The History of a Very Bad Idea: Energy Balance, Fat-Shaming and the Failed Science of Obesity

It’s constitutional. No matter how little you eat you put on flesh if you’re made that way.

The character John Tarleton, in George Bernard Shaw’s play

Misalliance, 1910

Until the mid-20^th Century, the medical thinking on obesity allowed for two equally commonsensical explanations. One was what today is called the energy balance or energy homeostasis perspective: we get fat because we consume an excess of calories. The other was a hormonal/regulatory explanation, favoured by German and Austrian researchers: obesity is a disorder of fuel partitioning or, simply, a fat storage disorder. In this paradigm, the causality is reversed: energy imbalance – overeating or under-exercising – is simply what happens when we have a physiological drive to accumulate excess fat.

This fat storage hypothesis effectively vanished with the Second World War, despite significant evidence then and still – including all major animal models – supporting it. Since the 1940s, research on obesity and its related chronic diseases has been predicated almost entirely on the energy balance notion. In short, researchers have been trying to explain why people with obesity might eat too much, not why they might accumulate too much fat, a different question. Meanwhile treatments based on the energy balance logic – eating less and exercising more – have typically failed and the prevalence of obesity has soared worldwide.

This lecture will discuss the history of these competing ways of thinking about obesity, paradigms and the implications today for treatment and prevention of the disorder. It suggests that a simple change of perspective from obesity as an energy balance disorder to an endocrine/constitutional or fuel-partitioning disorder has vast implications for therapy, prevention and treatment and the interpretation of obesity-related research.

Programme Symposium 2022 – 16:00 – 17:30 PM