The 'Behavioral Balance Model': A new perspective on the aetiology and therapy of obesity.
GLP-1 analogue
antidiabetic drug
appetite control
bariatric surgery
obesity therapy
weight control
Journal
Diabetes, obesity & metabolism
ISSN: 1463-1326
Titre abrégé: Diabetes Obes Metab
Pays: England
ID NLM: 100883645
Informations de publication
Date de publication:
12 2023
12 2023
Historique:
revised:
13
08
2023
received:
22
05
2023
accepted:
21
08
2023
medline:
13
11
2023
pubmed:
11
9
2023
entrez:
11
9
2023
Statut:
ppublish
Résumé
Obesity is a debilitating disease of global proportions that necessitates refined, concept-driven therapeutic approaches. Policy makers, the public and even health care professionals, but also individuals with obesity harbour many misconceptions regarding this disease, which leads to prejudice, negative attitudes, stigmatization, discrimination, self-blame, and failure to provide and finance adequate medical care. Decades of intensive, successful scientific research on obesity have only had a very limited effect on this predicament. We propose a science-based, easy-to-understand conceptual model that synthesizes the complex pathogenesis of obesity including biological, psychological, social, economic and environmental aspects with the aim to explain and communicate better the nature of obesity and currently available therapeutic modalities. According to our integrative 'Behavioral Balance Model', 'top-down cognitive control' strategies are implemented (often with limited success) to counterbalance the increased 'bottom-up drive' to gain weight, which is triggered by biological, psycho-social and environmental mechanisms in people with obesity. Besides offering a deeper understanding of obesity, the model also highlights why there is a strong need for multimodal therapeutic approaches that may not only increase top-down control but also reduce a pathologically increased bottom-up drive.
Types de publication
Journal Article
Review
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
3444-3452Informations de copyright
© 2023 John Wiley & Sons Ltd.
Références
Pi-Sunyer FX. The obesity epidemic: pathophysiology and consequences of obesity. Obes Res. 2002;10(Suppl 2):97S-104S.
Chu DT, Minh Nguyet NT, Nga VT, et al. An update on obesity: mental consequences and psychological interventions. Diabetes Metab Syndr. 2019;13(1):155-160.
Nolan LJ, Eshleman A. Paved with good intentions: paradoxical eating responses to weight stigma. Appetite. 2016;102:15-24.
Rubino F, Puhl RM, Cummings DE, et al. Joint international consensus statement for ending stigma of obesity. Nat Med. 2020;26(4):485-497.
Schwartz MW, Seeley RJ, Zeltser LM, et al. Obesity pathogenesis: an endocrine society scientific statement. Endocr Rev. 2017;38(4):267-296.
Morton GJ, Meek TH, Schwartz MW. Neurobiology of food intake in health and disease. Nat Rev Neurosci. 2014;15(6):367-378.
Levitsky DA, Barre L, Michael JJ, et al. The rise and fall of physiological theories of the control of human eating behavior. Front Nutr. 2022;9:826334.
van Baak MA, Mariman ECM. Mechanisms of weight regain after weight loss-the role of adipose tissue. Nat Rev Endocrinol. 2019;15(5):274-287.
Aronne LJ, Hall KD, Jakicic MJ, et al. Describing the weight-reduced state: physiology, behavior, and interventions. Obesity. 2021;29(Suppl 1):S9-S24.
Rosenbaum M, Leibel RL. 20 years of leptin: role of leptin in energy homeostasis in humans. J Endocrinol. 2014;223(1):T83-T96.
Hallschmid M, Schultes B. Central nervous insulin resistance: a promising target in the treatment of metabolic and cognitive disorders? Diabetologia. 2009;52(11):2264-2269.
Kullmann S, Heni M, Hallschmid M, Fritsche A, Preissl H, Häring HU. Brain insulin resistance at the crossroads of metabolic and cognitive disorders in humans. Physiol Rev. 2016;96(4):1169-1209.
Sumithran P, Prendergast LA, Delbridge E, et al. Long-term persistence of hormonal adaptations to weight loss. N Engl J Med. 2011;365(17):1597-1604.
Wing RR, Phelan S. Long-term weight loss maintenance. Am J Clin Nutr. 2005;82(1 Suppl):222S-225S.
Farias MM, Cuevas AM, Rodriguez F. Set-point theory and obesity. Metab Syndr Relat Disord. 2011;9(2):85-89.
