The Autophagy-Epigenome Axis in Hypothalamic Neurons: A Unified Framework for Understanding Obesity Persistence and Therapeutic Resistance.

Diet-induced obesity is increasingly understood as a disorder of central regulatory failure rather than simple energy imbalance. Two mechanisms-impaired hypothalamic autophagy and epigenetic reprogramming of feeding-regulatory genes-have been independently implicated in perpetuating obesity, yet their mechanistic intersection remains poorly defined. This perspective proposes that these processes are not parallel phenomena but components of a single self-reinforcing autophagy-epigenome axis (presented here as a working hypothesis) governed by shared nutrient-sensing hubs (mechanistic target of rapamycin complex 1, AMP-activated protein kinase, and sirtuin 1). In this model, chronic caloric excess simultaneously suppresses autophagic flux and induces epigenetic silencing of autophagy regulators, potentially creating a feed-forward loop that locks hypothalamic neurons into a pro-inflammatory, orexigenic state resistant to dietary normalization. The frequent weight regain observed after glucagon-like peptide-1 receptor agonist discontinuation-despite these agents' demonstrated capacity to enhance central autophagy and suppress neuroinflammation-raises the possibility that current pharmacotherapies may suppress downstream consequences without erasing the underlying epigenetic code. This perspective synthesizes preclinical and emerging translational evidence to argue that durable obesity treatment will require interventions capable of simultaneously restoring autophagic flux and reversing epigenetic modifications within hypothalamic feeding circuits, and identifies critical knowledge gaps that must be addressed to advance this paradigm from a bench to a bedside.