this post was submitted on 14 Mar 2025
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Let me introduce you to the The Carbohydrate-Insulin Model of Obesity - Beyond “Calories In, Calories Out”: https://doi.org/10.1001/jamainternmed.2018.2933 - Full Paper Here
TLDR: Insulin is the cause of almost all obesity you see. Carbohydrates drive blood sugar, blood sugar drives insulin, insulin drives weight gain. As a good example - T1Ds who don't take their insulin wont gain weight, no matter how much they eat.
T1D who don’t take their insulin won’t gain weight because of vomiting and dying from diabetic ketoacidosis. Sorry, but is is a horrible example and whoever has DM type 1, please take your insulin. People are really dying from DKA and while it is hard to prevent some factors triggering DKA, compliance with insulin is definitely within our control.
Insulin (and to be more precise it’s baseline level and spikes) is one of the obesitygenic factors. But there are much more other factors there too, and reducing such complex multifactorial disease as obesity to insulin only is incorrect.
Otherwise good paper and thank you for adding full article!
I'd love to learn about the other factors. Can you illuminate a more correct understanding for me?
Pathophysiology and risk factors are actually a pretty much half of the curriculum for a separate medical specialty. Here are some resources for a different depth levels of this rabbit hole:
Basic level: https://www.cdc.gov/obesity/risk-factors/risk-factors.html
Moderate to deep:
Obesity Pillars journal (open access) https://www.sciencedirect.com/journal/obesity-pillars
decent book: Handbook of Obesity 4th edition Vol 1 by George A. Bray and Claude Bouchar, available free on Anna’s Archive or can be bought on Amazon
Too deep (mostly for medical professionals) and more expensive: Course of lectures at Columbia university: https://www.ihn.cuimc.columbia.edu/education/continuing-medical-education-cme/columbia-cornell-obesity-medicine
Thank you for the detailed reply.
The CDC link was brief as you indicated.
The CME lectures I can't afford.
I'll grab the handbook and look over it.
You are welcome. I liked the book and it has relatively recent info. Combining it with Obesity Pillars articles, you can get a very good understanding of modern views on pathophysiology of obesity.