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

Abstract

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.

• Authors: David S Ludwig, Louis J Aronne, Arne Astrup, Rafael de Cabo, Lewis C Cantley, Mark I Friedman, Steven B Heymsfield, James D Johnson, Janet C King, Ronald M Krauss, Daniel E Lieberman, Gary Taubes, Jeff S Volek, Eric C Westman, Walter C Willett, William S Yancy, Cara B Ebbeling
• Journal: The American journal of clinical nutrition (Am J Clin Nutr) Vol. 114 Issue 6 Pg. 1873-1885 (12 01 2021) ISSN: 1938-3207 [Electronic] United States
• PMID: 34515299 (Publication Type: Journal Article, Research Support, N.I.H., Extramural)
• Copyright: © The Author(s) 2021. Published by Oxford University Press on behalf of the American Society for Nutrition.

Chemical References

• Carbohydrates
• Dietary Carbohydrates
• Dietary Fats
• Insulin

Topics

• Carbohydrates
• Dietary Carbohydrates
• Dietary Fats
• Energy Intake (physiology)
• Energy Metabolism (physiology)
• Humans
• Insulin
• Obesity (epidemiology, etiology)
• Pandemics