The etiology of obesity: relative contribution of metabolic factors, diet, and physical activity

doi:10.1016/S0002-9343(98)00190-9

The American Journal of Medicine

Volume 105, Issue 2, August 1998, Pages 145-150

https://doi.org/10.1016/S0002-9343(98)00190-9 Get rights and content

Abstract

Three major factors modulate body weight: metabolic factors, diet, and physical activity, each influenced by genetic traits. Despite recent advances in these areas, the prevalence of obesity in Westernized societies has increased. In contrast to monogenic animal models and rare human genetic syndromes, predisposition to common forms of obesity is probably influenced by numerous susceptibility genes, accounting for variations in energy requirements, fuel utilization, muscle metabolic characteristics, and taste preferences. Although recent increases in obesity prevalence cannot be explained by changes in the gene pool, previously “silent” genetic variants may now play important permissive roles in modern societies. Available data suggest that variations in resting energy expenditure, thermic effect of food, and fuel utilization exist but, by themselves, are unlikely to explain the onset of obesity. Regarding diet, the best available trend survey data indicate that fat and energy intake have fallen, in this and other Westernized countries. Diverging trends of decreasing energy intake and increasing body weight suggest that reduced physical activity may be the most important current factor explaining the rising prevalence of obesity. Subsistence in modern societies requires extreme adaptations in previously useful energy-conserving diet and exercise behaviors. Recognizing the difficulties in sustaining energy-restricted diets in the presence of fast foods and social feasts, the current trend toward increasing body weight is not likely to be reversed solely through recommendations for further reductions in energy intake. In all likelihood, activity levels will have to increase in response to an environment engineered to be more physically demanding.

Section snippets

Energy expenditure

The three components of total energy expenditure include resting energy expenditure, thermic effect of food, and activity-related energy expenditure. Genetic influences appear to affect resting energy expenditure 10, 11, thermic effect of food (11), and adaptive body fat changes to short-term overfeeding (12). The relative contribution of each component to daily energy expenditure is variable, the smallest coming from thermic effect of food, which accounts for about 10% of the total. Although

Role of appetite and dietary factors

In 1994 the leptin gene was described. Its product, leptin, acts via the leptin receptor to suppress food intake and to increase energy expenditure in animals (27). Evidence for genetic linkage of the leptin locus with human obesity has been reported, but only in extremely obese persons 28, 29. Only two cases of leptin deficiency in humans have been reported, due in both cases to a homozygous frame shift mutation in the leptin gene. The subjects are two young cousins from a consanguineous

Role of physical inactivity

There is an inverse relationship between physical activity and adiposity, with correlation coefficients in the order of −0.4 48, 49. In a large population of adult Finns, the prevalence of overweight was found to be considerably higher in sedentary women (21%) and men (14%) than in physically active women (8%) and men (7%) (50). Exercise training also generally results in at least a moderate decrease in body fat (approximately 0.1 kg/week) (51). However, the amount of energy expended differs

Conclusions

In contrast to the monogenic animal models of obesity and rare genetic syndromes of human obesity, the predisposition to common forms of obesity among humans is probably influenced by many susceptibility genes that may affect energy expenditure, fuel utilization, muscle fiber characteristics, and even taste preferences, all of which could impact on our behavioral responses to the environment. Although the increase in obesity prevalence in the past few decades cannot be explained by changes in

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^☆: Supported in part by grants from the National Institutes of Health (R01 DK-49779 and R01 DK-51684, R01 HD/HL-33064, R29 HD-32668); the United States Department of Agriculture (95-37200-1643); the University of Alabama at Birmingham General Clinical Research Center (M01-RR-00032); and the University of Alabama at Birmingham Pilot Centers Program.

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ReviewsThe etiology of obesity: relative contribution of metabolic factors, diet, and physical activity☆

Abstract

Section snippets

Energy expenditure

Role of appetite and dietary factors

Role of physical inactivity

Conclusions

Am J Clin Nutr

Am J Clin Nutr

Am J Clin Nutr

Am J Clin Nutr

Am J Clin Nutr

Lancet

Am J Clin Nutr

Am J Clin Nutr

Am J Med

Am J Clin Nutr

Am J Clin Nutr

Am J Clin Nutr

Am J Clin Nutr

Am J Clin Nutr

Lancet

Body composition in adopted and biological siblings

Human Biol

Genetics of obesity in adult adoptees and their biological siblings

BMJ

An adoption study of human obesity

NEJM

A twin study of human obesity

JAMA

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Prog Food Nutr Sci

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Int J Obesity

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Am J Epidemiol

Familial dependence of the resting metabolic rate

NEJM

Genetic effects in human energy expenditure components

Int J Obes

The response to long-term overfeeding in identical twins

NEJM

Predicted effects of small decreases in energy expenditure on weight gain in adult women

Int J Obesity

Reduced rate of energy expenditure as a risk factor for body-weight gain

NEJM

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Int J Obes

Metabolic predictors of obesitycontribution of resting energy expenditure, thermic effect of food, and fuel utilization to four-year weight gain of post-obese and never-obese women

J Clin Invest

Spontaneous physical activity and obesitycross-sectional and longitudinal studies in Pima Indians

Am J Physiol

Variation in total energy expenditure in humans

Obesity Res

Reviews
The etiology of obesity: relative contribution of metabolic factors, diet, and physical activity☆