Chapelot D, Charlot K. Physiology of energy homeostasis: models, actors, challenges and the glucoadipostatic loop. Metabolism. 2019;92:11-25.
Speakman JR, Levitsky DA, Allison DB, et al. Set points, settling points and some alternative models: theoretical options to understand how genes and environments combine to regulate body adiposity. Dis Model Mech. 2011;4(6):733-745.
Alonso-Alonso M, Pascual-Leone A. The right brain hypothesis for obesity. Jama. 2007;297(16):1819-1822.
Morales I, Berridge KC. “Liking” and “wanting” in eating and food reward: brain mechanisms and clinical implications. Physiol Behav. 2020;227:113152.
Volkow ND, Wang GJ, Baler RD. Reward, dopamine and the control of food intake: implications for obesity. Trends Cogn Sci. 2011;15(1):37-46.
Berridge KC, Ho CY, Richard JM, DiFeliceantonio AG. The tempted brain eats: pleasure and desire circuits in obesity and eating disorders. Brain Res. 2010;1350:43-64.
Berthoud HR, Münzberg H, Morrison CD. Blaming the brain for obesity: integration of hedonic and homeostatic mechanisms. Gastroenterology. 2017;152(7):1728-1738.
Farooqi IS, Bullmore E, Keogh J, Gillard J, O'Rahilly S, Fletcher PC. Leptin regulates striatal regions and human eating behavior. Science. 2007;317(5843):1355.
Hollmann M, Hellrung L, Pleger B, et al. Neural correlates of the volitional regulation of the desire for food. Int J Obes. 2012;36(5):648-655.
Heatherton TF, Wagner DD. Cognitive neuroscience of self-regulation failure. Trends Cogn Sci. 2011;15(3):132-139.
Weygandt M, Mai K, Dommes E, et al. The role of neural impulse control mechanisms for dietary success in obesity. Neuroimage. 2013;83:669-678.
DelParigi A, Chen K, Salbe AD, et al. Successful dieters have increased neural activity in cortical areas involved in the control of behavior. Int J Obes. 2007;31(3):440-448.
Higgs S, Spetter MS, Thomas JM, et al. Interactions between metabolic, reward and cognitive processes in appetite control: implications for novel weight management therapies. J Psychopharmacol. 2017;31(11):1460-1474.
Schwartz MW, Woods SC, Seeley RJ, Barsh GS, Baskin DG, Leibel RL. Is the energy homeostasis system inherently biased toward weight gain? Diabetes. 2003;52(2):232-238.
Geserick M, Vogel M, Gausche R, et al. Acceleration of BMI in early childhood and risk of sustained obesity. N Engl J Med. 2018;379(14):1303-1312.
Donofry SD, Stillman CM, Erickson KI. A review of the relationship between eating behavior, obesity and functional brain network organization. Soc Cogn Affect Neurosci. 2020;15(10):1157-1181.
Schultes B, Ernst B, Wilms B, Thurnheer M, Hallschmid M. Hedonic hunger is increased in severely obese patients and is reduced after gastric bypass surgery. Am J Clin Nutr. 2010;92(2):277-283.
Janssen LK, Horstmann A. Molecular imaging of central dopamine in obesity: a qualitative review across substrates and radiotracers. Brain Sci. 2022;12(4):486.
Ap D, Smith PK, van Baaren RB, Wigboldus DHJ. The unconscious consumer: effects of environment on consumer behavior. J Consum Psychol. 2005;15(3):193-202.
Gearhardt AN, Schulte EM. Is food addictive? A review of the science. Annu Rev Nutr. 2021;41(1):387-410.
Fletcher PC, Kenny PJ. Food addiction: a valid concept? Neuropsychopharmacology. 2018;43(13):2506-2513.
Gordon EL, Ariel-Donges AH, Bauman V, Merlo LJ. What is the evidence for “food addiction?” a systematic review. Nutrients. 2018;10(4):477.
Drewnowski A. Obesity, diets, and social inequalities. Nutr Rev. 2009;67(Suppl 1):S36-S39.
Vartanian LR, Porter AM. Weight stigma and eating behavior: a review of the literature. Appetite. 2016;102:3-14.
Żukiewicz-Sobczak W, Wróblewska P, Zwoliński J, et al. Obesity and poverty paradox in developed countries. Ann Agric Environ Med. 2014;21(3):590-594.
