Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Review
  • Published:

Malnutrition and obesity

Obesity as malnutrition: the dimensions beyond energy balance

European Journal of Clinical Nutrition volume 67, pages 507–512 (2013)Cite this article

Subjects

Abstract

The aetiology of obesity is seemingly simple to understand: individuals consume more energy than they expend, with the excess energy being stored in adipose tissue. Public health campaigns therefore promote dietary restraint and physical exercise, and emphasize individual responsibility for these behaviours. Increasingly, however, researchers are switching from thermodynamic to metabolic models of obesity, thereby clarifying how specific environmental factors promote lipogenesis. Obesity can best be explained not by counting ‘calories in and out’, but by understanding how specific dietary products and activity behaviours perturb cellular metabolism and promote net lipogenesis. This metabolic approach can furthermore be integrated with more sophisticated models of how commercial practices drive the consumer trends that promote obesogenic behaviours. Notably, obesity treatment has proven more effective if it bypasses individual responsibility, suggesting that a similar approach placing less emphasis on individual responsibility would improve the efficacy of obesity prevention. Successful obesity prevention campaigns are likely to emerge only when the public receive better ‘protection’ from the commercial practices that are driving the global obesity epidemic. Rather than populations failing to heed governments’ public health advice, governments are currently failing the public by abandoning their responsibility for regulating commercial activities.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2
Figure 3

Similar content being viewed by others

References

  1. Hess GH . The evolution of heat in multiple proportions. Poggendorf Ann Chemie Physik 1838; 47: 210–212.

    Google Scholar 

  2. von Helmholtz H . Uber Die Warmeenwicklung Bei Der Muskelaction. G Reiner: Berlin, Germany, 1847.

    Google Scholar 

  3. Prentice AM, Jebb SA . Obesity in Britain: gluttony or sloth? BMJ 1995; 311: 437–439.

    Article  CAS  Google Scholar 

  4. Blundell JE, Lawton CL, Cotton JR, Macdiarmid JI . Control of human appetite: implications for the intake of dietary fat. Annu Rev Nutr 1996; 16: 285–319.

    Article  CAS  Google Scholar 

  5. Prentice AM, Jebb SA . Fast foods, energy density and obesity: a possible mechanistic link. Obes Rev 2003; 4: 187–194.

    Article  CAS  Google Scholar 

  6. Woods SC, D’Alessio DA . Central control of body weight and appetite. J Clin Endocrinol Metab 2008; 93 (11 Suppl 1), S37–S50.

    Article  CAS  Google Scholar 

  7. Ferro-Luzzi A, Martino L . Obesity and physical activity. Ciba Found Symp 1996; 201: 207–221. discussion 221–207.

    CAS  PubMed  Google Scholar 

  8. Bar-Or O, Foreyt J, Bouchard C, Brownell KD, Dietz WH, Ravussin E et al. Physical activity, genetic, and nutritional considera- tions in childhood weight management. Med Sci Sports Exerc 1998; 30: 2–10.

    Article  CAS  Google Scholar 

  9. Goran MI, Treuth MS . Energy expenditure, physical activity, and obesity in children. Pediatr Clin North Am 2001; 48: 931–953.

    Article  CAS  Google Scholar 

  10. Lustig RH . Childhood obesity: behavioral aberration or biochemical drive? Reinterpreting the First Law of Thermodynamics. Nat Clin Pract Endocrinol Metab 2006; 2: 447–458.

    Article  CAS  Google Scholar 

  11. Taubes G . The Diet Delusion. Vermillion: London, UK, 2008.

    Book  Google Scholar 

  12. Wells JC, Siervo M . Obesity and energy balance: is the tail wagging the dog? Eur J Clin Nutr 2011; 65: 1173–1189.

    Article  CAS  Google Scholar 

  13. Hall KD, Sacks G, Chandramohan D, Chow CC, Wang YC, Gortmaker SL et al. Quantification of the effect of energy imbalance on bodyweight. Lancet 2011; 378: 826–837.

