Is the energy balance explanation of the obesity epidemic wrong?

Abstract

There is a striking discrepancy in both U.S and the U.K data between obesity rates, which are increasing, and self-reported food consumption rates, which are decreasing. There are two possible explanations for this discrepancy, namely that the widely accepted energy balance interpretation of obesity is wrong or that food consumption data are somehow biased. In a comment entitled "Obesity-an unexplained epidemic", Mozaffarian (2022) challenged the Energy Balance Model (EBM) and argued for a need to replace it with a novel biological theory. This challenge is premature, because there are psychological explanations for this discrepancy, namely that individuals with overweight and obesity underreport their food consumption and that this tendency has increased in recent years. To support these hypotheses, U.S and U.K data are reviewed that used the Doubly Labelled Water method (DLW), which is the gold standard for estimating energy expenditure. Such studies find not only consistent evidence of underreporting, but also that the discrepancy between measured energy expenditure and reported calorie consumption increased over time. Two psychological explanations for this pattern are discussed.

Keywords: Doubly Labelled Water method (DLW); Energy Balance Model (EBM); Obesity; Overweight; dietary recall measures.