Alimoradi Z, Golboni F, Griffiths MD, Broström A, Lin CY, Pakpour AH. Weight-related stigma and psychological distress: a systematic review and meta-analysis. Clin Nutr. 2020;39(7):2001-2013.
Hemmingsson E. Early childhood obesity risk factors: socioeconomic adversity, family dysfunction, offspring distress, and junk food self-medication. Curr Obes Rep. 2018;7(2):204-209.
Ziauddeen H, Alonso-Alonso M, Hill JO, Kelley M, Khan NA. Obesity and the neurocognitive basis of food reward and the control of intake. Adv Nutr. 2015;6(4):474-486.
Veronese N, Facchini S, Stubbs B, et al. Weight loss is associated with improvements in cognitive function among overweight and obese people: a systematic review and meta-analysis. Neurosci Biobehav Rev. 2017;72:87-94.
Paulus MP. Decision-making dysfunctions in psychiatry-altered homeostatic processing? Science. 2007;318(5850):602-606.
Hassapidou M, Duncanson K, Shrewsbury V, et al. EASO and EFAD position statement on medical nutrition therapy for the management of overweight and obesity in children and adolescents. Obes Facts. 2023;16(1):29-52.
Jacob A, Moullec G, Lavoie KL, et al. Impact of cognitive-behavioral interventions on weight loss and psychological outcomes: a meta-analysis. Health Psychol. 2018;37(5):417-432.
Lawlor ER, Islam N, Bates S, et al. Third-wave cognitive behaviour therapies for weight management: a systematic review and network meta-analysis. Obes Rev. 2020;21(7):e13013.
Machado AM, Guimarães NS, Bocardi VB, et al. Understanding weight regain after a nutritional weight loss intervention: systematic review and meta-analysis. Clin Nutr ESPEN. 2022;49:138-153.
Iturbe I, Echeburúa E, Maiz E. The effectiveness of acceptance and commitment therapy upon weight management and psychological well-being of adults with overweight or obesity: a systematic review. Clin Psychol Psychother. 2022;29(3):837-856.
Pitil PP, Ghazali SR. Acceptance and commitment therapy and weight-related difficulties in overweight and obese adults: a systematic review. Psychol Rep. 2022;332941221149172.
Boutelle KN, Eichen DM, Peterson CB, et al. Effect of a novel intervention targeting appetitive traits on body mass index among adults with overweight or obesity: a randomized clinical trial. JAMA Netw Open. 2022;5(5):e2212354.
Kohl SH, Veit R, Spetter MS, et al. Real-time fMRI neurofeedback training to improve eating behavior by self-regulation of the dorsolateral prefrontal cortex: a randomized controlled trial in overweight and obese subjects. Neuroimage. 2019;191:596-609.
Ferrulli A, Macrì C, Terruzzi I, et al. Weight loss induced by deep transcranial magnetic stimulation in obesity: a randomized, double-blind, sham-controlled study. Diabetes Obes Metab. 2019;21(8):1849-1860.
Cavicchioli M, Sarzetto A, Erzegovesi S, Ogliari A. Is repetitive transcranial magnetic stimulation (RTMS) a promising therapeutic intervention for eating disorders and obesity? Clinical considerations based on a meta-analytic review. Clin Neuropsychiatry. 2022;19(5):314-327.
Baer HJ, Rozenblum R, De La Cruz BA, et al. Effect of an online weight management program integrated with population health management on weight change: a randomized clinical trial. Jama. 2020;324(17):1737-1746.
Mauvais-Jarvis F, Bairey Merz N, Barnes PJ, et al. Sex and gender: modifiers of health, disease, and medicine. Lancet. 2020;396(10250):565-582.
Brewis AA. Stigma and the perpetuation of obesity. Soc Sci Med. 2014;118:152-158.
Ernst B, Wilms B, Thurnheer M, Schultes B. Eating behaviour in treatment-seeking obese subjects-influence of sex and BMI classes. Appetite. 2015;95:96-100.
Gibson EL. The psychobiology of comfort eating: implications for neuropharmacological interventions. Behav Pharmacol. 2012;23(5-6):442-460.
Chao AM, Loughead J, Bakizada ZM, et al. Sex/gender differences in neural correlates of food stimuli: a systematic review of functional neuroimaging studies. Obes Rev. 2017;18(6):687-699.
Wang GJ, Volkow ND, Telang F, et al. Evidence of gender differences in the ability to inhibit brain activation elicited by food stimulation. Proc Natl Acad Sci U S A. 2009;106(4):1249-1254.
