For example, shift-work schedules require people to work during the biological night (when circadian clocks promote sleep) and sleep during the biological day (when circadian clocks promote activity) 11, 12, 13. Furthermore, modern society is active 24 h a day, 7 days a week, which is conducive to circadian misalignment. Unfortunately, the prevalence of insufficient sleep is high in modern society, such that one-third or more of adults in the Americas, Europe and Asia sleep less than the 7 h per night recommended by public health authorities for health maintenance 6, 7, 8, 9, 10. Sleep is a foundational pillar of health (Box 1). Over the past 20 years, many novel contributors to obesity and the risk of associated metabolic disease have been identified 2, 3, including insufficient sleep and circadian misalignment 4, 5. However, traditional risk factors cannot fully explain the increase in obesity rates that have occurred in the past few decades. Efforts to counter the obesity pandemic and its associated metabolic dysregulations (for example, type 2 diabetes mellitus (T2DM) and non-alcoholic fatty liver disease) have largely focused on traditional risk factors, such as excess energy intake and insufficient physical activity. Obesity is a major public health issue worldwide caused by a complex interplay of multiple factors 1. Efforts are needed to highlight the importance of optimal sleep and circadian health in the maintenance of metabolic health and body weight regulation. Furthermore, modern working patterns, lifestyles and technologies are often not conducive to adequate sleep at times when the internal physiological clock is promoting it (for example, late-night screen time, shift work and nocturnal social activities). Millions of individuals worldwide do not obtain sufficient sleep for healthy metabolic functions. Some potential strategies to reduce the adverse effects of sleep disruption on metabolic health are provided and future research priorities are highlighted. This Review discusses the impact of insufficient sleep and circadian misalignment in humans on appetite hormones (focusing on ghrelin, leptin and peptide-YY), energy expenditure, food intake and choice, and risk of obesity. ![]() ![]() Insufficient sleep is defined as sleeping less than recommended for health benefits, whereas circadian misalignment is defined as wakefulness and food intake occurring when the internal circadian system is promoting sleep. ![]() Insufficient sleep and circadian misalignment predispose individuals to poor metabolic health and promote weight gain and have received increased research attention in the past 10 years. Traditional risk factors for obesity and the metabolic syndrome, such as excess energy intake and lack of physical activity, cannot fully explain the high prevalence of these conditions.
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