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An integrated model of obesity pathogenesis that revisits causal direction

Weight gain indicates a positive energy balance, with calorie intake exceeding expenditure. However, this fact of physics cannot inform causality. Potential pathways to obesity include a positive energy balance that drives weight gain or weight gain that drives the positive energy balance. Here, we propose an integrated model of obesity pathogenesis that incorporates both pathways.

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Fig. 1: An integrated model of obesity pathogenesis.


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Correspondence to David S. Ludwig or Thorkild I. A. Sørensen.

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Competing interests

D.S.L. received royalties for books that recommend a carbohydrate-modified diet; his spouse owns a nutrition education and consulting business. T.I.A.S. declares no competing interests.

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Ludwig, D.S., Sørensen, T.I.A. An integrated model of obesity pathogenesis that revisits causal direction. Nat Rev Endocrinol 18, 261–262 (2022).

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