Obesity Management – Metabolic Pathways

Management of obesity is far from a simple process, despite the prevailing simple notion that all that need be understood is that the condition results from consuming more calories than are expended.  The number of pathways involved, both physiologic and psychologic, is extensive, variable from patient to patient and otherwise not fully understood. Attempts to intervene in these pathways and produce a long-term, sustainable outcome for the obese are challenged as a result.  But the fundamental demand for clinically effective options remains undiminished.

Management of obesity is far from a simple process, despite the prevailing simple notion that all that need be understood is that the condition results from consuming more calories than are expended.  The number of pathways involved, both physiologic and psychologic, is extensive, variable from patient to patient and otherwise not fully understood. Attempts to intervene in these pathways and produce a long-term, sustainable outcome for the obese are challenged as a result.  But the fundamental demand for clinically effective options remains undiminished.  This has driven, and will continue to drive, the development of many products in obesity and many different clinical approaches, from behavioral management, OTC treatments, ethical pharmaceuticals (and combinations), surgeries, devices and others.

Synopsizing the pathways as they are thus far understood (and elucidated in MMD report #S835), we show the main elements of the “metabolic pathways of energy homeostasis” below:

Metabolic Pathways of Energy Homeostasis

• Role of the Hypothalamus and Amygdala
• Role of the Stomach
• Role of the Small Intestine
• Role of the Pancreas
• Role of Adipose Tissue as Endocrine Organ
  • Brown Fat vs. White Fat
  • Adipocytes and Adipokines
  • Leptin
  • Adiponectin
  • Angiotensin II and Cardiac Remodeling
  • Plasminogen Activator Inhibitor-1
  • Interleukin-6
  • Fat Distribution

For more information, see Report #S835, “Products, Technologies and Markets Worldwide for the Clinical Management of Obesity, 2011-2019.”