    Article  Google Scholar 

  14. Lustig RH . Which comes first? The obesity or the insulin? The behavior or the biochemistry? J Pediatr 2008; 152: 601–602.

    Article  Google Scholar 

  15. Hoffman DJ, Sawaya AL, Verreschi I, Tucker KL, Roberts SB . Why are nutritionally stunted children at increased risk of obesity? Studies of metabolic rate and fat oxidation in shantytown children from Sao Paulo, Brazil. Am J Clin Nutr 2000; 72: 702–707.

    Article  CAS  Google Scholar 

  16. Spiegel K, Tasali E, Penev P, Van CE . Brief communication: sleep curtailment in healthy young men is associated with decreased leptin levels, elevated ghrelin levels, and increased hunger and appetite. Ann Intern Med 2004; 141: 846–850.

    Article  Google Scholar 

  17. Astrup A . The role of dietary fat in the prevention and treatment of obesity. Efficacy and safety of low-fat diets. Int J Obes 2001; 25 (Suppl 1), S46–S50.

    Article  CAS  Google Scholar 

  18. Bell SJ, Sears B . Low-glycemic diets: impact on obesity and chronic diseases. Crit Rev Food Sci Nutr 2003; 43: 357–377.

    Article  Google Scholar 

  19. Stanhope KL, Schwarz JM, Keim NL, Griffen SC, Bremer AA, Graham JL et al. Consuming fructose-sweetened, not glucose- sweetened, beverages increases visceral adiposity and lipids and decreases insulin sensitivity in overweight/obese humans. J Clin Invest 2009; 119: 1322–1334.

    Article  CAS  Google Scholar 

  20. Bray GA, Nielsen SJ, Popkin BM . Consumption of high- fructose corn syrup in beverages may play a role in the epidemic of obesity. Am J Clin Nutr 2004; 79: 537–543.

    Article  CAS  Google Scholar 

  21. Bremer AA, Mietus-Snyder M, Lustig RH . Toward a unifying hypothesis of metabolic syndrome. Pediatrics 2012; 129: 557–570.

    Article  Google Scholar 

  22. Maersk M, Belza A, Stodkilde-Jorgensen H, Ringgaard S, Chabanova E, Thomsen H et al. Sucrose-sweetened beverages increase fat storage in the liver, muscle, and visceral fat depot: a 6-mo randomized intervention study. Am J Clin Nutr 2012; 95: 283–289.

    Article  CAS  Google Scholar 

  23. James J, Thomas P, Cavan D, Kerr D . Preventing childhood obesity by reducing consumption of carbonated drinks: cluster randomised controlled trial. BMJ 2004; 328: 1237.

    Article  Google Scholar 

  24. Ebbeling CB, Swain JF, Feldman HA, Wong WW, Hachey DL, Garcia-Lago E et al. Effects of dietary composition on energy expenditure during weight-loss maintenance. JAMA 2012; 307: 2627–2634.

    Article  CAS  Google Scholar 

  25. Hopkins M, King NA, Blundell JE . Acute and long-term effects of exercise on appetite control: is there any benefit for weight control? Curr Opin Clin Nutr Metab Care 2010; 13: 635–640.

    Article  Google Scholar 

  26. Cappuccio FP, Taggart FM, Kandala NB, Currie A, Peile E, Stranges S et al. Meta-analysis of short sleep duration and obesity in children and adults. Sleep 2008; 31: 619–626.

    Article  Google Scholar 

  27. Taheri S, Lin L, Austin D, Young T, Mignot E . Short sleep duration is associated with reduced leptin, elevated ghrelin, and increased body mass index. PLoS Med 2004; 1: e62.

    Article  Google Scholar 

  28. Chaput JP, Visby T, Nyby S, Klingenberg L, Gregersen NT, Tremblay A et al. Video game playing increases food intake in adolescents: a randomized crossover study. Am J Clin Nutr 2011; 93: 1196–1203.

