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Heindel JJ, Lustig RH, Howard S, Corkey BE. Obesogens: a unifying theory for the global rise in obesity. Int J Obes (Lond) 2024; 48:449-460. [PMID: 38212644 PMCID: PMC10978495 DOI: 10.1038/s41366-024-01460-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 12/14/2023] [Accepted: 01/02/2024] [Indexed: 01/13/2024]
Abstract
Despite varied treatment, mitigation, and prevention efforts, the global prevalence and severity of obesity continue to worsen. Here we propose a combined model of obesity, a unifying paradigm that links four general models: the energy balance model (EBM), based on calories as the driver of weight gain; the carbohydrate-insulin model (CIM), based on insulin as a driver of energy storage; the oxidation-reduction model (REDOX), based on reactive oxygen species (ROS) as a driver of altered metabolic signaling; and the obesogens model (OBS), which proposes that environmental chemicals interfere with hormonal signaling leading to adiposity. We propose a combined OBS/REDOX model in which environmental chemicals (in air, food, food packaging, and household products) generate false autocrine and endocrine metabolic signals, including ROS, that subvert standard regulatory energy mechanisms, increase basal and stimulated insulin secretion, disrupt energy efficiency, and influence appetite and energy expenditure leading to weight gain. This combined model incorporates the data supporting the EBM and CIM models, thus creating one integrated model that covers significant aspects of all the mechanisms potentially contributing to the obesity pandemic. Importantly, the OBS/REDOX model provides a rationale and approach for future preventative efforts based on environmental chemical exposure reduction.
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Affiliation(s)
- Jerrold J Heindel
- Healthy Environment and Endocrine Disruptor Strategies (HEEDS), Bozeman, MT, 59715, USA.
| | - Robert H Lustig
- Department of Pediatrics and Institute for Health Policy Studies, University of California, San Francisco, CA, 94143, USA
| | - Sarah Howard
- Healthy Environment and Endocrine Disruptor Strategies (HEEDS), Bozeman, MT, 59715, USA
| | - Barbara E Corkey
- Department of Medicine, Boston University, Chobanian and Avedisian School of Medicine, Boston, MA, 02118, USA
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Wan Y, Tobias DK, Dennis KK, Guasch-Ferré M, Sun Q, Rimm EB, Hu FB, Ludwig DS, Devinsky O, Willett WC. Association between changes in carbohydrate intake and long term weight changes: prospective cohort study. BMJ 2023; 382:e073939. [PMID: 37758268 PMCID: PMC10523278 DOI: 10.1136/bmj-2022-073939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/31/2023] [Indexed: 09/30/2023]
Abstract
OBJECTIVE To comprehensively examine the associations between changes in carbohydrate intake and weight change at four year intervals. DESIGN Prospective cohort study. SETTING Nurses' Health Study (1986-2010), Nurses' Health Study II (1991-2015), and Health Professionals Follow-Up Study (1986-2014). PARTICIPANTS 136 432 men and women aged 65 years or younger and free of diabetes, cancer, cardiovascular disease, respiratory disease, neurodegenerative disorders, gastric conditions, chronic kidney disease, and systemic lupus erythematosus before baseline. MAIN OUTCOME MEASURE Weight change within a four year period. RESULTS The final analyses included 46 722 women in the Nurses' Health Study, 67 186 women in the Nurses' Health Study II, and 22 524 men in the Health Professionals Follow-up Study. On average, participants gained 1.5 kg (5th to 95th centile -6.8 to 10.0) every four years, amounting to 8.8 kg on average over 24 years. Among men and women, increases in glycemic index and glycemic load were positively associated with weight gain. For example, a 100 g/day increase in starch or added sugar was associated with 1.5 kg and 0.9 kg greater weight gain over four years, respectively, whereas a 10 g/day increase in fiber was associated with 0.8 kg less weight gain. Increased carbohydrate intake from whole grains (0.4 kg less weight gain per 100 g/day increase), fruit (1.6 kg less weight gain per 100 g/day increase), and non-starchy vegetables (3.0 kg less weight gain per 100 g/day increase) was inversely associated with weight gain, whereas increased intake from refined grains (0.8 kg more weight gain per 100 g/day increase) and starchy vegetables (peas, corn, and potatoes) (2.6 kg more weight gain per 100 g/day increase) was positively associated with weight gain. In substitution analyses, replacing refined grains, starchy vegetables, and sugar sweetened beverages with equal servings of whole grains, fruit, and non-starchy vegetables was associated with less weight gain. The magnitude of these associations was stronger among participants with overweight or obesity compared with those with normal weight (P<0.001 for interaction). Most of these associations were also stronger among women. CONCLUSIONS The findings of this study highlight the potential importance of carbohydrate quality and source for long term weight management, especially for people with excessive body weight. Limiting added sugar, sugar sweetened beverages, refined grains, and starchy vegetables in favor of whole grains, fruit, and non-starchy vegetables may support efforts to control weight.
