Obesity is among the most common and costly chronic disorders worldwide. Estimates suggest that in the United States obesity affects one-third of adults, accounts for up to one-third of total mortality, is concentrated among lower income groups, and increasingly affects children as well as adults. A lack of effective options for long-term weight reduction magnifies the enormity of this problem; individuals who successfully complete behavioral and dietary weight-loss programs eventually regain most of the lost weight. We included evidence from basic science, clinical, and epidemiological literature to assess current knowledge regarding mechanisms underlying excess body-fat accumulation, the biological defense of excess fat mass, and the tendency for lost weight to be regained. A major area of emphasis is the science of energy homeostasis, the biological process that maintains weight stability by actively matching energy intake to energy expenditure over time. Growing evidence suggests that obesity is a disorder of the energy homeostasis system, rather than simply arising from the passive accumulation of excess weight. We need to elucidate the mechanisms underlying this “upward setting” or “resetting” of the defended level of body-fat mass, whether inherited or acquired. The ongoing study of how genetic, developmental, and environmental forces affect the energy homeostasis system will help us better understand these mechanisms and are therefore a major focus of this statement. The scientific goal is to elucidate obesity pathogenesis so as to better inform treatment, public policy, advocacy, and awareness of obesity in ways that ultimately diminish its public health and economic consequences.

中文翻译：

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肥胖发病机制：内分泌学会科学声明

肥胖症是全世界最常见和最昂贵的慢性疾病之一。估计表明，在美国，肥胖影响了三分之一的成年人，占总死亡率的三分之一，集中在低收入群体中，并且越来越多地影响儿童和成人。缺乏长期减肥的有效选择会放大这个问题的严重性；成功完成行为和饮食减肥计划的人最终会恢复大部分减重。我们纳入了来自基础科学、临床和流行病学文献的证据，以评估当前关于体内脂肪过多积累机制、过多脂肪量的生物防御以及体重恢复趋势的知识。一个主要的重点领域是能量稳态科学，通过随着时间的推移主动匹配能量摄入与能量消耗来保持体重稳定的生物过程。越来越多的证据表明，肥胖是一种能量稳态系统的紊乱，而不是简单地由超重的被动积累引起。我们需要阐明这种“向上设置”或“重置”体脂质量防御水平背后的机制，无论是遗传的还是后天的。正在进行的关于遗传、发育和环境力量如何影响能量稳态系统的研究将帮助我们更好地理解这些机制，因此是本声明的主要焦点。科学目标是阐明肥胖的发病机制，以便更好地为治疗、公共政策、宣传、