16. Obesity as a dopaminergic Disorder

Obesity can be promoted by disorders of the dopaminergic system.

The following presentation is largely based on Ezrokhi et al., 2021.¹

The dopaminergic circadian rhythm in the central nervous system (CNS) modulates peripheral energy metabolism:

• it influences the hypothalamic regulation of the neuroendocrine axis, which targets peripheral metabolic organs such as the liver, adipose tissue, endocrine pancreas and muscles^{23 4 5 6}
• it influences the neurophysiology of the striatum, which manifests itself in feeding behavior⁷⁸⁹

A reduction in the natural circadian dopamine peak in the CNS favors an insulin-resistant, obese state that is associated with cardiovascular disease.
Restoring the dopaminergic circadian rhythm in the CNS eliminates these problems.^102341112

A short-acting dopamine agonist is administered 2 hours after waking up, at the start of physical activity, at the time of maximum dopaminergic circadian rhythm. ¹³
Bromocriptine QR is the only known fast-acting dopamine agonist (60 minutes), only approved in the USA (since 2009 as Cycloset), not approved in Europe, and quite expensive in the USA. In Europe, no fast-acting dopamine agonist is approved for “modeling the circadian dopamine rhythm” for diabetes or metabolic syndrome.

Reduced D2R increases the risk of obesity.¹⁴

This could explain the significantly increased prevalence of obesity in ADHD, which essentially shows its symptoms as a result of a disorder of the dopamine system.