NEUROPEPTIDE-Y AND ENERGY-BALANCE - ONE-WAY AHEAD FOR THE TREATMENT OF OBESITY

Obesity is a vast and ever-expanding problem in affluent societies, wh ich we have so far failed to confront. Over 20% of Western European an d North American adults are overweight to a degree which may potential ly shorten their life expectancy. Obesity has well-known associations with non-insulin-dependent diabetes (NIDDM), hypertension, dyslipidaem ia and coronary heart disease, as well as less obvious links with dise ases such as osteoarthrosis and various malignancies; it also causes c onsiderable problems through reduced mobility and decreased quality of life. The overall financial burden of obesity is impossible to calcul ate precisely, but may account for 6-8% of total health-care expenditu re in North America [1] (similar estimates probably apply to Western E urope). Obesity is difficult to treat and many patients remain obstina tely overweight despite our best efforts. The available options range from behavioural therapy to gastrointestinal surgery and include numer ous drugs designed to suppress appetite or increase energy expenditure . As in many other areas of medicine, the length and diversity of this list are reliable signs that effective treatment is still beyond our reach. This article argues that new anti-obesity drugs may emerge from recent advances in understanding the control of energy balance in rod ents. The discussion is structured around neuropeptide Y (NPY), a majo r brain peptide which at present appears to be important in regulating energy balance and seems a promising candidate for therapeutic exploi tation.