A scale model of obesity

Whatever the individual cause of obesity is, in the absolute majority of cases, carbohydrate restriction works effectively at reducing adipose tissue weight. This is a common observation in most human and animal studies. Carbohydrate restriction for the most part works because it influences insulin and glucose. In addition it affects our sensations of hunger and satiety and affects the energy flow to the individual tissues. This might be a simplification, but it’s a fair simplification. The increased fat storage and insufficient fat release apparent in overweight must in most cases be explained by the specific disease or condition’s influence on insulin and glucose metabolism, simply because insulin and glucose are the main regulators of fat metabolism.

I’ve often pictured the adipose tissue as a scale. All the factors that influence energy release from this tissue rest in one cup and all the factors influencing storage of energy rest in the other. Tipping the scale to one side symbolizes fat storage, tipping to the other symbolizes fat release. If the scale is in perfect equilibrium, the storage of energy matches the release of energy and the fat tissue remains roughly the same size.

Most people are more or less weight stable most of the time. The behavior of our fat tissue is, like most other physiological processes, a process seeking equilibrium (although not likely due to a set-point). Imagine any factor that is known to influence fat metabolism. Take dietary carbohydrates. Let us ad an increased intake of dietary carbohydrates as a factor on one side.

The factors contributing to the storage of energy now overpower the factors contributing the release of energy. Increasing carbohydrate intake will cause a decrease in lipolysis (fat release), mainly through the increased insulin release and increased glucose levels. Tipping the scale in this way (provided all other factors remain constant) will cause a net storage and we will gain weight in the form of fat. A larger fat storage in relation to the fat release will cause a more rapid weight gain. Of course, the scale that is our fat tissue goes up and down during the day and night. It does not remain in a fixed position for any amount of time, but the more time spent below horizontal position on one side in relation to the other, the larger the effect.

Adding an increase in exercise level to the scale will once again tip it towards equilibrium. 

Exercise improves the glucose tolerance of our skeletal muscles. Exercise might increase the level of LPL (lipoprotein lipase) in muscles and reduce the level in fat tissue. It might increase glucose uptake in muscles both by reducing glycogen stores, increasing glucose transporters or simply increasing muscle size. The net effect of exercise is that blood glucose and insulin levels are kept at a lower level and the scale is tipped in favor of fat release. Although exercise very often does not make us leaner, it may also do so and the above-mentioned mechanisms are likely explanations.

Exercise and diet are two lifestyle factors with large impact on our imaginary scale. Lifestyle factors do however affect us differently because of our different genetic heritage. Genetic factors may also more easily be understood using a scale model. Looking at fat storage this way, might give us a simple way of explaining many of the often-cited paradoxes of overweight.

Imagine for example that you are overweight while your brother is not, despite having an apparently similar lifestyle. It seems that your scale is tipping in the opposite direction of that of your brother (or sister, friend or whoever). As fat storage most often must be explained through insulin and /or glucose metabolism and not through energy intake or energy expenditure, we can imagine several scenarios that could explain the brotherly differences. Perhaps your brother has been genetically equipped with a more effective glucose uptake in skeletal muscles or that he needs a smaller stimulus (physical activity) in order to improve glucose uptake. A better glucose uptake would mean smaller increase in blood glucose after ingestion of dietary carbohydrate, a smaller insulin release and thus a smaller fat storage with an ensuing better fat release. This small difference would mean that your brother could consume more dietary carbohydrate without tipping the scale too far in direction of fat storage. It might also make your brother more physically active. It is not fair, but it is how it is. We are not all equipped with the same physiology or the same potential for changing our physiology.

I don’t suspect my scale contributes to the knowledge and understanding of health and nutrition, but it has helped me picture how our body works and it reminds me that overweight is about fat tissue size and not body size or body weight. When faced with a non responder (e.g. a person not losing much weight with carbohydrate restriction) we know the factors working against fat storage overpower the factors working for fat release. Knowing the effect of different factors on our physiology we can easily investigate the less common factors like cortisol, thyroid hormones or perhaps myostatin for that matter. The scale may help remind us that we are built differently and respond differently to any external factors.

I am still surprised by the way people often talk about overweight as if we were all physiologically identical. Most people will for example have no difficulty admitting that we tan differently and have different skin complexions from birth, but somehow when it comes to weight it is often expected that we are all created equal. Well, we’re not. Although the underlying cause of overweight and obesity are pretty much the same in all of us, we all have different potential to gain weight both locally and systemic. The scale model may illustrate our genetic differences and answer the poor, but often encountered argument "If carbohydrates make us fat, why isn’t everybody consuming carbohydrates fat?" Our scales are loaded differently from birth. Carbohydrates in a certain amount definitely do have the potential to make most of us fatter, but from a physiological point of view, we are not created equal.