![]() This endocrine (hormonal) or constitutional concept may have been best phrased not by a scientist or physician but by playwright George Bernard Shaw in his 1910 work “Misalliance.” “It’s constitutional,” says the character John Tarleton. “The medical profession in general believes that there are two kinds of obese persons,” is how Louis Newburgh of the University of Michigan described this schism in 1930 in the first of two papers in which he claimed to have settled the issue, “those who have become fat because they overeat or under-exercise and those composing a second group whose adiposity is not closely related to diet, but is caused by an endocrine or constitutional disorder.” A group of women perform “slimming exercises” in 1933 Douglas Miller/Topical Press Agency/Getty ImagesĪ century ago, the general thinking on obesity still allowed for two equally commonsensical ways to conceive of the pathology of the disorder. ![]() Its implications are simple and profound: People don’t get fat because they eat too much, consuming more calories than they expend, but because the carbohydrates in their diets - both the quantity of carbohydrates and their quality - establish a hormonal milieu that fosters the accumulation of excess fat.ĭespite the unorthodoxy of this thinking, it is an easy case to make by studying the history of obesity research, as I’ve had to do as a journalist investigating the institutional failure to rein in the obesity/diabetes epidemic. Because these hormonal responses are dominated by the insulin signaling system, which in turn responds primarily (although not entirely) to the carbohydrate content of the diet, this thinking is now known as the carbohydrate-insulin model. This energy-in-energy-out conception of weight regulation, we argue, is fatally, tragically flawed: Obesity is not an energy balance disorder, but a hormonal or constitutional disorder, a dysregulation of fat storage and metabolism, a disorder of fuel-partitioning. We argue that the reason so little progress has been made against obesity and type 2 diabetes is because the field has been laboring, quite literally, in the sense intended by philosopher of science Thomas Kuhn, under the wrong paradigm. ![]() The principal author is David Ludwig, a professor of pediatrics at Harvard Medical School and of nutrition at the Harvard T.H. ![]() This is why I am now a co-author, along with 16 influential academic researchers, of a lengthy review the American Journal of Clinical Nutrition is publishing on Sept. The failure to make meaningful progress either treating or preventing obesity cannot be ignored. Those assessments were made prior to the appearance of Covid-19, for which obesity and diabetes are second only to advanced age in elevating the likelihood of bad outcomes. The twin epidemics of obesity and diabetes have become a public health crisis, one the director of the World Health Organization has called a slow-motion disaster and the World Bank has called a ticking time bomb. Virtually all obesity research is interpreted in the context of this balance principle all related public health discussions, not just on obesity but on all the common chronic diseases that associate with it, as well as the very nature of a healthy diet, rely fundamentally on its implications. This is the central dogma of obesity science. By this ubiquitous thinking, obesity is an energy balance disorder: People get fat because they take in more calories than they expend. But watching researchers in the field of obesity almost blindly follow a failed paradigm has led me to cross a line that few journalists ever do, to publicly embrace and promote a minority opinion that many in the obesity field think is quackery.įor nearly a century, obesity research has been predicated on the belief that the cause of the disorder “is an energy imbalance between calories consumed and calories expended,” to quote the World Health Organization. I’ve wanted to assume that the experts I interview can be trusted to understand their subjects. I’ve been a science reporter for 40 years. Exclusive analysis of biotech, pharma, and the life sciences Learn More ![]()
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