The number of people living with obesity has tripled worldwide since 1975 with serious implications for public health, as having obesity is linked to a significantly higher chance of early death from associated comorbidities (metabolic syndrome, type 2 diabetes and cardiovascular disease). As obesity is a consequence of food intake exceeding the demands of energy expenditure, efforts are made to better understand the homeostatic and hedonic mechanisms governing food intake. Gastrointestinal peptides are secreted from enteroendocrine cells in response to nutrient and energy intake, and modulate food intake either via afferent nerves, including the vagus nerve, or directly within the central nervous system, predominantly gaining access at circumventricular organs. Enteroendocrine hormones modulate homeostatic control centres at hypothalamic nuclei and the dorso-vagal complex. Additional roles of these peptides in modulating hedonic food intake and/or preference via the neural systems of reward are starting to be elucidated, with both peripheral and central peptide sources potentially contributing to central receptor activation. Pharmacological interventions and gastric bypass surgery for the treatment of type 2 diabetes and obesity elevate enteroendocrine hormone levels and also alter food preference. Hence, understanding of the hedonic mechanisms mediated by gut peptide action could advance development of potential therapeutic strategies for the treatment of obesity and its comorbidities.
Key points-Enteroendocrine cells produce a range of gut peptides that have key roles in the regulation of appetite and beneficial effects on body weight. -Gut peptides are secreted as feedback to nutrient and energy intake, communicating directly or indirectly with the brain. -These peptides, some of which are also expressed in the CNS, alter food intake and reward via their widely distributed receptors. -Understanding these interactions is one of the challenges for developing effective pharmacotherapies that reduce feeding without producing negative side effects (e.g. nausea).