The prevalence of obesity is increasing in the industrialized world, so that the World Health Organization considers obesity as a “pandemia” in rich populations. The autonomic nervous system plays a crucial role in the control of energy balance and body weight. This review summarizes our own data and perspectives, emphasizing the influence exerted by autonomic nervous system on energy expenditure and food intake, which are able to determine the body weight. Activation of the sympathetic discharge causes an increase in energy expenditure and a decrease in food intake, while reduction of food intake and body weight loss determines a reduction of the sympathetic activity. On the other hand, pathophysiological mechanisms of the obesity involve alterations of the sympathetic nervous system in accordance with the “Mona Lisa Hypothesis,” an acronym for “most obesities known are low in sympathetic activity.” Furthermore, the parasympathetic influences on the energy expenditure are analyzed in this review, showing that an increase in parasympathetic activity can induce a paradoxical enhancement of energy consumption. 1. Introduction Body weight stability and the associated regulatory processes depend upon nutrient intake, but are also influenced by compensatory genetic-dependent metabolic and neuroendocrine mechanisms [1–4]. The control of the maintenance of body composition has been the subject of a number of theories or pathways. Systems that control food intake and/or energy expenditure are able to influence body weight. Several substances are able to influence food intake. The “glucostatic hypothesis” emphasizes the role of blood glucose, considering that an increase in glucose blood level induces a reduction of food intake [5]. Leptin, a peptide secreted by white adipose tissue, acts on the hypothalamic areas inducing a reduction of food ingestion. This is in accord with the “lipostatic hypothesis” of food intake [6, 7]. Gastrointestinal hormones also lower food intake; this influence is known as the “hypothesis of gastrointestinal control of food intake” [8, 9]. The autonomic nervous system is involved in the control of eating behavior through influences exerted on the production and loss of heat [10, 11]. Thus, the control of body temperature is strictly associated with the control of body weight; this is in accord with the “thermoregulatory hypothesis” of food intake [12]. On the other hand, the metabolic balance is controlled by the autonomic nervous system, so that the vegetative influences affect the storage and the consumption of energy. Adipose
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