Competing Paradigms of Obesity Pathogenesis
1 AMA PRA Category 1 Credit™
Long-held beliefs about the role of energy balance in weight regulation and obesity may be flawed and lead to treatment failure. Since the 1950s, conventional thinking has held that the cause of obesity is fundamentally the overconsumption of calories — we get fat because we eat too much and move too little. Virtually all research on obesity and its related chronic diseases is predicated on this notion that obesity is an energy balance disorder. Regrettably, treatments based on this logic — eating less and exercising more — have typically failed, suggesting the possibility that this energy balance hypothesis of obesity, simple as it seems, may be misconceived.
In this lecture, Gary Taubes discusses an alternative explanation for obesity and the obesity epidemic. Prior to World War II, European clinical investigators argued obesity was caused by a defect in the regulation of fat tissue metabolism. In this hypothesis, the changes in energy balance that must associate with increases in body fat — increased energy consumption and/or decreased expenditure — are compensatory effects of this hormonal defect that works directly to trap calories as fat in adipocytes. By the 1960s, researchers had demonstrated that fat accumulation is largely regulated by the hormone insulin, which in turn is secreted primarily in response to the carbohydrates in our diet. This insight then led to the hypothesis that obesity is caused by a defect in insulin secretion and signaling, triggered by the carbohydrate content of the diet. While this hypothesis has been associated with allegedly fad diets such as Atkins, South Beach, Protein Power, the Zone, Wheat Belly, Grain Brain, and now paleo and ketogenic diets, a significant and growing body of research literature has supported it.
Gary Taubes is an investigative science and health journalist and co-founder and director of the nonprofit Nutrition Science Initiative. He is the author of The Case Against Sugar (2017), Why We Get Fat and What to Do About It (2011), and Good Calories, Bad Calories (2007).
Taubes is the recipient of a Robert Wood Johnson Foundation Investigator Award in Health Policy Research. He has also won numerous other awards for his journalism, including the International Health Reporting Award from the Pan American Health Organization and the National Association of Science Writers Science in Society Journalism Award(1996, 1999, and 2001).
Taubes graduated from Harvard College in 1977 with an S.B. degree in applied physics and received an M.S. degree in engineering from Stanford University (1978) and in journalism from Columbia University (1981).
- Review the history of the two hypotheses for obesity: the energy balance hypothesis and the hypothesis that obesity is a hormonal/regulatory disorder.history of the hypothesis that obesity is a hormonal/regulatory disorder.
- Evaluate the evidence for these two hypotheses, why this is still a controversy after a century of discussion, and the dietary implications.
- Be able to demonstrate this obtained knowledge in clinical practice by explaining to patients that carbohydrate intake causes an increase in blood glucose, which in turn increases serum insulin, which is the key hormone involved in the storage of fat.
Disclosures relevant to speaker:
Disclosures relevant to speaker:
This activity is not commercially supported.
Mr. Taubes reports no relevant disclosures related to the planning or presentation of this activity.
- Co-founder of the non-profit Nutrition Science Initiative (NuSI.org).
- Author – Publications can be found here.
- Paid content contributor to CrossFit, Inc.