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 Article
  • Published:

The energy balance hypothesis of obesity: do the laws of thermodynamics explain excessive adiposity?

European Journal of Clinical Nutrition volume 76, pages 1374–1379 (2022)Cite this article

Subjects

Abstract

In this work, we reflect upon the energy balance hypothesis of obesity. International organizations, the general population and many scientists hold the belief that obesity is indisputably caused by an imbalance between energy intake and energy expenditure. Most of them argue that the laws of thermodynamics support this view. We identify and review the main arguments used to support this belief, and we explain the reasoning mistakes those arguments harbor. We show that the laws of thermodynamics do not support the idea that obesity is an energy problem nor an energy balance problem more than they do in the growth of any other tissue in the human body. We argue that the validity of the energy balance paradigm for obesity must be questioned. Although correction of a wrong belief is laudable per se, in this particular case harm may arise by influencing the way in which obesity prevention is tackled and obese patients are treated.

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

Fig. 1: The energy balance paradigm for obesity.
Fig. 2: Compartmental model of the human body.
Fig. 3: Causality and the First Law of Thermodynamics.
Fig. 4: The temporality problem.
Fig. 5: Water tank analogy.
Fig. 6
Fig. 7

Similar content being viewed by others

References

  1. Ng M, Fleming T, Robinson M, Thomson B, Graetz N, Margono C, et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014;384:766–81.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Swinburn BA. Obesity prevention: the role of policies, laws and regulations. Aust New Zealand Health Policy. 2008;5:12–8.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Hill JO, Wyatt HR, Peters JC. The importance of energy balance. Eur Endocrinol. 2013;9:111–5.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Newburgh LH, Woodwell Johnston M. Endogenous obesity—a misconception. Ann Intern Med. 1930;3:815–25.

    Article  Google Scholar 

  5. Yudkin J. The causes and cure of obesity. Lancet. 1959;274:1135–8.

    Article  Google Scholar 

  6. Hervey GR. Physiological mechanisms for the regulation of energy balance. Proc Nutr Soc. 1971;30:109–16.

    Article  CAS  PubMed  Google Scholar 

  7. Rosen ED, Spiegelman BM. Adipocytes as regulators of energy balance and glucose homeostasis. Nature. 2006;444:847–53.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Caballero B. The global epidemic of obesity: an overview. Epidemiol Rev. 2007;29:1–5.

    Article  PubMed  Google Scholar 

  9. Booth DA, Nouwen A. Satiety. No way to slim. Appetite. 2010;55:718–21.

    Article  PubMed  Google Scholar 

  10. Johnson LM. The genetic epidemiology of obesity: a case study. Genetic Epidemiology. Methods in Molecular Biology (Methods and Protocols), vol 713. In: Teare M, editor. Totowa, NJ: Humana Press; 2011. p. 227–37.

  11. Frayn KN. Metabolic Regulation : A Human Perspective. Hoboken: John Wiley & Sons, Incorporated; 2010.

  12. Walsh JA. Obesity & the First Law of Thermodynamics. Am Biol Teach. 2013;75:413–5.

    Article  Google Scholar 

  13. Varela Moreiras G, Ávila JM, Ruiz E. Energy balance, a new paradigm and methodological issues: the ANIBES study in Spain. Nutricion Hospitalaria. 2015;31:101–12.

    PubMed  Google Scholar 

  14. Hume DJ, Yokum S, Stice E. Low energy intake plus low energy expenditure (low energy flux), not energy surfeit, predicts future body fat gain. Am J Clin Nutr. 2016;103:1389–96.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Schwartz MW, Seeley RJ, Zeltser LM, Drewnowski A, Ravussin E, Redman LM, et al. Obesity pathogenesis: an Endocrine Society scientific statement. Endocr Rev. 2017;38:267–96.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Piaggi P. Metabolic determinants of weight gain in humans. Obesity. 2019;27:691–9.

    Article  PubMed  Google Scholar 

  17. Puhl RM, Phelan SM, Nadglowski J, Kyle TK. Overcoming weight bias in the management of patients with diabetes and obesity. Clin Diabetes. 2016;34:44–50.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Nichols BL. Atwater and USDA nutrition research and service: a prologue of the past century. J Nutr. 1994;124:1718S–27S.

    Article  CAS  PubMed  Google Scholar 

  19. Pennington AW. A reorientation on obesity. N. Engl J Med. 1953;248:959–64.

    Article  CAS  PubMed  Google Scholar 

  20. Noorden CV. Metabolism and practical medicine. Vol. III. William Heinemann; 1907.

  21. Taubes G. Good calories, bad calories: fats, carbs, and the controversial science of diet and health. New York: Knopf; 2007.

  22. Ludwig DS, Ebbeling CB. The carbohydrate-insulin model of obesity: beyond “Calories In, Calories Out”. JAMA Intern Med. 2018;178:1098–103.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Sztalryd C, Hamilton J, Horwitz BA, Johnson P, Kraemer FB. Alterations of lipolysis and lipoprotein lipase in chronically nicotine-treated rats. Am J Physiol-Endocrinol Metab. 1996;270:E215–23.

