Effective therapy for obesity would result in an improved quality of life and possibly even an increased life expectancy for many individuals. To understand why current therapy for obesity is inadequate, it is necessary to review what is known about the regulation of body composition. In individuals of normal weight, energy balance is maintained at a body fat content of less than 25percnt; by adjustments in both energy intake and energy expenditure. Obese individuals are able to achieve long-term energy balance only at a higher body fat content. Both obese and normal weight individuals respond to any deviation of body fat content from its customary value with counterregulatory changes in energy expenditure and appetite. This review will elaborate upon these observations both to explain the limitations of current weight loss therapy and to suggest a strategy for targeting available therapy until the physiology of energy balance is better understood.
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