Energy balance and obesity: a UK perspective on the gluttonyv.sloth debate

Abstract

Obesity in the UK was assumed to have developed against a population decline in physical activity, with health messages focused on diet and exercise prevention strategies. Doubly-labelled water (DLW) studies of energy expenditure have indicated the alternative scenario that the increased obesity prevalence reflects excessive food energy intake with physical activity levels unchanged. This analysis is questionable, deriving in part from a weakness of the DLW methodology in identifying changing physical activity levels within populations of increasing body weight. This has resulted in an underestimation of the reduction in physical activity in the overweight and obese, as revealed by direct studies of such behaviour. Furthermore, a close examination of food energy supply, household food purchases and individual food energy consumption since 1955, in relation to likely estimates of current intakes indicated by simple modelling of predicted energy expenditure, identifies: (a) food energy supply as markedly overestimating energy intakes; (b) individual food energy consumption as markedly underestimating energy intakes; and (c) household food purchase data as the closest match to predicted current food energy intakes. Energy intakes indicated by this latter method have fallen by between 20 to 30 %, suggesting comparable falls in physical activity. Although unequivocal evidence for a matching UK trend in falling physical activity is limited, as is evidence that obesity follows reductions in physical activity, such a link has been recently suggested in a large prospective study in adolescents. Thus, for the UK, obesity has developed within a 'move less-eat somewhat less but still too much' scenario. A focus on both diet and exercise should remain the appropriate public health policy.

A new model of the role of psychological and emotional distress in promoting obesity: conceptual review with implications for treatment and prevention

“…The bullying and discrimination of the obese is particularly upsetting given that many obese already have to cope with a disharmonious childhood, socioeconomic disadvantage and health problems. This review suggests that obesity causation is much more complex than mere gluttony or sloth , and could in fact have very little to do with a lack of effort or self‐discipline.…”

Growing healthy muscles to optimise metabolic health into adult life

“…There is an ongoing debate over which side of the equation has the greatest bearing on the obesity epidemic. 13 It has been suggested that sedentary lifestyle rather than increased energy intake was to blame. 14,15 However, studies using the doubly labelled water technique indicate that energy expenditure has not decreased since the 1980s, thereby implying that increased energy intake rather than sedentary behaviour has fuelled the doubling of obesity rates.…”

The Validity of US Nutritional Surveillance: USDA’s Loss-Adjusted Food Availability Data Series 1971-2010

“…Nevertheless, if PA and PAEE have declined as precipitously as current evidence suggests, 4,47-49,69 the actual increments in population-level weight over the study period 65,66,68 lead to the counter-stereotypical conclusion that caloric consumption may have actually declined as the prevalence of obesity increased. This has been referred to as the ‘“move less—eat somewhat less but still too much’ scenario.” 13 Unfortunately, there are no valid data to support any speculations regarding population-level trends in actual caloric consumption. 10-12 …”

“…3-7 Although numerous issues may underlie the lack of consensus, 8,9 conceptual and methodological limitations to the measurement of caloric consumption appear to play a central role. 10-13 Without accurate assessments of population-level trends in energy intake, there are no valid data to support inferences regarding the role of food and beverage consumption in the etiology of the obesity epidemic and trends in energy-contingent, chronic noncommunicable diseases (eg, cardiovascular diseases and type 2 diabetes mellitus, T2DM).…”