For a century, this notion of “energy balance” has dominated obesity prevention and treatment, from the original focus on calorie count in the early 1900s, at low fat diet (targeting the most energy-dense nutrient) from the late 1900s, until the recent emphasis on reducing intake of modern processed foods high in fat and sugar.
However, if this theory is correct, it is difficult to square with the facts. After rising for more than three decades, calorie intake in the United States has either stagnated or declined since 2000, concludes a new analysis. But obesity rates have risen by more than a third since then, to a staggering 42 percent of today’s population. This paradox cannot be explained simply by our sedentary lifestyle; in fact, Americans have become somewhat more physically active in the last 20 years.
So what if the focus on calories and energy balance is simply wrong, reversing cause and effect? writing on the European Journal of Clinical Nutrition This week, my co-authors (researchers, doctors, public health experts) and I argue that overeating is not the main cause of obesity. Instead, the process of gaining weight causes us to overeat..
This is a different model of obesity, the carbohydrate-insulin model. This theory lays the blame for rising obesity levels on the fast-digesting, processed carbohydrates that flooded our diets during the low-fat diet craze: white bread, white rice, prepared breakfast cereals, potato and sugary foods. It posits that consuming these carbohydrates raises insulin levels too high and causes other hormonal changes that program our bodies to store extra fat.
Seen this way, obesity is not a problem of overeating, it is a problem of calorie distribution: too many calories from each meal are diverted to adipose tissue and too few are left in the blood to meet the body’s energy needs. Consequently, our brains make us feel hungrier before we eat to make up for those sequestered calories. If we try to ignore hunger and restrict calories, the body conserves energy by slowing down metabolism. In this sense, obesity is a state of starvation in the midst of plenty.
According to this theory, simply cutting calories won’t work in the long run, because it doesn’t address the underlying predisposition to store excess fat driven by hormones and other biological influences. Instead, the focus should be on reducing the rise in blood glucose and insulin after meals with a diet high in fat and low in processed carbohydrates. In this way, adipose tissue can be persuaded to release stored calories, which reduces hunger. Weight loss occurs without the need for caloric restriction, which increases the likelihood of long-term success.
So is the carb-insulin model more correct than energy balance? Unfortunately, we still don’t know for sure. The definitive research needed to resolve this controversy has never been done, in part because alternative paradigms for obesity have not been taken seriously.
Two scholar documents, in addition to this week’s new one, have aimed to build the model of carbohydrates and insulin based on the available scientific evidence. However, there has been more than one dozen documents of critics claiming have refuted the model based on weak evidence, such as small, short-term trials of two weeks or less.
Meanwhile, despite investing in Many important low in fat diet trials (virtually all failed to show any benefit for the main results), the government’s National Institutes of Health has yet to fund a single long-term low-carb trial of similar scope. This has not been a fair contest of ideas.
One of the reasons for this resistance could be cultural. For centuries, obesity has been viewed as a character flaw. Despite decades of research on the genetic and biological influences Regarding body weight, people with obesity continue to be stigmatized, more than those with almost any other chronic disease, as if their weight is their fault.
Energy balance thinking implicitly contributes to these stereotypes by blaming overeating on poor self-control. Despite new versions of energy balance Emphasize the primary reward centers in the brain that drive food intake, however, people with obesity are considered unable to resist tempting foods for conscious or subconscious reasons. However, if the alternative paradigm is correct, then deeply held notions about obesity are simply wrong.
Scientists are supposed to be skeptical. But when variations of the same approach continue to fail, and obesity rates continue to rise, it’s critical that new ideas be encouraged, not suppressed. And with the cost of a single weight-related complication, type 2 diabetes, almost $1 billion per daywe must consider different ways to solve the intractable problem of obesity and open our minds to a radical-sounding notion: overeating is a symptom, not a cause.