    Article  CAS  Google Scholar 

  24. Camps SG, Kaur B, Quek RYC, Henry CJ. Does the ingestion of a 24 h low glycaemic index Asian mixed meal diet improve glycaemic response and promote fat oxidation? A controlled, randomized cross-over study. Nutr J. 2017;16:43.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Lee M-S, Kim I-H, Kim C-T, Kim Y. Reduction of body weight by dietary garlic is associated with an increase in uncoupling protein mRNA expression and activation of AMP-activated protein kinase in diet-induced obese mice. J Nutr. 2011;141:1947–53.

    Article  CAS  PubMed  Google Scholar 

  26. Chen VP, Gao Y, Geng L, Stout MB, Jensen MD, Brimijoin S. Butyrylcholinesterase deficiency promotes adipose tissue growth and hepatic lipid accumulation in male mice on high-fat diet. Endocrinology. 2016;157:3086–95.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Dugas LR, Harders R, Merrill S, Ebersole K, Shoham DA, Rush EC, et al. Energy expenditure in adults living in developing compared with industrialized countries: a meta-analysis of doubly labeled water studies. Am J Clin Nutr. 2011;93:427–41.

    Article  CAS  PubMed  Google Scholar 

  28. Witte MM, Resuehr D, Chandler AR, Mehle AK, Overton JM. Female mice and rats exhibit species-specific metabolic and behavioral responses to ovariectomy. Gen Comp Endocrinol. 2010;166:520–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Carlson MG, Campbell PJ. Intensive insulin therapy and weight gain in IDDM. Diabetes. 1993;42:1700–7.

    Article  CAS  PubMed  Google Scholar 

  30. St-Onge M-P, Bosarge A. Weight-loss diet that includes consumption of medium-chain triacylglycerol oil leads to a greater rate of weight and fat mass loss than does olive oil. Am J Clin Nutr. 2008;87:621–6.

    Article  CAS  PubMed  Google Scholar 

  31. Martin CK, Johnson WD, Myers CA, Apolzan JW, Earnest CP, Thomas DM, et al. Effect of different doses of supervised exercise on food intake, metabolism, and non-exercise physical activity: The E-MECHANIC randomized controlled trial. Am J Clin Nutr. 2019;110:583–92.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Bouchard C. The magnitude of the energy imbalance in obesity is generally underestimated. Int J Obes. 2008;32:879–80.

    Article  CAS  Google Scholar 

  33. Bray GA, Champagne CM. Beyond energy balance: there is more to obesity than kilocalories. J Am Dietetic Assoc. 2005;105:S17–23.

    Article  Google Scholar 

  34. Schrauwen P, Hesselink M. UCP2 and UCP3 in muscle controlling body metabolism. J Exp Biol. 2002;205:2275–85.

    Article  CAS  PubMed  Google Scholar 

  35. Casazza K, Fontaine KR, Astrup A, Birch LL, Brown AW, Bohan Brown MM, et al. Myths, presumptions, and facts about obesity. N. Engl J Med. 2013;368:446–54.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. American Medical Association. A critique of low-carbohydrate ketogenic weight reduction regimens: a review of Dr. Atkins’ diet revolution. Nutr Rev. 1974;32:15–23.

  37. Joshi S, Ostfeld RJ, McMacken M. The ketogenic diet for obesity and diabetes—enthusiasm outpaces evidence. JAMA Intern Med. 2019;179:1163–4.

    Article  PubMed  Google Scholar 

  38. Ravussin E, Beyl RA, Poggiogalle E, Hsia DS, Peterson CM. Early time‐restricted feeding reduces appetite and increases fat oxidation but does not affect energy expenditure in humans. Obesity. 2019;27:1244–54.

    Article  CAS  PubMed  Google Scholar 

  39. Pearl J. 3. The foundations of causal inference. Sociol Methodol. 2010;40:75–149.

    Article  Google Scholar 

  40. Zając A, Wilk M, Socha T, Maszczyk A, Chycki J. Effects of growth hormone and testosterone therapy on aerobic and anaerobic fitness, body composition and lipoprotein profile in middle-aged men. Ann Agric Environ Med. 2014;21:156–60.

    PubMed  Google Scholar 

  41. Jackman MR, MacLean PS, Bessesen DH. Energy expenditure in obesity-prone and obesity-resistant rats before and after the introduction of a high-fat diet. Am J Physiol-Regulatory, Integr Comp Physiol. 2010;299:R1097–105.

    Article  CAS  Google Scholar 

  42. Wetzler S, Jean C, Tomé D, Larue-Achagiotis C. A carbohydrate diet rich in sucrose increased insulin and WAT in macronutrient self-selecting rats. Physiol Behav. 2003;79:695–700.

    Article  CAS  PubMed  Google Scholar 

  43. Srivastava S, Baxa U, Niu G, Chen X, Veech RL. A ketogenic diet increases brown adipose tissue mitochondrial proteins and UCP1 levels in mice. IUBMB Life. 2013;65:58–66.

