an increase in physical activity.
... Questo non indica che il farmaco abbia cessato di funzionare ma che ulteriori perdite di peso richiederanno l'implementazione di strategie aggiuntive. Inoltre, è prevedibile un recupero del peso in caso di interruzione della terapia farmacologica [4][5][6]. Gli agenti farmacologici antiobesità non solo facilitano il calo ponderale, ma possono anche migliorare il mantenimento sul lungo termine del peso perso: studi a quattro anni suggeriscono che la terapia farmacologica offre un miglior mantenimento del peso rispetto agli approcci tradizionali, sebbene siano ancora necessari studi a lungo termine per confermare questi risultati [7]. ...
Sommario
Una nuova era di trattamenti per l’obesità si avvicina all’efficacia della chirurgia bariatrica, attualmente la migliore strategia per la perdita di peso e il suo mantenimento. Recente è lo sviluppo di farmaci come semaglutide 2,4 mg iniettiva, che induce un calo del 15–17% e offre cardioprotezione, appena uscita in Italia, in pipeline agonisti orali del GLP-1 con simile efficacia, e future terapie combinano GLP-1 con ormoni come GIP, glucagone e amilina. La tirzepatide, un agonista GLP-1/GIP, ha mostrato un’efficacia sulla perdita di peso anche maggiore di semaglutide ed è prossima alla commercializzazione in Italia; seguiranno altre promettenti molecole nel prossimo futuro.
... Lifestyle and behavioral interventions (e.g., increased daily physical activity and decreased caloric intake) are fundamental components of weight control [83]. Modifications to diet habits affect glucose levels, lower insulin levels and also reduce systemic inflammation [84]. ...
An active lifestyle is of key importance for reduction of obesity and inflammation, as well as circulating levels of adipokines. Therefore, the aim of our study was to assess the relationship of physical fitness with chronic inflammatory status, and to evaluate biomarkers useful in the analysis of adipose tissue dysfunction. Sixty-three older adults (69.6 ± 5.1 years) were allocated to a high n = 31 (women n = 23 and men n = 8 male) or low physical fitness n = 32 (women n = 29 and men n = 3) group based on gait speed values (1.4–1.8 m/s or ≤ 1.3 m/s). The gait speed correlated with hand grip strength (rs = 0.493, p = 0.0001) and with leptin level (R = -0.372, p = 0.003), which shows the benefits of physical activity on muscle strength and circulating adipokines. In low physical fitness group, 58.1% individuals had adiponectin to leptin ratio (Adpn/Lep) < 0.5 revealing dysfunction of adipose tissue and high cardiometabolic risk; 20% of the group were obese with BMI ≥ 30 kg/m². In high physical fitness group, 25.8% of individuals had Adpn/Lep ≥ 1.0 i.e., within the reference range. Markers of systemic inflammation were significantly related to physical fitness: CRP/gait speed (rs = -0.377) and HMGB-1/gait speed (rs = -0.264). The results of the ROC analysis for Adpn (AUC = 0.526), Lep (AUC = 0.745) and HMGB-1 (AUC = 0.689) indicated their diagnostic potential for clinical prognosis in older patients. The optimal threshold values corresponded to 1.2 μg/mL for Adpn (sensitivity 74.2%, specificity 41.9%, OR = 1.4, 95%Cl 0.488–3.902), 6.7 ng/mL for Lep (sensitivity 56.2%, specificity 93.5%, OR = 14.8, 95%Cl 3.574–112.229), 2.63 mg/L for CRP (sensitivity 51.6%, specificity 84.3%, OR = 4.4, 95% Cl 1.401- 16.063) and 34.2 ng/mL for HMGB-1 (sensitivity 62.0%, specificity 86.6%, OR = 12.0, 95%Cl 3.254—61.614). The highest sensitivity and specificity were observed for Leptin and HMGB-1. The study revealed changes in inflammatory status in older adults at various levels of physical fitness and demonstrated diagnostic usefulness of adipokines in the assessment of adipose tissue inflammation.
