Lee Taesung, Park Seeun, Lee Seokhyun, Hwangbo Areum, Bae HanGyeol, Lee Yumin, Choi Hyung Jin
Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Korea.
Department of Brain and Cognitive Sciences, Seoul National University, Seoul, Korea.
J Obes Metab Syndr. 2025 Jul 30;34(3):196-212. doi: 10.7570/jomes25053. Epub 2025 Jul 24.
The global obesity epidemic can no longer be explained by personal choice or caloric excess alone. Mounting evidence points to underlying neurobehavioral dysfunction, exacerbated by environments engineered to promote overconsumption. Modern obesity is driven by five interrelated neurobehavioral factors: cue-evoked eating, habitual-context eating, food addiction, emotional eating, and restrained eating. These maladaptive eating patterns arise from a decoupling of homeostatic and hedonic brain circuits in an obesogenic environment. This review synthesizes evidence from neuroimaging, behavioral experiments, and animal studies to illustrate how each factor contributes to obesity risk and relapse after weight loss. We further discuss emerging interventions -including digital therapeutics (DTx) and electroceuticals-that target these drivers with increasing precision. DTx platforms deliver scalable, phenotype-informed interventions through cognitive-behavioral modules, real-time monitoring, and artificial intelligence-driven coaching. Electroceutical strategies, including non-invasive brain stimulation and vagus nerve modulation, show promise in reshaping dysfunctional circuits. Finally, we propose a neurobehavioral subtyping model to guide personalized obesity treatment, integrating brain-based phenotyping with multimodal interventions. This framework may offer a path toward sustained and mechanism-driven obesity care.
全球肥胖流行已不能仅用个人选择或热量摄入过多来解释。越来越多的证据表明存在潜在的神经行为功能障碍,而旨在促进过度消费的环境又加剧了这种障碍。现代肥胖由五个相互关联的神经行为因素驱动:提示诱发进食、习惯情境进食、食物成瘾、情绪化进食和节制进食。这些适应不良的饮食模式源于致胖环境中稳态和享乐性脑回路的脱耦。本综述综合了神经影像学、行为实验和动物研究的证据,以说明每个因素如何导致肥胖风险以及减肥后的复发。我们进一步讨论了新兴的干预措施,包括数字疗法(DTx)和电疗法,这些措施越来越精确地针对这些驱动因素。DTx平台通过认知行为模块、实时监测和人工智能驱动的指导提供可扩展的、基于表型的干预措施。电疗法策略,包括非侵入性脑刺激和迷走神经调节,在重塑功能失调回路方面显示出前景。最后,我们提出了一种神经行为亚型模型,以指导个性化肥胖治疗,将基于脑的表型分析与多模式干预相结合。该框架可能为持续的、基于机制的肥胖护理提供一条途径。