The carbohydrate-insulin model: a physiological perspective on the obesity pandemic.
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.
Ludwig, DS; Aronne, LJ; Astrup, A; de Cabo, R; Cantley, LC; Friedman, MI; Heymsfield, SB; Johnson, JD; King, JC; Krauss, RM; Lieberman, DE; Taubes, G; Volek, JS; Westman, EC; Willett, WC; Yancy, WS; Ebbeling, CB
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