... König et al. [8] also found that a higher preference for deliberation was positively related to restrained eating. Individuals who control their eating in a restrictive way may have difficulty maintaining the homeostatic system of hunger and satiety, activating 'hedonic' reward pathways associated with the palatability (e.g., sight, smell, and taste) of food, making them eat according to external motivations, such as emotional ones [30][31][32]. ...
The Preference for Intuition and Deliberation in Food Decision-Making Scale (E-PID) was developed to evaluate both intuitive and deliberative food decision-making within a single instrument. However, its psychometric properties have only been assessed among German-speaking participants. The main aim of the present study was to evaluate evidence of validity and reliability of the E-PID among 604 Brazilian adult women. Exploratory (n = 289) and confirmatory factor analyses (n = 315) were conducted to evaluate the factor structure of the E-PID. Convergent validity was assessed correlating the E-PID with measures of eating behaviors (Tree-Factor Eating Questionnaire-18), intuitive eating (Intuitive Eating Scale-2), and a measure of beliefs and attitudes towards food (Food-Life Questionnaire-SF). McDonald’s Omega coefficient (ω) was used to test the internal consistency of the E-PID. Results from an exploratory and confirmatory factor analysis supported a two-factor structure with seven items. We found good internal consistency (McDonald’s ω = 0.77–0.81). Furthermore, the E-PID demonstrated adequate convergent validity with measures of intuitive, restrictive, emotional and uncontrolled eating, and beliefs and attitudes towards food. Results support the use of the E-PID as a measure of intuition and deliberation in food decision-making among Brazilian adult women, expanding the literature on eating decision-making styles.
... Additionally, acute and chronic 3 exercise modulate appetite-regulating hormones, including ghrelin, in both lean and obese individuals. These physiological adaptations may contribute to the success of exercise interventions in promoting weight loss and long-term weight maintenance after bariatric surgery [20]. ...
Introduction: Leptin and ghrelin are two hormones that play a role in weight homeostasis. Leptin, which is produced primarily by adipocytes and is dependent on body fat mass, suppresses appetite and increases energy expenditure. Conversely, ghrelin is the “hunger hormone”, it stimulates appetite and promotes fat storage. Bariatric surgery significantly alters the levels and activity of these hormones, contributing to weight loss and metabolic improvements. Clarifying the interplay between bariatric surgery, weight loss, physical exercise, leptin, and ghrelin is essential for developing comprehensive strategies for optimizing long-term outcomes for candidates for bariatric surgery, especially sarcopenic patients. Methods: This was a randomized controlled study with two groups (n=22). The patients in both groups have obesity and sarcopenia. A Roux-en-Y-gastric bypass (RYGB) procedure was performed in all patients. The intervention group participated in a structured exercise program three times per week beginning one month after surgery and lasting 16 weeks. Patient assessment was performed before surgery (baseline) and after completion of the exercise program. The control group received the usual standard of care and was assessed similarly. Results: After surgery, weight, BMI and lean mass decreased significantly in both groups from baseline to the second assessment. Leptin was not significantly different from baseline to the second assessment in the physical exercise group but was significantly lower in the control group (p=0.05). Ghrelin increased over time in both groups, but the differences were not significant. When we associated leptin (the dependent variable) with weight (the independent variable), we found that lower weight was associated with lower leptin levels. A similar relationship was also observed between leptin and sarcopenia parameters (muscle strength and mass), as well as with bone health parameters (bone mineral density and t-score). Higher ghrelin levels were significantly associated with higher t-scores and z-score (p
... 5,6 In addition, there are neuroendocrine changes accompanying weight loss that favor weight regain. [7][8][9] Pharmacological treatment of obesity has improved dramatically in recent years; 10 however, patients often regain most of the weight lost upon discontinuation of the drug. 11 For this reason, interventions to prevent weight gain are likely to be a better strategy than treating obesity once it is established. ...
