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Obesity is a complex, multifactorial disease influenced by genetic, molecular, environmental, and behavioral factors. Characterized as having excessive body fat, obesity affects more than 650 million people worldwide and markedly increases a person’s risk for many chronic diseases, including cardiovascular disease, type 2 diabetes, cancer, and depression, among others. The authors of a recent report challenge the prevailing theory regarding the root causes of obesity.

A widely espoused concept in bodyweight management is the “eat less, exercise more” model, based on the principle that the number of calories consumed must be equivalent to (or less than) the number of calories expended. This model is supported by evidence suggesting that consuming high-fat foods drives overconsumption of calories due the foods' high caloric levels, poor ability to provide satisfaction and fullness, and high “pleasure factor.” However, this concept, which forms the basis for national dietary guidelines, public health messaging, and dietary counseling, is inherently flawed, because it fails to take into consideration the biological mechanisms that promote weight gain. Ultimately it places blame on people with obesity and promotes stigmatization.

In recent decades, scientists have proposed a new model for explaining the root causes of obesity. In this model, body fat accumulation arises from hormonal responses to the consumption of high-glycemic load carbohydrates, ultimately driving a vicious cycle of body fat accumulation, hunger, and food intake. Commonly referred to as the “carbohydrate-insulin” model of obesity, this new paradigm reverses causation and provides a starting point for developing testable hypotheses.

The concepts presented in this report suggest that what a person eats, rather than how much, plays key roles in body weight management. The authors of the report posited that if the carbohydrate-insulin model is accurate, dietary modifications that limit carbohydrate intake, such as a ketogenic diet, may alter hormonal responses and promote fat oxidation and weight loss. Learn more about the health benefits of the ketogenic diet in this clip featuring Dr. Dominic D'Agostino.

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