    Article  CAS  Google Scholar 

  29. Mellecker RR, Lanningham-Foster L, Levine JA, McManus AM . Energy intake during activity enhanced video game play. Appetite 2010; 55: 343–347.

    Article  Google Scholar 

  30. Coupe B, Grit I, Darmaun D, Parnet P . The timing of ‘catch-up growth’ affects metabolism and appetite regulation in male rats born with intrauterine growth restriction. Am J Physiol Regul Integr Comp Physiol 2009; 297: R813–R824.

    Article  CAS  Google Scholar 

  31. Muhlhausler BS, Duffield JA, Ozanne SE, Pilgrim C, Turner N, Morrison JL et al. The transition from fetal growth restriction to accelerated postnatal growth: a potential role for insulin signalling in skeletal muscle. J Physiol 2009; 587 (Pt 17), 4199–4211.

    Article  CAS  Google Scholar 

  32. Said-Mohamed R, Bernard JY, Ndzana AC, Pasquet P . Is overweight in stunted preschool children in Cameroon related to reductions in fat oxidation, resting energy expenditure and physical activity? PLoS One 2012; 7: e39007.

    Article  CAS  Google Scholar 

  33. Wells JC . Obesity as malnutrition: the role of capitalism in the obesity global epidemic. Am J Hum Biol 2012; 24: 261–276.

    Article  Google Scholar 

  34. Lustig RH . The ‘skinny’ on childhood obesity: how our western environment starves kid’s brains. Pediatr Ann 2006; 35: 898–897.

    PubMed  Google Scholar 

  35. Popkin BM . The nutrition transition in the developing world. Dev Policy Rev 2003; 21: 581–597.

    Article  Google Scholar 

  36. Popkin BM . The world is fat. Sci Am 2007; 297: 88–95.

    Article  Google Scholar 

  37. Misra A, Khurana L . Obesity and the metabolic syndrome in developing countries. J Clin Endocrinol Metab 2008; 93 (11 Suppl 1), S9–30.

    Article  CAS  Google Scholar 

  38. Jones-Smith JC, Gordon-Larsen P, Siddiqi A, Popkin BM . Is the burden of overweight shifting to the poor across the globe? Time trends among women in 39 low- and middle-income countries (1991–2008). Int J Obes 2012; 36: 1114–1120.

    Article  CAS  Google Scholar 

  39. Ezzati M, Vander Hoorn S, Lawes CM, Leaach R, James WP, Lopez AD et al. Rethinking the ‘diseases of affluence’ paradigm: global patterns of nutritional risks in relation to economic development. PLoS Med 2005; 2: e133.

    Article  Google Scholar 

  40. Monteiro CA, Moura EC, Conde WL, Popkin BM . Socioeconomic status and obesity in adult populations of developing countries: a review. Bull World Health Organ 2004; 82: 940–946.

    PubMed  Google Scholar 

  41. Monteiro CA, Conde WL, Lu B, Popkin BM . Obesity and inequities in health in the developing world. Int J Obes 2004; 28: 1181–1186.

    Article  CAS  Google Scholar 

  42. Wells JC, Marphatia AA, Cole TJ, McCoy D . Associations of economic and gender inequality with global obesity prevalence: understanding the female excess. Soc Sci Med 2012; 75: 482–490.

    Article  Google Scholar 

  43. Nestle M . Food Politics: How the Food Industry Influences Nutrition and Health. University of California Press: Berkeley, CA, USA, 2007.

    Google Scholar 

  44. Baudrillard J . The Consumer Society: Myths and Structures. Sage Publications: Los Angeles, CA, USA, 1970/1998.

    Google Scholar 

  45. Mintz SW . Sweetness and Power: The Place of Sugar in Modern History. Viking Penguin Inc.: New York, NY, USA, 1985.

    Google Scholar 

  46. Zurawicki L . Neuromarketing: Exploring the Brain of the Consumer. Springer-Verlag: Heidelberg, Germany, 2010.

    Book  Google Scholar 

  47. Berthoud HR . The neurobiology of food intake in an obesogenic environment. Proc Nutr Soc 2012; 71: 478–487.

    Article  Google Scholar 

  48. Keast RS, Sayompark D, Sacks G, Swinburn BA, Riddell LJ . The influence of caffeine on energy content of sugar-sweetened beverages: ‘the caffeine-calorie effect’. Eur J Clin Nutr 2012; 65: 1338–1344.

