Moderating "the great debate": The carbohydrate-insulin vs. the energy balance models of obesity.

Abstract

The increased prevalence of obesity in recent decades is a topic of great scientific and medical interest, but despite many advances, the causes of this increase have not been adequately identified. In this context, two conflicting models for obesity-the carbohydrate-insulin model (CIM) and the energy balance model (EBM)-are being vigorously debated by distinct cohorts of experts in the field. The goal of this perspective is to assess this "conflict of models" from a neutral perspective. I conclude that although both models have produced useful insights, they differ fundamentally in what they seek to explain, and neither has yet provided a validated mechanistic account for the rising obesity prevalence in some but not all members of the population. Rather than engaging in such debates over competing models, the field should be more focused on establishing specific mechanistic insights in identified patient groups and, eventually, actionable interventions based on them.