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Etiological Assessment of Obesity

Regular readers of these pages may recall an earlier post in which I emphasized the importance of not just describing behaviours (this patient eats too much) but rather actually attempting to determine the root causes of these behaviours (why does this patient eat too much?).

I also suggested that obesity can best be conceptualized as the physical manifestation of chronic energy excess.

In fact, using the analogy of oedema, the consequence of positive fluid balance or fluid retention, I explained that obesity can be seen as the consequence of positive energy balance or calorie ‘retention’.

I further recommended that just as the assessment of oedema requires a comprehensive assessment of factors related to fluid balance, the assessment of obesity requires a systematic assessment of factors potentially affecting energy intake, metabolism and expenditure.

The full paper describing this concept has now been published as an early release on OBESITY REVIEWS.

I believe that this paper provides an aetiological framework for the systematic assessment of the socio-cultural, biomedical, psychological and iatrogenic factors that influence energy input, metabolism and expenditure.

The full paper discusses factors that affect metabolism (age, sex, genetics, neuroendocrine factors, sarcopenia, metabolically active fat, medications, prior weight loss), energy intake (socio-cultural factors, mindless eating, physical hunger, emotional eating, mental health, medications) and activity (socio-cultural factors, physical and emotional barriers, medications).

Based on my own experience of using this framework in my practice, I anticipate that clinicians will find this approach helpful in systematically assessing, identifying and thereby addressing the aetiological determinants of positive energy balance.

I very much hope that application of this framework will ultimate result in more effective obesity prevention and management.

As always, comments are most welcome.

Toronto, Ontario


  1. I like this comprehensive approach.

    I would like to learn more details of how prior weight loss affects metabolism.

    Thank you for your work Dr Sharma.

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  2. I’ve always loved this analogy of yours Arya.

    Great work getting it published.


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  3. Chronic energy excess has no ‘failure’ in its definition. Only a sign! Brilliant. This really helps me use this term with my clients. They HATE the word Obese. Thank you for your very interesting research, education and kind heart! Mahri

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  4. Congratulations on a v. interesting and important paper. This article
    is effective in highlighting the complexity of obesity and the need for
    interprofessional health teams for the treatment of obesity. This is an
    article I could use with students to demonstrate the application of
    rehabilitation principles to the treatment of obesity. I was reminded
    of the conceptual model of obesity drivers out of the UK while reading
    your paper. The framework that you are proposing considers a number of
    factors driving obesity in the UK model that need to be looked at
    Well done

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