The effect of biomolecular and hormonal modulation in the treatment of obesity: A systematic review

Abstract

Obesity is a complex and multifactorial chronic disease due to a sustained imbalance in energy intake and energy expenditure, the imbalance explained by hormonal dysregulation. The key regulators of appetite, energy homeostasis, and metabolism are called key biomolecules, such as leptin, ghrelin, adiponectin, and insulin. In the past decade, many randomized controlled trials (RCTs) have been conducted on various interventions, including various dietary changes (ketogenic, low-calorie, high protein, and fasting intermittently), exercise programs as well as pharmacologic interventions aimed at modulating these hormones. Clinically significant outcomes have been achieved with these interventions including weight loss, improvement in insulin sensitivity, and alterations in metabolic profile. It systematically reviews RCT evidence published from 2010 to 2024 on interventions aimed at these biomolecules in obese people. Finally, supporting mechanistic insights and data from high-quality reviews are discussed. The study characteristics, hormonal changes, and clinical outcomes are summarized in 6 tables, mechanistic pathways, and comparisons of intervention strategies and safety/tolerability profiles are also summarized. Overall, taken together, this evidence suggests that such targeted modulation of these hormones may be the right adjunct in obesity management, but we need more standardization and further long-term research.