TY - JOUR

T1 - The carbohydrate-insulin model: a physiological perspective on the obesity pandemic

AU - Ludwig, David S

AU - Aronne, Louis J

AU - Astrup, Arne

AU - de Cabo, Rafael

AU - Cantley, Lewis C

AU - Friedman, Mark I

AU - Heymsfield, Steven B

AU - Johnson, James D

AU - King, Janet C

AU - Krauss, Ronald M

AU - Lieberman, Daniel E

AU - Taubes, Gary

AU - Volek, Jeff S

AU - Westman, Eric C

AU - Willett, Walter C

AU - Yancy, William S

AU - Ebbeling, Cara B

N1 - © The Author(s) 2021. Published by Oxford University Press on behalf of the American Society for Nutrition.

PY - 2021

Y1 - 2021

N2 - 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.

AB - 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.

KW - Faculty of Science

KW - Obesity

KW - Weight loss

KW - Dietary carbohydrate

KW - Energy balance

KW - Macronutrients

KW - Endocrinology

KW - Insulin

KW - Glucagon

KW - Incretins

KW - Scholarly discourse

U2 - 10.1093/ajcn/nqab270

DO - 10.1093/ajcn/nqab270

M3 - Journal article

C2 - 34515299

VL - 114

SP - 1873

EP - 1885

JO - American Journal of Clinical Nutrition

JF - American Journal of Clinical Nutrition

SN - 0002-9165

IS - 6

ER -