Obesity Research Group, Department of Clinical Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
Centre for Obesity and Innovation, Clinic of Surgery, St. Olav University Hospital, Trondheim, Norway.
Am J Clin Nutr. 2020 Nov 11;112(5):1170-1179. doi: 10.1093/ajcn/nqaa243.
Weight regain remains the main challenge in obesity management, and its etiology remains elusive. The aim of the present review was to revise the available evidence regarding the "Compensatory Theory," which is an explanatory model of relapse in obesity treatment, and to propose alternative mechanisms that can contribute to weight regain. It has been proposed, and generally accepted as true, that when a person loses weight the body fights back, with physiological adaptations on both sides of the energy balance equation that try to bring body weight back to its original state: this is the Compensatory Theory. This theory proposes that the increased orexigenic drive to eat and the reduced energy expenditure that follow weight loss are the main drivers of relapse. However, evidence showing a link between these physiological adaptations to weight loss and weight regain is lacking. Here, we propose that the physiological adaptations to weight loss, both at the level of the homeostatic appetite control system and energy expenditure, are in fact a normalization to a lower body weight and not drivers of weight regain. In light of this we explore other potential mechanisms, both physiological and behavioral, that can contribute to the high incidence of relapse in obesity management. More research is needed to clearly ascertain whether the changes in energy expenditure and homeostatic appetite markers seen in reduced-obese individuals are a compensatory mechanism that drives relapse or a normalization towards a lower body weight, and to explore alternative hypotheses that explain relapse in obesity management.
体重反弹仍然是肥胖管理的主要挑战,其病因仍然难以捉摸。本综述的目的是复习现有的关于“补偿理论”的证据,该理论是肥胖治疗中复发的解释模型,并提出可以促进体重反弹的替代机制。人们已经提出并普遍接受这样一种观点,即当一个人减肥时,身体会做出反应,能量平衡方程的两侧都会出现生理适应,试图使体重恢复到原来的状态:这就是补偿理论。该理论提出,减肥后食欲增加和能量消耗减少是导致复发的主要驱动因素。然而,缺乏证据表明这些对减肥的生理适应与体重反弹之间存在联系。在这里,我们提出,体重下降时,无论是在稳态食欲控制系统还是能量消耗方面的生理适应,实际上是体重下降的正常化,而不是体重反弹的驱动因素。有鉴于此,我们探讨了其他可能的机制,包括生理和行为机制,这些机制可能导致肥胖管理中复发率高。需要更多的研究来明确确定在体重减轻的个体中观察到的能量消耗和稳态食欲标志物的变化是导致复发的补偿机制还是体重下降的正常化,以及探索解释肥胖管理中复发的替代假设。