New Weapons to Fight the Obesity Epidemic in XXI Century - Will They Fulfill the Promise?

Today most nations reached a point where obesity has changed from an individual health problem to a major public health issue reaching epidemic proportions. In the United States, 65% of Americans are overweight and of these, 31% are obese. Obesity is a complex health condition associated with increased risk of numerous diseases, including type 2 diabetes, hypertension, stroke, cardiovascular disease, respiratory problems, gallbladder disease, osteoarthritis, sleep apnea and certain cancers (including endometrial, colon, gall bladder, prostate, kidney and postmenopausal breast cancer); obesity also has serious social and psychological consequences, such as low self-esteem and clinical depression, and affects all ages and socioeconomic groups [1]. There is no definite single contributing factor to this epidemic but some of them can be credited largely to the lifestyle changes with the promotion of a highly technological urban existence with the ability of successful functioning when eating more and moving less.
The research on fat metabolism has made large progress over the last decade and has challenged several established views. One of the most important findings in recent obesity research was revealing that fat is an endocrine tissue (gland that secrets hormones in the body). Also, very important was the discovery of a number of peptides (short protein chains) that function as central regulators of food intake and energy metabolism. Such findings revealed that the neural and hormonal body systems are involved in complex interactions where the central nervous system (brain and the spinal cord) and fat communicate through hormones and neurotransmitters, and affect other organs.
The anti-obesity effect might be achieved by any of three basic approaches: a reduction in energy intake, a decrease in energy storage or an increase in energy expenditure. Each of them can be addressed by various specific mechanisms. With such perspectives the drug market should be blooming. In reality, disregarding the advertising scams and marketing schemes, there is not much in the store today, and what is available is disappointingly far from perfect. In fact, all today available drugs and most of those in clinical development belong to the reduction in energy intake category acting either by appetite suppression or inhibition of intestinal absorption.