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Diabetes 52:232-238, 2003
© 2003 by the American Diabetes Association, Inc.

Perspectives in Diabetes

Is the Energy Homeostasis System Inherently Biased Toward Weight Gain?

Michael W. Schwartz1, Stephen C. Woods2, Randy J. Seeley2, Gregory S. Barsh3, Denis G. Baskin1,4, and Rudolph L. Leibel5

1 Department of Medicine, University of Washington, Seattle, Washington
2 Department of Psychiatry, University of Cincinnati, Cincinnati, Ohio
3 Department of Pediatrics and Genetics, Stanford University, Palo Alto, California
4 Department of Biological Structure, University of Washington, Seattle, Washington
5 Department of Pediatrics, Columbia University, New York, New York

We describe a model of energy homeostasis to better understand neuronal pathways that control energy balance and their regulation by hormonal signals such as insulin and leptin. Catabolic neuronal pathways are those that both reduce food intake and increase energy expenditure (e.g., melanocortin neurons in the hypothalamic arcuate nucleus) and are stimulated by input from insulin and leptin. We propose that in the basal state, catabolic effectors are activated in response to physiological concentrations of leptin and insulin, and that this activation is essential to prevent excessive weight gain. In contrast, anabolic pathways (e.g., neurons containing neuropeptide Y) are those that stimulate food intake and decrease energy expenditure and are strongly inhibited by these same basal concentrations of insulin and leptin. In the basal state, therefore, catabolic effector pathways are activated while anabolic effector pathways are largely inhibited. The response to weight loss includes both activation of anabolic and inhibition of catabolic pathways and is, thus, inherently more vigorous than the response to weight gain (stimulation of already-activated catabolic pathways and inhibition of already-suppressed anabolic pathways). Teleological, molecular, physiological, and clinical aspects of this hypothesis are presented, along with a discussion of currently available supporting evidence.


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