Some periods during the year, such as festive and summer holiday periods, have been associated with weight gain. We aimed to assess the effect of interventions for the prevention of body weight gain during festive and holiday periods in children and adults. A systematic search was conducted in six databases and supplementary sources until January 4, 2023. We included randomized controlled trials (RCTs), cluster‐RCTs, and non‐RCTs. Our primary outcome measure was the change in body weight in adults or the change in BMI z‐score or BMI percentile in children and adolescents. From 4216 records, 12 primary studies (from 22 reports) met the inclusion criteria—10 from the United States, one from the United Kingdom, and one from Chile. Two studies had a low risk of bias, two moderate, seven high, and one critical risk of bias. The meta‐analysis in children included four of seven studies during the summer holidays (six interventions) and showed a mean difference in BMI z‐score favoring the intervention group (−0.06 [95% CI −0.10, −0.01], p = 0.01, I ² = 0%, very low certainty evidence). The meta‐analysis in adults included five studies during festive periods with a mean difference in weight favoring the intervention group (−0.99 kg [95% CI −2.15, 0.18], p = 0.10, I ² = 89%, very low certainty evidence). This review has highlighted potential interventions to prevent the increase in body weight during holiday periods. More work is needed to improve the quality of the evidence and to extend it to countries outside of the United States and United Kingdom and to the adolescent population.
... It is well-established that obesity is governed and maintained by a central dysregulation of the appetite/satiety mechanism. Furthermore, a counter-regulatory response to a negative energy balance can contribute to weight regain [6,10]. ...
Bioinformatics has emerged as a valuable tool for screening drugs and understanding their effects. This systematic review aimed to evaluate whether in silico studies using anti-obesity peptides targeting therapeutic pathways for obesity, when subsequently evaluated in vitro and in vivo, demonstrated effects consistent with those predicted in the computational analysis. The review was framed by the question: “What peptides or proteins have been used to treat obesity in in silico studies?” and structured according to the acronym PECo. The systematic review protocol was developed and registered in PROSPERO (CRD42022355540) in accordance with the PRISMA-P, and all stages of the review adhered to these guidelines. Studies were sourced from the following databases: PubMed, ScienceDirect, Scopus, Web of Science, Virtual Heath Library, and EMBASE. The search strategies resulted in 1015 articles, of which, based on the exclusion and inclusion criteria, 7 were included in this systematic review. The anti-obesity peptides identified originated from various sources including bovine alpha-lactalbumin from cocoa seed (Theobroma cacao L.), chia seed (Salvia hispanica L.), rice bran (Oryza sativa), sesame (Sesamum indicum L.), sea buckthorn seed flour (Hippophae rhamnoides), and adzuki beans (Vigna angularis). All articles underwent in vitro and in vivo reassessment and used molecular docking methodology in their in silico studies. Among the studies included in the review, 46.15% were classified as having an “uncertain risk of bias” in six of the thirteen criteria evaluated. The primary target investigated was pancreatic lipase (n = 5), with all peptides targeting this enzyme demonstrating inhibition, a finding supported both in vitro and in vivo. Additionally, other peptides were identified as PPARγ and PPARα agonists (n = 2). Notably, all peptides exhibited different mechanisms of action in lipid metabolism and adipogenesis. The findings of this systematic review underscore the effectiveness of computational simulation as a screening tool, providing crucial insights and guiding in vitro and in vivo investigations for the discovery of novel anti-obesity peptides.
... Lifestyle modifications, such as dietary restriction (DR) and exercise, remain the mainstay of recommended therapeutic interventions in overweight and obese individuals with MASLD, with the aim of reducing body weight by at least 10% [6,7]. However, the sustainability of long-term (hypocaloric) dietary management poses several challenges, particularly for individuals with severe obesity [8]. Consequently, bariatric surgery (BS) has emerged as a viable option for obese patients, particularly when conventional nutritional and behavioral therapy fails to achieve the desired therapeutic outcomes. ...
