Energy expenditure and obesity across the economic spectrum, McGrosky et al. 2025

J

Jaybee00

Senior Member (Voting Rights)

Significance​

Economic development is associated with increased prevalence of obesity and related health problems, but the relative importance of increased caloric intake and reduced energy expenditure remains unresolved. We show that daily energy expenditures are greater in developed populations, and activity energy expenditures are not reduced in more industrialized populations, challenging the hypothesis that decreased physical activity contributes to rises in obesity with economic development. Instead, our results suggest that dietary intake plays a far greater role than reduced expenditure in the elevated prevalence of obesity associated with economic development.

Abstract​

Global economic development has been associated with an increased prevalence of obesity and related health problems. Increased caloric intake and reduced energy expenditure are both cited as development-related contributors to the obesity crisis, but their relative importance remains unresolved. Here, we examine energy expenditure and two measures of obesity (body fat percentage and body mass index, BMI) for 4,213 adults from 34 populations across six continents and a wide range of lifestyles and economies, including hunter-gatherer, pastoralist, farming, and industrialized populations. Economic development was positively associated with greater body mass, BMI, and body fat, but also with greater total, basal, and activity energy expenditure. Body size–adjusted total and basal energy expenditures both decreased approximately 6 to 11% with increasing economic development, but were highly variable among populations and did not correspond closely with lifestyle. Body size–adjusted total energy expenditure was negatively, but weakly, associated with measures of obesity, accounting for roughly one-tenth of the elevated body fat percentage and BMI associated with economic development. In contrast, estimated energy intake was greater in economically developed populations, and in populations with available data (n = 25), the percentage of ultraprocessed food in the diet was associated with body fat percentage, suggesting that dietary intake plays a far greater role than reduced energy expenditure in obesity related to economic development.

 
Not very surprising.

The rural seaside town of Woodbridge has a high obesity rate, and an even higher overweight rate and these people are walking up and down the seafront and the shopping streets. Last week we met a very overweight young woman about to cross the north sea in a small sailing boat overnight in a force 6 wind. No way is that couch potato behaviour. Walk in to a supermarket and you see what the problem is.
 
We are so rich now we can afford far far more calories than we need. But is that the whole story? The question of whether there's any more to it than simply caloric intake is one that is endlessly fascinating to me.

The reason I'm fascinated is because answer is almost certainly: yes, there is more to it than that.

There are weird quirks in obesity prevalence:
  • France (17% obese) is consdierably less obese than the UK (26%) . That's not about wealth.
  • Colorado (25% obese) is so much thinner than Kansas (36%), which is next door, and Oregon (33%), which is similarly white and rich.
  • Egypt and Vietname have similar GDP per capita but Egypt (39.8% obese) would absolutely dominate Vietnam (2.1% obese) in a sumo competition.
In my view cultural factors determining what foods are eaten probably matter. Because - and this part is important - the foods themselves matter. A calorie is unlikely to simply be a calorie, from an obesity standpoint. I'm certainly open to
- a seed oil hypothesis (these were rare in the diet 100 years ago), and also
- a hyper-palatability hypothesis (I can eat a whole pack of nacho cheese doritos but not a whole bag of almonds), but also
- an environmental contamination hypothesis (a fun one is lithium - we started mining and refining that about 60 years ago and it is shown to cause obesity very very clearly in psychiatric practice).
 
Yes, quite clear that it is not just quantity of calories that count, but quality too. If it was only about quantity then we could just eat a couple of handfuls of sugar a day and be done with it.
 
Murph said:
We are so rich now we can afford far far more calories than we need. But is that the whole story? The question of whether there's any more to it than simply caloric intake is one that is endlessly fascinating to me.
Click to expand...

The cause is obviously the processed foods, the industrially produced foods designed to be irresistible, the sugar, the additives.

Also the easy access to these foods.
 
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