Abstract
Diet, exercise, and pharmacological interventions have limited effects in counteracting the worldwide increase in pediatric body weight. Moreover, the promise that individualized drug design will work to induce weight loss appears to be exaggerated. We suggest that the reason for this limited success is that the cause of obesity has been misunderstood. Body weight is mainly under external control; our brain permits us to eat under most circumstances, and unless the financial or physical cost of food is high, eating and body weight increase by default. When energy-rich, inexpensive foods are continually available, people need external support to maintain a healthy body weight. Weight loss can thereby be achieved by continuous feedback on how much and how fast to eat on a computer screen.
Highlights
The medical consequences of overweight and obesity in adults and children alike are well known [1,2,3], and attempts to curb further escalation of the problem have met with some limited success [4,5,6,7], childhood obesity continues to increase throughout the world [8]
The effect in obese mice appears not to be due to the decrease in gastric size, but to an increase in bile acids and their associated changes in intestinal microbe populations [29]. Mimicking these effects pharmacologically might work with obese humans, and may even prevent the re-emergence of type-2 diabetes, which has been reported after bariatric surgery, despite the maintenance of a reduced body weight [30, 31]
That the reason why most approaches to effect weight loss have failed is that the causes of obesity have been misunderstood and that our present understanding of how the neuroendocrine system is engaged in eating and body weight regulation is mistaken
Summary
Specialty section: This article was submitted to Child Health and Human Development, a section of the journal Frontiers in Pediatrics. Exercise, and pharmacological interventions have limited effects in counteracting the worldwide increase in pediatric body weight. The promise that individualized drug design will work to induce weight loss appears to be exaggerated. Body weight is mainly under external control; our brain permits us to eat under most circumstances, and unless the financial or physical cost of food is high, eating and body weight increase by default. When energy-rich, inexpensive foods are continually available, people need external support to maintain a healthy body weight. Weight loss can thereby be achieved by continuous feedback on how much and how fast to eat on a computer screen
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