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Affiliation(s)
- Yi Wan
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Deirdre K Tobias
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Kristine K Dennis
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Marta Guasch-Ferré
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Qi Sun
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Eric B Rimm
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Frank B Hu
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - David S Ludwig
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
- New Balance Foundation Obesity Prevention Center, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Orrin Devinsky
- Department of Neurology, New York University Grossman School of Medicine, New York, NY, USA
| | - Walter C Willett
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Apovian CM, Guo XR, Hawley JA, Karmali S, Loos RJF, Waterlander WE. Approaches to addressing the rise in obesity levels. Nat Rev Endocrinol 2023; 19:76-81. [PMID: 36450930 DOI: 10.1038/s41574-022-00777-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/28/2022] [Indexed: 12/02/2022]
Abstract
Levels of obesity and overweight are increasing globally, with affected individuals often experiencing health issues and reduced quality of life. The pathogenesis of obesity is complex and multifactorial, and effective solutions have been elusive. In this Viewpoint, experts in the fields of medical therapy, adipocyte biology, exercise and muscle, bariatric surgery, genetics, and public health give their perspectives on current and future progress in addressing the rising prevalence of obesity.
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Affiliation(s)
- Caroline M Apovian
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Xi-Rong Guo
- Hongqiao International Institute of Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - John A Hawley
- Exercise & Nutrition Research Program, The Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia.
| | - Shahzeer Karmali
- Division of General Surgery, University of Alberta, Edmonton, Alberta, Canada.
| | - Ruth J F Loos
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, USA.
| | - Wilma E Waterlander
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC Location University of Amsterdam, Amsterdam, Netherlands.
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Competing paradigms of obesity pathogenesis: energy balance versus carbohydrate-insulin models. Eur J Clin Nutr 2022; 76:1209-1221. [PMID: 35896818 PMCID: PMC9436778 DOI: 10.1038/s41430-022-01179-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 06/24/2022] [Accepted: 06/28/2022] [Indexed: 02/07/2023]
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.
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Mozaffarian D. Perspective: Obesity-an unexplained epidemic. Am J Clin Nutr 2022; 115:1445-1450. [PMID: 35460220 PMCID: PMC9170462 DOI: 10.1093/ajcn/nqac075] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 03/24/2022] [Indexed: 12/11/2022] Open
Abstract
Since 1980, obesity prevalence among US adults has soared from 14% to 42%. The commonly accepted explanation is pervasive overeating: ever-increasing energy intake as the population gains weight, year after year. However, evidence does not support this hypothesis. National data on energy intake and energy availability show increases between 1961 and 2000, during modern industrialization of food; but a plateau or declines thereafter-even as obesity continued rising-and while physical activity modestly increased. Thus, Americans appear to be eating relatively less since 2000, for ever-increasing body sizes, as time has progressed. Although both energy intake and energy availability are measured with error, such errors would have to be new since 2000 and systematically increasing over time for these 2 separate, independent measures. Given the tremendous societal consequences of obesity, and failure to date of energy balance-focused interventions to stem the tide, it is critical for the scientific community to consider and test alternative hypotheses. Growing evidence suggests complex, interrelated biological interactions between food processing (including acellular nutrients, depleted prebiotics, additives), gut microbial composition and function, host metabolic expenditure, and intergenerational transmission of risk (including epigenetics, noncoding RNAs, microbial species). In this paradigm, whereas increasing energy intake may have contributed to rising obesity in earlier years, today pervasive adiposity and its physiologic adaptations have created a biological milieu which interacts with industrialized foods to promote escalating obesity, even with stable energy intake-a self-sustaining, difficult-to-reverse cycle. These scientific hypotheses must be rigorously evaluated, because even partial confirmation would dramatically shift and expand current prevention and treatment strategies. Urgent new investment in research is required. Simultaneously, uncertain evidence on the obesity epidemic's primary drivers does not mean there is no evidence on actions that can help, and existing science must be more rapidly translated and refined into clinical, public health, and policy interventions.
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