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In energy deficiency states we clearly need to advance further our understanding of the role of leptin (and other hormones) to improve and/or correct the neuroendocrine abnormalities of women with hypothalamic amenorrhea and anorexia nervosa as well as those of obese subjects dieting to lose weight and/or having had surgery for obesity. We also need conclusive evidence from randomized trials on whether leptin and/or other treatment options could also improve the osteoporosis of subjects with anorexia nervosa or hypothalamic amenorrhea. Importantly, we need to learn whether the effect of leptin in improving neuroendocrine function could facilitate weight maintenance of obese subjects who strive to lose weight. Much needed investigations are underway in this area.

With obesity affecting greater numbers of people each year and with currently available methods having only modest success to reduce the increasing prevalence of obesity, there is an urgent need to develop better weight loss and weight maintenance programs. We also need to clearly identify the many genetic and environmental components that are involved in the pathogenesis of the problem and to carefully study the underlying molecular, cellular, and hormonal mechanisms. On the basis of elucidating these factors, effective diagnostic tools and pharmaceuticals could hopefully be designed, appropriate behavioral modification programs could be investigated, and well-informed public health recommendations could be formulated to direct and implement pervasive, effective, and enduring changes to the ways we live our lives.

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