Evidence map›Paper›PMID 35896818›Full record

ReviewEuropean journal of clinical nutrition2022

Competing paradigms of obesity pathogenesis: energy balance versus carbohydrate-insulin models.

David S Ludwig, Caroline M Apovian, Louis J Aronne, Arne Astrup, Lewis C Cantley, Cara B Ebbeling, Steven B Heymsfield, James D Johnson, Janet C King, Ronald M Krauss and 6 more

Open access · hybridAbstract readReview
PubMed Full text at PMC Publisher
In one paragraph

Review in European journal of clinical nutrition, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 61 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
61citing papers in PubMed, 2 pooled it
10.6field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

61 citing papers in PubMed, 2 syntheses or guidelines pooled it, 95 citations in OpenAlex.

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1 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

16 authors at 13 institutions in 3 countries.

David S LudwigNew Balance Foundation Obesity Prevention Center, Boston Children's Hospital, Boston, MA, USA. david.ludwig@childrens.harvard.edu.ORCID http://orcid.org/0000-0003-3307-8544
Caroline M ApovianDivision of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Louis J AronneDepartment Comprehensive Weight Control Center, Weill Cornell Medicine, New York, NY, USA.
Arne AstrupObesity and Nutrition Science, the Novo Nordisk Foundation, Hellerup, Denmark.ORCID http://orcid.org/0000-0001-8968-8996
Lewis C CantleyDepartment of Medicine, Weill Cornell Medicine, New York, NY, USA.
Cara B EbbelingNew Balance Foundation Obesity Prevention Center, Boston Children's Hospital, Boston, MA, USA.
Steven B HeymsfieldMetabolism & Body Composition Laboratory, Pennington Biomedical Research Center, Baton Rouge, LA, USA.ORCID http://orcid.org/0000-0003-1127-9425
James D JohnsonLife Sciences Institute, University of British Columbia, Vancouver, BC, Canada.
Janet C KingDepartment of Nutritional Sciences & Toxicology, UC Berkeley, Berkeley, CA, USA.
Ronald M KraussDepartments of Pediatrics and Medicine, UC San Francisco, San Francisco, CA, USA.
Gary TaubesIndependent journalist, Oakland, CA, USA.
Jeff S VolekDepartment of Human Sciences, Ohio State University, Columbus, OH, USA.
Eric C WestmanDepartment of Medicine, Duke University School of Medicine, Durham, NC, USA.
Walter C WillettDepartment of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
William S YancyDepartment of Medicine, Duke University School of Medicine, Durham, NC, USA.
Mark I FriedmanMonell Chemical Senses Center, Philadelphia, PA, USA.
Boston Children's Hospital · USCornell University · USDuke University · USBrigham and Women's Hospital · USFilm Independent · USHarvard University · USMonell Chemical Senses Center · USNovo Nordisk Foundation · DKPennington Biomedical Research Center · USThe Ohio State University · USUniversity of British Columbia · CAUniversity of California, Berkeley · USUniversity of California, San Francisco · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

The obesity pandemic continues unabated despite a persistent public health campaign to decrease energy intake ("eat less") and increase energy expenditure ("move more"). One explanation for this failure is that the current approach, based on the notion of energy balance, has not been adequately embraced by the public. Another possibility is that this approach rests on an erroneous paradigm. A new formulation of the energy balance model (EBM), like prior versions, considers overeating (energy intake > expenditure) the primary cause of obesity, incorporating an emphasis on "complex endocrine, metabolic, and nervous system signals" that control food intake below conscious level. This model attributes rising obesity prevalence to inexpensive, convenient, energy-dense, "ultra-processed" foods high in fat and sugar. An alternative view, the carbohydrate-insulin model (CIM), proposes that hormonal responses to highly processed carbohydrates shift energy partitioning toward deposition in adipose tissue, leaving fewer calories available for the body's metabolic needs. Thus, increasing adiposity causes overeating to compensate for the sequestered calories. Here, we highlight robust contrasts in how the EBM and CIM view obesity pathophysiology and consider deficiencies in the EBM that impede paradigm testing and refinement. Rectifying these deficiencies should assume priority, as a constructive paradigm clash is needed to resolve long-standing scientific controversies and inform the design of new models to guide prevention and treatment. Nevertheless, public health action need not await resolution of this debate, as both models target processed carbohydrates as major drivers of obesity.

Indexed as

Dietary CarbohydratesInsulinEnergy IntakeEnergy MetabolismHumansHyperphagiaObesityDietary CarbohydratesInsulin

Identifiers

PMID35896818
PMCPMC9436778
OpenAlexW4288057989

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.