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Crystal Ball series

From fat cells through an obesity theory

European Journal of Clinical Nutrition volume 72, pages 1329–1335 (2018)Cite this article

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For me, nutrition science has for about 50 years centered on various aspects of causes, consequences, development, occurrence, and correlates of human obesity, and, as a transitory sidetrack, on health-damaging effects of alcohol intake, with a few cross-links between the two topics. My attempts to interpret what I see in the crystal ball as possible leads to the future by reflecting the past will here only be in the obesity track. I will spin a few threads from the very beginning to the current state of the art with all its gaps, as I see them; I will be upfront and apologize for any mistakes and for not being comprehensive in any way, in regards to either my own work or the literature in general. My focus here is on the journey, with its unexpected opportunities and surprising findings that may lead to—but in no way is—solid knowledge. In looking back to my journey on this track, I will pay tribute to and mention some of my many colleagues in Denmark and abroad, who have paved the way, often in very surprising ways and with only vague ideas about where their encouragement would take me. However, it has worked so well that I still want to contribute the best I can even though I have just turned 72.

In summary, as it often happens, during the many years of work where I, alongside numerous others, have tried to get answers to the fundamental questions about obesity. Why is it there? Why has it changed? Why is it harmful? What can we do about it beyond starving people? It becomes clear that we are still facing several apparent enigmas that require a lot of work. I have realized that obesity is about much more than nutrition, and possibly even very little about it when defined by what and how much we eat—except that there must be food enough, not only to build up the fat stores, but even more so to satisfy the accompanying increased daily energy expenditure. I am not sure we have come much further than what always has been prevailing ideas about obesity; stored fat in humans is primarily a cost-effective, biological inert nutritional reserve (with some secondary systemic functions), as it is ubiquitously in nature, but why do we get more of it, even up to harmful levels, when we need less of it? I see a need to try solving the enigmas not only by much more work on diverse specific issues, but by development of a comprehensive obesity theory that is consistent with the currently available knowledge and that also includes odd elements not fitting in usual thinking about obesity. Such theory should be the basis for development of novel hypotheses for future research to test, aiming at a better understanding of this condition, which is becoming a major threat to global public health and welfare. I am optimistic that future research will eventually deliver the right answers. By the way, I use “obesity” collectively for “adiposity”, “overweight”, and just increased body mass index (BMI), neglecting these otherwise important distinctions.

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Authors and Affiliations

  1. Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, University of Copenhagen, Copenhagen, Denmark

    Thorkild I. A. Sørensen

  2. Department of Public Health, Section of Epidemiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark

    Thorkild I. A. Sørensen

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Correspondence to Thorkild I. A. Sørensen.

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Sørensen, T.I.A. From fat cells through an obesity theory. Eur J Clin Nutr 72, 1329–1335 (2018). https://doi.org/10.1038/s41430-018-0100-7

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