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An integrated model of obesity pathogenesis that revisits causal direction

Nature Reviews Endocrinology volume 18, pages 261–262 (2022)Cite this article

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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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Authors and Affiliations

  1. New Balance Foundation Obesity Prevention Center, Boston Children’s Hospital, Boston, MA, USA

    David S. Ludwig

  2. Department of Pediatrics, Harvard Medical School, Boston, MA, USA

    David S. Ludwig

  3. Department of Public Health and Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark

    Thorkild I. A. Sørensen

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  1. David S. Ludwig
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  2. Thorkild I. A. Sørensen
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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). https://doi.org/10.1038/s41574-022-00635-0

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