    Article  CAS  PubMed  Google Scholar 

  44. Cho I, Yamanishi S, Cox L, Methé BA, Zavadil J, Li K, et al. Antibiotics in early life alter the murine colonic microbiome and adiposity. Nature. 2012;488:621–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  45. Do M, Lee E, Oh M-J, Kim Y, Park H-Y. High-glucose or -fructose diet cause changes of the gut microbiota and metabolic disorders in mice without body weight change. Nutrients. 2018;10:761.

    Article  PubMed Central  Google Scholar 

  46. Campbell WW, Barton J, Marvin L, Cyr-Campbell D, Davey SL, Beard JL, et al. Effects of an omnivorous diet compared with a lactoovovegetarian diet on resistance-training-induced changes in body composition and skeletal muscle in older men. Am J Clin Nutr. 1999;70:1032–9.

    Article  CAS  PubMed  Google Scholar 

  47. Barakat C, Pearson J, Escalante G, Campbell B, De Souza EO. Body recomposition: can trained individuals build muscle and lose fat at the same time? Strength Conditioning J. 2020;42:7–21.

    Article  Google Scholar 

  48. Feinman RD, Fine EJ. Nonequilibrium thermodynamics and energy efficiency in weight loss diets. Theor Biol Med Model. 2007;4:27–39.

  49. Agha M, Agha R. The rising prevalence of obesity: part A: impact on public health. Int J Surg Oncol. 2017;2:e17.

    Article  Google Scholar 

  50. Gill TP, Boylan S. Public health messages: why are they ineffective and what can be done? Curr Obes Rep. 2012;1:50–8.

    Article  Google Scholar 

  51. 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;378:826–37.

    Article  PubMed  Google Scholar 

  52. Hall KD, Kahan S. Maintenance of lost weight and long-term management of obesity. Med Clin North Am. 2018;102:183–97.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Franz MJ, VanWormer JJ, Crain AL, Boucher JL, Histon T, Caplan W, et al. Weight-loss outcomes: a systematic review and meta-analysis of weight-loss clinical trials with a minimum 1-year follow-up. J Am Dietetic Assoc. 2007;107:1755–67.

    Article  Google Scholar 

  54. Mann T, Tomiyama AJ, Westling E, Lew A-M, Samuels B, Chatman J. Medicare’s search for effective obesity treatments: Diets are not the answer. Am Psychologist. 2007;62:220–33.

    Article  Google Scholar 

  55. Must A, Spadano J, Coakley EH, Field AE, Colditz G, Dietz WH. The disease burden associated with overweight and obesity. JAMA. 1999;282:1523–9.

    Article  CAS  PubMed  Google Scholar 

  56. Puhl RM, Heuer CA. Obesity stigma: important considerations for public health. Am J Public Health. 2010;100:1019–28.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Puhl RM, Heuer CA. The stigma of obesity: a review and update. Obesity. 2009;17:941–64.

    Article  PubMed  Google Scholar 

  58. Rony HR. Obesity and leanness. Obes Res. 1995;3:609–24.

    Article  CAS  PubMed  Google Scholar 

  59. Pennington AW. Treatment of obesity: developments of the past 150 years. Am J Digestive Dis. 1954;21:65–9.

    Article  CAS  Google Scholar 

  60. Taubes G. The science of obesity: what do we really know about what makes us fat? An essay by Gary Taubes. BMJ. 2013;346:f1050.

    Article  PubMed  Google Scholar 

  61. Wells JCK, Siervo M. Obesity and energy balance: is the tail wagging the dog? Eur J Clin Nutr. 2011;65:1173–89.

    Article  CAS  PubMed  Google Scholar 

  62. Wells JCK. Obesity as malnutrition: the dimensions beyond energy balance. Eur J Clin Nutr. 2013;67:507–12.

    Article  CAS  PubMed  Google Scholar 

  63. Hebert JR, Allison DB, Archer E, Lavie CJ, Blair SN. Scientific decision making, policy decisions, and the obesity pandemic. Mayo Clin Proc. 2013;88:593–604.

    Article  PubMed  Google Scholar 

  64. Chandaria SA. The emerging paradigm shift in understanding the causes of obesity. In: Controversies in obesity. London: Springer London; 2014. pp. 63–73.

  65. Camacho S, Ruppel A. Is the calorie concept a real solution to the obesity epidemic? Glob Health Action. 2017;10:1289650.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Universitat Politècnica de València, Valencia, Spain

    Vicente Torres-Carot

  2. Universidade de Vigo, Vigo, Spain

    Andrés Suárez-González

  3. Universidad Alfonso X el Sabio, Madrid, Spain

    Cecilia Lobato-Foulques

Authors
  1. Vicente Torres-Carot
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Andrés Suárez-González
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Cecilia Lobato-Foulques
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

VTC conceived the first draft of the article. All authors contributed to the development of subsequent draft versions.

Corresponding author

Correspondence to Vicente Torres-Carot.

Ethics declarations

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Torres-Carot, V., Suárez-González, A. & Lobato-Foulques, C. The energy balance hypothesis of obesity: do the laws of thermodynamics explain excessive adiposity?. Eur J Clin Nutr 76, 1374–1379 (2022). https://doi.org/10.1038/s41430-021-01064-4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41430-021-01064-4

This article is cited by

Search

Advanced search

Quick links