The energy balance model of obesity: beyond calories in, calories out

Research output: Contribution to journalJournal articlepeer-review

  • Kevin D. Hall
  • I. Sadaf Farooqi
  • Jeffery M. Friedman
  • Samuel Klein
  • Loos, Ruth
  • David J. Mangelsdorf
  • Stephen O'Rahilly
  • Eric Ravussin
  • Leanne M. Redman
  • Donna H. Ryan
  • John R. Speakman
  • Deirdre K. Tobias

A recent Perspective article described the "carbohydrate-insulin model (CIM)" of obesity, asserting that it "better reflects knowledge on the biology of weight control" as compared with what was described as the "dominant energy balance model (EBM)," which fails to consider "biological mechanisms that promote weight gain." Unfortunately, the Perspective conflated and confused the principle of energy balance, a law of physics that is agnostic as to obesity mechanisms, with the EBM as a theoretical model of obesity that is firmly based on biology. In doing so, the authors presented a false choice between the CIM and a caricature of the EBM that does not reflect modern obesity science. Here, we present a more accurate description of the EBM where the brain is the primary organ responsible for body weight regulation operating mainly below our conscious awareness via complex endocrine, metabolic, and nervous system signals to control food intake in response to the body's dynamic energy needs as well as environmental influences. We also describe the recent history of the CIM and show how the latest "most comprehensive formulation" abandons a formerly central feature that required fat accumulation in adipose tissue to be the primary driver of positive energy balance. As such, the new CIM can be considered a special case of the more comprehensive EBM but with a narrower focus on diets high in glycemic load as the primary factor responsible for common obesity. We review data from a wide variety of studies that address the validity of each model and demonstrate that the EBM is a more robust theory of obesity than the CIM.

Original languageEnglish
Book seriesAmerican Journal of Clinical Nutrition
Volume115
Issue number5
Pages (from-to)1243-1254
Number of pages12
ISSN0002-9165
DOIs
Publication statusPublished - 2022

Bibliographical note

Publisher Copyright:
Published by Oxford University Press on behalf of the American Society for Nutrition 2022.

    Research areas

  • carbohydrates, energy balance, food intake, insulin, obesity

ID: 307099793