New insights in the mechanisms of weight‐loss maintenance: Summary from a Pennington symposium

Abstract

Obesity is a chronic disease that affects more than 650 million adults worldwide. Obesity not only is a significant health concern on its own, but predisposes to cardiometabolic comorbidities, including coronary heart disease, dyslipidemia, hypertension, type 2 diabetes, and some cancers. Lifestyle interventions effectively promote weight loss of 5% to 10%, and pharmacological and surgical interventions even more, with some novel approved drugs inducing up to an average of 25% weight loss. Yet, maintaining weight loss over the long‐term remains extremely challenging, and subsequent weight gain is typical. The mechanisms underlying weight regain remain to be fully elucidated. The purpose of this Pennington Biomedical Scientific Symposium was to review and highlight the complex interplay between the physiological, behavioral, and environmental systems controlling energy intake and expenditure. Each of these contributions were further discussed in the context of weight‐loss maintenance, and systems‐level viewpoints were highlighted to interpret gaps in current approaches. The invited speakers built upon the science of obesity and weight loss to collectively propose future research directions that will aid in revealing the complicated mechanisms involved in the weight‐reduced state.

Revisiting the beyond BMI paradigm in excess weight diagnosis and management: A call to action

“…Several scientific societies are currently working on developing new working frameworks to better capture the reality of excess weight and its appropriate management. 5,[20][21][22][23] On the one hand, the simplicity of the measurement of weight, height, waist, hip and combinations to derive anthropometric indices makes it useful in clinical as well epidemiological settings. On the other hand, being a mere surrogate of adiposity the right balance between usefulness and meaningfulness needs to be struck.…”

“…4 Undoubtedly, biology exerts a pivotal role in energy homeostasis with genetic susceptibility underlying the potential development of obesity in the middle of an obesogenic environment that can drive body weight variation. 5 Thus, it is important to weigh up the relative contribution of both nurture and nature in excess weight regulation. While genes underlie the expression of many of the phenotypic traits, environmental influences and nurture certainly play a relevant role.…”

“…Moreover, a higher prevalence of excess weight is observed in socioeconomically disadvantaged people with a clear socioeconomic gradient being established by low educational level and decreased income. 4,5 In spite of the worldwide interest in deaccelerating the numbers of people living with obesity (PwO), its prevalence continues to increase in adults as well as in adolescents and children. 3,[9][10][11][12][13][14] Noteworthy, obesity is a multifactorial, chronic, progressive and frequently relapsing non-communicable disease accompanied by increased morbi-mortality and decreased quality of life.…”

“…In this context, the nurture versus nature concept is a frequently put forward opposition 4 . Undoubtedly, biology exerts a pivotal role in energy homeostasis with genetic susceptibility underlying the potential development of obesity in the middle of an obesogenic environment that can drive body weight variation 5 . Thus, it is important to weigh up the relative contribution of both nurture and nature in excess weight regulation.…”

“…Thus, modern humans are engulfed by a surrounding obesogenic environment in which energy‐dense foods are readily available and opportunities for physical activity succumb in a sedentary habitat favour that currently every person can easily put on excess weight. Moreover, a higher prevalence of excess weight is observed in socioeconomically disadvantaged people with a clear socioeconomic gradient being established by low educational level and decreased income 4,5 …”