on September 15, 2005
Published online before print September 15, 2005, doi: 10.1161/01.ATV.0000186208.06964.91
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Submitted on July 12, 2005
Accepted on August 29, 2005
Fast Food, Central Nervous System Insulin Resistance, and Obesity
Elvira Isganaitis and Robert H. Lustig *
From the Department of Pediatrics, University of California, San Francisco, Calif.
* To whom correspondence should be addressed. E-mail: rlustig{at}peds.ucsf.edu.
Abstract--Rates of obesity and insulin resistance have climbed sharply over the past 30 years. These epidemics are temporally related to a dramatic rise in consumption of fast food; until recently, it was not known whether the fast food was driving the obesity, or vice versa. We review the unique properties of fast food that make it the ideal obesigenic foodstuff, and elucidate the mechanisms by which fast food intake contributes to obesity, emphasizing its effects on energy metabolism and on the central regulation of appetite. After examining the epidemiology of fast food consumption, obesity, and insulin resistance, we review insulin’s role in the central nervous system’s (CNS) regulation of energy balance, and demonstrate the role of CNS insulin resistance as a cause of leptin resistance and in the promotion of the pleasurable or "hedonic" responses to food. Finally, we analyze the characteristics of fast food, including high-energy density, high fat, high fructose, low fiber, and low dairy intake, which favor the development of CNS insulin resistance and obesity.
Key words: fast food • fructose • hypothalamus • insulin hypersecretion • insulin resistance • leptin resistance • nucleus accumbens • obesity • ventral tegmental area
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