A recent viewpoint article published in The Journal of the American Medical Association (JAMA) discusses an alternative theory of chronic overeating as “a manifestation rather than the primary cause of obesity.” David Ludwig and Mark Friedman, “Increasing Adiposity: Consequence or Cause of Overeating?,” JAMA, June 2014. Authored by New Balance Foundation Obesity Prevention Center Boston Children’s Hospital Director David Ludwig and Nutrition Science Initiative Vice President of Research Mark Friedman, the article discusses the physiological and genetic mechanisms that may contribute to obesity, arguing that “a focus on diet composition, not total calories, may best facilitate weight loss.”

In particular, Ludwig and Friedman not only point to previous studies claiming that the body adapts its metabolic responses “to defend baseline body weight,” but argue that insulin disorders “highlight the potential influence of metabolic fuel concentration on body weight regulation.” They also note that, contrary to a calorie-centric view of obesity, research has purportedly shown that genetic and environmental factors can induce “an excessively anabolic state that favors storage rather than oxidation of ingested calories.”

“If anabolic metabolic defects precede and promote overeating, then conventional calorie-restricted diets would comprise symptomatic treatment, destined to fail over the long term for most people in an environment of unlimited food availability,” report the authors. “Although reduced energy intake acutely decreases fat mass, predictable physiological and behavioral adaptations progressively lessen the ability of most people to maintain voluntary energy restriction.”