![]() Any useful biological hypothesis of obesity pathogenesis must consider causal direction, and the law of energy conservation allows more than one possibility.īoth models of obesity share a common feature: presumed homeostatic regulation of a critical physiological parameter to promote optimal functioning. Clearly, fever can only develop in the presence of a positive “heat balance,” but patients with fever don’t require instruction in this self-evident concept and academic reviews of febrile illness don’t dwell on the physics of heat. A gain in body energy stores-fat mass, for practical purposes-necessarily constitutes a positive energy balance explaining the former by the latter is tautological. ![]() However, these reiterations of the first law of thermodynamics conflate physics with pathophysiology. A scientific statement from the Endocrine Society concludes that “Obesity pathogenesis involves … sustained positive energy balance (energy intake > energy expenditure)” and an expert panel report from major professional health associations asserts, “To achieve weight loss, an energy deficit is required”. Textbooks, public health guidelines and patient education materials characteristically conceptualize obesity as a disorder of energy balance. Nevertheless, public health action need not await resolution of this debate, as both models target processed carbohydrates as major drivers of obesity. Rectifying these deficiencies should assume priority, as a constructive paradigm clash is needed to resolve long-standing scientific controversies and inform the design of new models to guide prevention and treatment. Here, we highlight robust contrasts in how the EBM and CIM view obesity pathophysiology and consider deficiencies in the EBM that impede paradigm testing and refinement. Thus, increasing adiposity causes overeating to compensate for the sequestered calories. An alternative view, the carbohydrate-insulin model (CIM), proposes that hormonal responses to highly processed carbohydrates shift energy partitioning toward deposition in adipose tissue, leaving fewer calories available for the body’s metabolic needs. This model attributes rising obesity prevalence to inexpensive, convenient, energy-dense, “ultra-processed” foods high in fat and sugar. A new formulation of the energy balance model (EBM), like prior versions, considers overeating (energy intake > expenditure) the primary cause of obesity, incorporating an emphasis on “complex endocrine, metabolic, and nervous system signals” that control food intake below conscious level. Another possibility is that this approach rests on an erroneous paradigm. One explanation for this failure is that the current approach, based on the notion of energy balance, has not been adequately embraced by the public. Department of Health & Human Services has also launched "Move Your Way," encouraging Americans to start moving, adding that any amount is better than none.The obesity pandemic continues unabated despite a persistent public health campaign to decrease energy intake (“eat less”) and increase energy expenditure (“move more”). has launched national efforts such as the CDC's "Active People, Healthy Nation," with a goal of helping 27 million Americans become more physically active by 2027. ![]() ![]() Meanwhile, physical activity has several health benefits such as improving sleep, cognition and bone and musculoskeletal health while reducing the risk of dementia, according to the CDC. Researchers say the findings are concerning because not getting enough physical training can lead to several diseases that increase the risk of death including obesity, heart disease, type 2 diabetes and cancer. These adults were also most likely to meet individual guidelines with 50% for aerobic and 35.2% for muscle-training.Īdults in rural areas were the least likely with 16.2% meeting both, 38.2% meeting aerobic and 21.1% meeting muscle-strengthening. When it came to seeing who was meeting guidelines by urban-rural classification, adults in large central metros - such as New York City, Chicago and Miami - were the most likely to meet both guidelines at 27.8%. ![]()
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