Obesity as malnutrition: the dimensions beyond energy balance

The aetiology of obesity is seemingly simple to understand: individuals consume more energy than they expend, with the excess energy being stored in adipose tissue. Public health campaigns therefore promote dietary restraint and physical exercise, and emphasize individual responsibility for these behaviours. Increasingly, however, researchers are switching from thermodynamic to metabolic models of obesity, thereby clarifying how specific environmental factors promote lipogenesis. Obesity can best be explained not by counting 'calories in and out', but by understanding how specific dietary products and activity behaviours perturb cellular metabolism and promote net lipogenesis. This metabolic approach can furthermore be integrated with more sophisticated models of how commercial practices drive the consumer trends that promote obesogenic behaviours. Notably, obesity treatment has proven more effective if it bypasses individual responsibility, suggesting that a similar approach placing less emphasis on individual responsibility would improve the efficacy of obesity prevention. Successful obesity prevention campaigns are likely to emerge only when the public receive better 'protection' from the commercial practices that are driving the global obesity epidemic. Rather than populations failing to heed governments' public health advice, governments are currently failing the public by abandoning their responsibility for regulating commercial activities.