Sala A, Malpetti M, Ferrulli A, et al. High body mass index, brain metabolism and connectivity: an unfavorable effect in elderly females. Aging. 2019;11(19):8573-8586.
Twells LK, Harris Walsh K, Blackmore A, et al. Nonsurgical weight loss interventions: a systematic review of systematic reviews and meta-analyses. Obes Rev. 2021;22(11):e13320.
Roth A, Sattelmayer M, Schorderet C, Gafner S, Allet L. Effects of exercise training and dietary supplement on fat free mass and bone mass density during weight loss-a systematic review and meta-analysis. F1000Res. 2022;11:8.
Wang S, Zhou H, Zhao C, He H. Effect of exercise training on body composition and inflammatory cytokine levels in overweight and obese individuals: a systematic review and network meta-analysis. Front Immunol. 2022;13:921085.
O'Donoghue G, Blake C, Cunningham C, Lennon O, Perrotta C. What exercise prescription is optimal to improve body composition and cardiorespiratory fitness in adults living with obesity? A network meta-analysis. Obes Rev. 2021;22(2):e13137.
Morze J, Rücker G, Danielewicz A, et al. Impact of different training modalities on anthropometric outcomes in patients with obesity: a systematic review and network meta-analysis. Obes Rev. 2021;22(7):e13218.
Levine JA, Lanningham-Foster LM, McCrady SK, et al. Interindividual variation in posture allocation: possible role in human obesity. Science. 2005;307(5709):584-586.
Berglind D, Willmer M, Tynelius P, Ghaderi A, Näslund E, Rasmussen F. Accelerometer-measured versus self-reported physical activity levels and sedentary behavior in women before and 9 months after Roux-en-Y gastric bypass. Obes Surg. 2016;26(7):1463-1470.
Wilms B, Ernst B, Thurnheer M, Schultes B. Subjective and objective physical activity patterns after Roux-en Y gastric bypass surgery compared with non-operated obese and non-obese control women. Obes Res Clin Pract. 2016;10(1):49-55.
Stubbe JH, Boomsma DI, Vink JM, et al. Genetic influences on exercise participation in 37,051 twin pairs from seven countries. PLoS One. 2006;1(1):e22.
Beunen G, Thomis M. Genetic determinants of sports participation and daily physical activity. Int J Obes Relat Metab Disord. 1999;23(Suppl 3):S55-S63.
De Moor MHM, Liu YJ, Boomsma DI, et al. Genome-wide association study of exercise behavior in Dutch and American adults. Med Sci Sports Exerc. 2009;41(10):1887-1895.
Look AHEAD Research Group; Rena R Wing, Paula Bolin, et al. Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes. NEJM 2013;369(2):145-154.
Al-Najim W, Docherty NG, le Roux CW. Food intake and eating behavior after bariatric surgery. Physiol Rev. 2018;98(3):1113-1141.
Courcoulas AP, King WC, Belle SH, et al. Seven-year weight trajectories and health outcomes in the longitudinal assessment of bariatric surgery (LABS) study. JAMA Surg. 2018;153(5):427-434.
Adams TD, Davidson LE, Litwin SE, et al. Weight and metabolic outcomes 12 years after gastric bypass. N Engl J Med. 2017;377(12):1143-1155.
Stemmer K, Müller TD, DiMarchi RD, Pfluger PT, Tschöp MH. CNS-targeting pharmacological interventions for the metabolic syndrome. J Clin Invest. 2019;129(10):4058-4071.
Bradley CL, McMillin SM, Hwang AY, Sherrill CH. High-dose once-weekly Semaglutide: a new option for obesity management. Ann Pharmacother. 2022;56(8):941-950.
Drucker DJ. GLP-1 physiology informs the pharmacotherapy of obesity. Mol Metab. 2022;57:101351.
Jastreboff AM, Aronne LJ, Ahmad NN, et al. Tirzepatide once weekly for the treatment of obesity. N Engl J Med. 2022;387(3):205-216.
Wilding JPH, Batterham RL, Davies M, et al. Weight regain and cardiometabolic effects after withdrawal of semaglutide: the STEP 1 trial extension. Diabetes Obes Metab. 2022;24(8):1553-1564.
Schultes B. Pharmacological interventions against obesity: current status and future directions. Visc Med. 2016;32(5):347-351.