Dear Editor:
As co-authors of an Endocrine Society Scientific Statement on Obesity Pathogenesis published in 2017 (1), we write to point out that the recent American Journal of Clinical Nutrition (AJCN) Perspectives article by Ludwig and colleagues (2) contains several misleading and factually incorrect statements.
Having created the historical dichotomy that there have been only 2 major competing models for understanding obesity pathogenesis—the carbohydrate-insulin model (CIM) and the energy balance model (EBM)—the authors proceed to emphasize that the EBM offers no insight into obesity pathogenesis beyond the requirement that more calories need to be consumed than expended. In mischaracterizing the Endocrine Society's Scientific Statement, Ludwig et al. ignore its main thrust, which views obesity as a complex disorder of energy homeostasis that is characterized by the biological defense of elevated body fat mass in our obesogenic environment. A large literature now exists not only in support of this concept but in the identification of underlying mechanisms; none of this work is acknowledged. By sidestepping this crucial and well-developed aspect of obesity pathogenesis, Ludwig et al. provide a selective and one-sided view of the issue.
This AJCN Perspective is, unfortunately, not the scholarly comparison of 2 leading models of obesity pathogenesis it purports to be. It is also unfortunate that press releases quoting this article are claiming falsely that “overeating is not the primary cause of obesity” and that “obesity is not a disorder of energy balance” (https://news.sky.com/story/amp/overeating-not-the-primary-cause-of-obesity-claim-scientists-12406990; https://nutrition.org/scientists-claim-that-overeating-is-not-the-primary-cause-of-obesity/). Readers of the Journal should be fully aware of these facts.
Acknowledgments
Support: LMR (NIH grants R01DK124806, R01NR017644, U01AG073204, 1T32DK064584, and NORC P30DK072476); LMZ (NIH grantsMH113353, DK125094, AG032959, the Russell Berrie Foundation, and the Klarman Family Foundation); RJS (NIH grantsDK089503 and DK117821); MWS (NIH grantsDK83042, DK035816, DK124238, DoD W81XWH2110635, and Novo Nordisk); RLL [NIH grantsDK52431, DK26687 (NORC), DK11862 (RADIANT), ug3DK128302, LEVO Therapeutics, the Russell Berrie Foundation].
MWS: research support provided by Novo Nordisk A/S. RJS: Consultant/SAB: Novo Nordisk, Scohia, Fractyl, and ShouTi Pharma; research support: Novo Nordisk and Astra Zeneca; Equity: Calibrate and Rewind. AD is the developer of the Nutrient Rich Food (NRF) index and has received grants, contracts, and honoraria from entities, both public and private, with an interest in nutrient profiling and assessing nutrient density of foods. The other authors report no conflicts of interest.
Contributor Information
Adam Drewnowski, From the Center for Public Health Nutrition, University of Washington, Seattle, WA, USA.
Rudolph L Leibel, Naomi Berrie Diabetes Center and Department of Pathology and Cell Biology, Columbia University, New York, NY, USA; Division of Molecular Genetics, Department of Pediatrics, Columbia University, New York, NY, USA.
Eric Ravussin, John S McIlhenny Skeletal Muscle Physiology Laboratory, Pennington Biomedical Research Center, Baton Rouge, LA, USA.
Leanne M Redman, John S McIlhenny Skeletal Muscle Physiology Laboratory, Pennington Biomedical Research Center, Baton Rouge, LA, USA.
Michael W Schwartz, Diabetes Institute, University of Washington, Seattle, WA, USA.
Randy J Seeley, Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
Lori M Zeltser, Naomi Berrie Diabetes Center and Department of Pathology and Cell Biology, Columbia University, New York, NY, USA.
References
- 1. Schwartz MW, Seeley RJ, Zeltser LM, Drewnowski A, Ravussin E, Redman LM, Leibel RL. Obesity pathogenesis: an Endocrine Society Scientific Statement. Endocr Rev. 2017;38(4):267–96. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2. Ludwig DS, Aronne LJ, Astrup A, de Cabo R, Cantley LC, Friedman MI, Heymsfield SB, Johnson JD, King JC, Krauss RMet al. The carbohydrate-insulin model: a physiological perspective on the obesity pandemic. Am J Clin Nutr. 2021;114(6):1873–85. [DOI] [PMC free article] [PubMed] [Google Scholar]