    Article  Google Scholar 

  49. Garber AK, Lustig RH . Is fast food addictive? Curr Drug Abuse Rev 2011; 4: 146–162.

    Article  CAS  Google Scholar 

  50. Wells JC . The Evolutionary Biology of Human Body Fatness. Cambridge University Press: Cambridge, UK, 2010.

    Google Scholar 

  51. Doak C, Monteiro C, Adai LS, Bentley ME, Popkin BM . Coexisting overweight and underweight within households is related to the nutrition transition. FASEB J 2000; 14: A792.

    Google Scholar 

  52. Doak CM, Adair LS, Bentley M, Monteiro C, Popkin BM . The dual burden household and the nutrition transition paradox. Int J Obes 2005; 29: 129–136.

    Article  CAS  Google Scholar 

  53. Stuckler D, McKee M, Ebrahim S, Basu S . Manufacturing epidemics: the role of global producers in increased consumption of unhealthy commodities including processed foods, alcohol, and tobacco. PLoS Med 2012; 9: e1001235.

    Article  Google Scholar 

  54. Basu S, Stuckler D, McKee M, Galea G . Nutritional determinants of worldwide diabetes: an econometric study of food markets and diabetes prevalence in 173 countries. Public Health Nutr 2012; 13: 1–8.

    Google Scholar 

  55. Grijalva-Eternod CS, Wells JC, Cortina-Borja M, Salse-Ubach N, Tondeur MC, Dolan C et al. The emerging challenge of obesity and the double burden of malnutrition in a protracted emergency setting: a cross-sectional study of western Sahara refugees. PLoS Med 2012; 9: e1001320.

    Article  Google Scholar 

  56. Buchwald H, Estok R, Fahrbach K, Banel D, Jensen MD, Pories WJ et al. Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Am J Med 2009; 122: 248–256.

    Article  Google Scholar 

  57. Wilding J . Clinical evaluation of anti-obesity drugs. Curr Drug Targets 2004; 5: 325–332.

    Article  CAS  Google Scholar 

  58. Rodgers RJ, Tschöp MH . Wilding JPH. Anti-obesity drugs: past, present and future. Dis Model Mech 2012; 5: 621–626.

    Article  CAS  Google Scholar 

  59. World Bank. World Development Indicators. World Bank: Washington, DC, USA, 2011.

  60. Prentice AM, Black AE, Coward WA, Cole TJ . Energy expenditure in overweight and obese adults in affluent societies: an analysis of 319 doubly-labelled water measurements. Eur J Clin Nutr 1996; 50: 93–97.

    CAS  PubMed  Google Scholar 

  61. Chaput JP, Klingenberg L, Rosenkilde M, Gilbert JA, Tremblay A, Sjödin A . Physical activity plays an important role in body weight regulation. J Obes 2011;, 2011: pii: 360257.

  62. Tomiyama A, Schamarek I, Lustig RH, Kirschbaum C, Puterman E, Havel PJ et al. Leptin concentrations in response to acute stress predict subsequent intake of comfort foods. Physiol Behav 2012; 107: 34–39.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

I am very grateful to Akanksha Marphatia for critical comments on the manuscript.

Author information

Authors and Affiliations

  1. Childhood Nutrition Research Centre, UCL Institute of Child Health, London, UK

    J C K Wells

Authors
  1. J C K Wells
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J C K Wells.

Ethics declarations

Competing interests

The author declares no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Wells, J. Obesity as malnutrition: the dimensions beyond energy balance. Eur J Clin Nutr 67, 507–512 (2013). https://doi.org/10.1038/ejcn.2013.31

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ejcn.2013.31

Keywords

This article is cited by

Search

Advanced search

Quick links