Physiological and socio-behavioral factors regulate food intake, appetite and individual responses to satiety signals. Opinion remains divided on the best approach to weight control and interest in drugs, dietary supplements or fad diets for weight loss is waning. While weight control is highlighted frequently as a key public health initiative, the underlying metabolic problems that accompany obesity remain often poorly addressed in clinical practice. Practitioners of integrative medicine may have failed to understand the importance of correction of Metabolic Syndrome X in many overweight individuals. As many as 70 million American people may have the variable combination of excessive body weight, hypertension and hypercholesterolemia, linked by insulin resistance (Syndrome X). The components and associations of Syndrome X present a unifying concept of disease which may explain an increased occurrence of chronic degenerative disorders, as a consequence of delayed metabolic evolution to modern lifestyles. While genetic predispositions to obesity, Metabolic Syndrome X, and diabetes mellitus operate variably, much evidence indicates that positive changes in lifestyle domains to promote health is the pivotal maneuver in the combat against obesity related diseases, including the wide ranging associations of the Metabolic Syndrome X. Syndrome X presents an increased risk of disability and death from many causes and it is associated with cardiovascular risks, thrombotic tendencies, female endocrine disorders, immune impairment, general inflammation, cancer, and degenerative brain disease.
Much attention is focused on ways of controlling appetite, hunger and satiety, but this focused approach has the same disadvantages and limitations of unitary interventions to treat a variety of obesity related disorders e.g. hypertension or hypercholesterolemia. Pharmacological control of appetite using compounds that are involved in CNS signaling seems an attractive approach to weight control e.g. endocannabinoid receptor modulators, steroidal glycosides and modified opioids. No matter how elegant this approach becomes, the causation and consequences of obesity are very complex and they require multi-factorial strategies for patient management. First, Metabolic Syndrome X and its consequences must be addressed in a large number of overweight individuals. Second, our understanding of the pathophysiology of obesity reveals a need to manage underlying inflammatory processes, immunological factors, altered biorhythms and emerging public health problems such as sleeplessness. The prevalence of Metabolic Syndrome X has increased dramatically over the past two decades and a consensus has emerged that the first-line option to deal with this health crisis is the use of integrative medicine where positive lifestyle change and nutrition are of paramount importance.