Factors regulating body weight: role of the neural pathways of integration and coordination of feeding and energy metabolism
Irina Stoyanova (Bulgaria)
Obesity represents a growing threat for the health of the world population because it leads to a higher risk of developing disorders such as cardiovascular diseases and diabetes. Excess adiposity is a result of prolonged positive energy balance, and genetic and environmental factors are involved in its pathogenesis. In most cases, human obesity does not appear to be due to a single gene defect, but rather to effects of the environment upon a large number of susceptible genes. In addition, a neural network regarded as an “input-integration-output” system, residing in the hypothalamus, is implicated in the regulation of energy homeostasis. This central regulation involves the integration of humoral and afferent neuronal input to some hypothalamic nuclei – the arcuate, paraventricular, ventromedial and dorsomedial, and the dorsolateral area, as well as descending output commands through the brainstem and spinal cord, and via vagal and spinal neurons to the body. The hypothalamic projections to the caudal medulla and the spinal cord have the potential to stimulate or inhibit food intake, and regulate energy balance and ingestive behavior. Since obesity is due to a chronic imbalance between energy intake and energy expenditure, the most important issue in the prevention and treatment of this disorder is our understanding of the molecular mechanisms implicated in energy homeostasis. The complexity of such a neuroendocrine control system gives multiple possible key points of intervention with new drugs, which predominantly target the ingestive behavior. Thus, the behavioral therapy, together with diet and life style changes, is likely to remain the cornerstone ethiological treatment of the common obesity in the foreseeable future.
Biomed Rev 2003; 14: 63-74.
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Received 17 May 2003 and accepted 8 November 2003.
Correspondence and reprint requests to Dr Irina Stoyanova, P.O. Box 1025, BG-6010 Stara Zagora, Bulgaria. Tel.: 359 42 2819294, Fax: 359 42 30219.
E-mail: ir_stoyanova@hotmail.com
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