Psychology

Ecology

Production (economics)

Database

Physical medicine and rehabilitation

Artificial intelligence

Economics

Energy balance

Conceptual model

Obesity

Infectious disease (medical specialty)

Disease

Coronavirus disease 2019 (COVID-19)

Biology

Pandemic

Endocrinology

Macroeconomics

Overconsumption

Perspective (graphical)

Computer science

Balance (ability)

Internal medicine

Medicine

American Journal of Clinical Nutrition

According to a commonly held view, the obesity pandemic is caused by overconsumption of modern, highly palatable, energy-dense processed foods, exacerbated by a sedentary lifestyle. However, obesity rates remain at historic highs, despite a persistent focus on eating less and moving more, as guided by the energy balance model (EBM). This public health failure may arise from a fundamental limitation of the EBM itself. Conceptualizing obesity as a disorder of energy balance restates a principle of physics without considering the biological mechanisms that promote weight gain. An alternative paradigm, the carbohydrate-insulin model (CIM), proposes a reversal of causal direction. According to the CIM, increasing fat deposition in the body-resulting from the hormonal responses to a high-glycemic-load diet-drives positive energy balance. The CIM provides a conceptual framework with testable hypotheses for how various modifiable factors influence energy balance and fat storage. Rigorous research is needed to compare the validity of these 2 models, which have substantially different implications for obesity management, and to generate new models that best encompass the evidence.

The carbohydrate-insulin model: a physiological perspective on the obesity pandemic