Magkos Faidon
Department of Nutrition, Exercise and Sports, University of Copenhagen, Rolighedsvej 26, 1958, Frederiksberg C, Denmark.
Curr Obes Rep. 2025 Jul 5;14(1):58. doi: 10.1007/s13679-025-00650-y.
Many physiological models have been put forth to explain the pathogenesis of obesity. All causes must eventually act by altering energy intake, energy expenditure, or the metabolic handling of ingested nutrients to favor storage over oxidation. These mechanisms culminate in two apparently competing models-the Energy Balance Model (EBM) and the Carbohydrate Insulin Model (CIM). In the EBM, eating more precedes increased adiposity, whereas in the CIM, increased adiposity precedes eating more.
Epidemiological observations on energy intake and obesity prevalence during the last 50 years have often become the source of controversy between models. Here, I present a hypothesis, which borrows key elements from the EBM and CIM, and offers a framework that traces the root cause of obesity outside of the modern food environment and aligns with historical, 100-year-long trends in metabolic rate, food intake, physical activity, and adiposity. Body weight has been steadily increasing throughout the previous century, in conjunction with reductions in resting metabolic rate. This, superimposed with varying changes in dietary energy intake and physical activity energy expenditure resulted in an accelerated rise in obesity prevalence after the 1970s. Obesity is a multifactorial disease and alterations in the underlying metabolic pathways that synergize to promote net fat deposition in the body have likely been operating for many decades, if not centuries, and involve both food-related and non-food-related factors.
已经提出了许多生理模型来解释肥胖的发病机制。所有病因最终都必须通过改变能量摄入、能量消耗或对摄入营养物质的代谢处理，以促进储存而非氧化。这些机制最终形成了两个明显相互竞争的模型——能量平衡模型（EBM）和碳水化合物胰岛素模型（CIM）。在EBM中，吃得更多先于肥胖增加，而在CIM中，肥胖增加先于吃得更多。
过去50年中关于能量摄入和肥胖患病率的流行病学观察常常成为模型之间争议的来源。在此，我提出一个假说，它借鉴了EBM和CIM的关键要素，并提供了一个框架，该框架追溯了现代食物环境之外肥胖的根本原因，并与代谢率、食物摄入量、身体活动和肥胖的长达100年的历史趋势相一致。在上个世纪，体重一直在稳步增加，同时静息代谢率下降。这与饮食能量摄入和身体活动能量消耗的不同变化叠加在一起，导致20世纪70年代后肥胖患病率加速上升。肥胖是一种多因素疾病，协同促进体内净脂肪沉积的潜在代谢途径的改变可能已经运作了数十年，如果不是数百年的话，并且涉及与食物相关和非食物相关的因素。