Metabolic dysfunction-associated steatotic liver disease (MASLD) is a chronic, progressive liver disease that encompasses a spectrum of steatosis, steatohepatitis (or MASH), and fibrosis. Evidence suggests that dietary restriction (DR) and sleeve gastrectomy (SG) can lead to remission of hepatic steatosis and inflammation through weight loss, but it is unclear whether these procedures induce distinct metabolic or immunological changes in MASLD livers. This study aims to elucidate the intricate hepatic changes following DR, SG or sham surgery in rats fed a high-fat diet as a model of obesity-related MASLD, in comparison to a clinical cohort of patients undergoing SG. Single-cell and single-nuclei transcriptome analysis, spatial metabolomics, and immunohistochemistry revealed the liver landscape, while circulating biomarkers were measured in serum samples. Artificial intelligence (AI)-assisted image analysis characterized the spatial distribution of hepatocytes, myeloid cells and lymphocytes. In patients and experimental MASLD rats, SG improved body mass index, circulating liver injury biomarkers and triglyceride levels. Both DR and SG attenuated liver steatosis and fibrosis in rats. Metabolism-related genes (Ppara, Cyp2e1 and Cyp7a1) were upregulated in hepatocytes upon DR and SG, while SG broadly upregulated lipid metabolism on cholangiocytes, monocytes, macrophages, and neutrophils. Furthermore, SG promoted restorative myeloid cell accumulation in the liver not only ameliorating inflammation but activating liver repair processes. Regions with potent myeloid infiltration were marked with enhanced metabolic capacities upon SG. Additionally, a disruption of periportal hepatocyte functions was observed upon DR. In conclusion, this study indicates a dynamic cellular crosstalk in steatotic livers of patients undergoing SG. Notably, PPARα-and gut-liver axis-related processes, and metabolically active myeloid cell infiltration indicate intervention-related mechanisms supporting the indication of SG for the treatment of MASLD.
... As a result, Several studies have demonstrated that nutritional and physical activity interventions resulting in weight loss in breast cancer survivors decrease the risk of recurrence and increase the recurrence-free survival in the long-term [16,[36][37][38][39]. Although lifestyle interventions are the cornerstone of weight management, most patients are not able to achieve significantly sustained weight loss with these interventions due to physiologic and behavioral adaptations of the weight reduced state [40][41][42][43][44]. AOM have been demonstrated to induce more weight loss than lifestyle interventions alone, and when taken long-term, they also result in weight loss maintenance [45][46][47]. ...
Purpose
Aromatase inhibitors (AI) block estrogen synthesis and are used as long-term adjuvant treatment for breast cancer in postmenopausal women. AI use can be associated with weight gain that can lead to increased cardiometabolic risk. The response to anti-obesity medications (AOM) in patients using AI has yet to be studied. We sought to investigate weight loss outcomes of AOM in patients taking AI for breast cancer treatment.
Methods
This is a matched retrospective cohort study of breast cancer survivors on AI using AOM (AOM/AI group). We compared their weight loss outcomes with a group of female patients with obesity, without a history of breast cancer or AI use, on AOM (AOM group). The primary endpoint was total body weight loss percentage (TBWL %) at the last follow-up. We performed mixed linear regression models, including diabetes status at baseline, to assess associations between use of AOM with/without AI with total body weight loss percentage (TBWL%).
Results
We included 124 patients: 62 in the AOM/AI group (63.6 ± 10 years, body mass index [BMI] 34.3 ± 7.1 kg/m²) and 62 in the AOM group (62.8 ± 9.9 years, BMI 34.6 ± 6.5 kg/m²). The mean time of follow up was 9.3 ± 3.5 months, with no differences among the two groups. The AOM/AI group had a lower TBWL% compared to the AOM group at the last follow-up −5.3 ± 5.0 vs. −8.2 ± 6.3 (p = 0.005). The results remained significant after adjusting for diabetes status (p = 0.0002). At 12 months, the AOM/AI group had a lower TBWL% compared to the AOM group 6.4 ± 0.8% vs. 9.8 ± 0.9% (p = 0.04). The percentage of patients achieving ≥ 5%, ≥ 10%, and ≥ 15% of weight loss at 12 months was greater in the AOM compared to the AOM/AI group. Although the weight loss response was suboptimal, patients in the AOM/AI group had improvement in fasting glucose, glycated hemoglobin, systolic blood pressure, and low-density lipoprotein cholesterol.
Conclusions
The use of AI in breast cancer survivors is associated with less weight loss response to AOM compared to patients without breast cancer history and who do not take AI. Studies are needed to assess the mechanisms behind the differential weight loss response to AOM in women taking AI.
