Chemobiology of Obesity and Advances in Bariatrics: A Systematic Review

Background: Obesity is a complex metabolic disorder with significant global health implications. Its pathophysiology is deeply rooted in chemobiological processes involving adipose tissue dysfunction, hormonal imbalances, and inflammatory pathways. Recent advances in bariatric research have expanded beyond surgical interventions to include pharmacological and molecular innovations aimed at addressing obesity at a biochemical level. Objectives: This review explores the chemobiology of obesity, highlighting key molecular and biochemical mechanisms underlying adipogenesis, energy metabolism, and inflammation. Additionally, it examines recent innovations in bariatric research, including emerging pharmacotherapies, minimally invasive procedures, and metabolic-targeted interventions. Methods: A systematic search was conducted across major databases (PubMed, Scopus, Web of Science, Embase) for studies published between 2010 and 2024. The review adhered to preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, and studies were included if they met predefined inclusion criteria. Data were extracted from randomized controlled trials, observational studies, and systematic reviews. Risk of bias was assessed using the Cochrane risk of bias tool for randomized controlled trails (RCTs) and risk of bias in non-randomized studies of interventions (ROBINS-I) tool for non-randomized studies. Data were synthesized narratively, with a meta-analysis conducted for studies with comparable methodologies. Results: The review identified key chemobiological mechanisms implicated in obesity, including dysregulated leptin-ghrelin signaling, chronic low-grade inflammation, and altered adipokine profiles. Innovations in bariatric research were categorized into three main domains: (1) pharmacological therapies targeting glucagon-like peptide-1 (GLP-1) receptors, lipolysis, and metabolic pathways; (2) minimally invasive endoscopic and device-assisted interventions; and (3) novel genetic and microbiome-based strategies. Evidence suggests that integrating these approaches may enhance long-term weight management and metabolic outcomes. Conclusion: Understanding the chemobiological underpinnings of obesity is crucial for developing more effective and sustainable interventions. The landscape of bariatric research is rapidly evolving, with promising advancements that extend beyond traditional surgical approaches. Further interdisciplinary research is needed to optimize these innovations and improve patient outcomes.