Perturbations in energy balance underlie the most common public health nutrition problems today. In the United States, 68% of adults and 35% of children are now overweight or obese (Flegal et al. , 2010 ; Ogden et al. , 2006 ). The prevalence of obesity is also increasing in developing countries, where undernutrition has tradition-ally been the primary nutrition challenge and remains prevalent (Kurpad et al. , 2005 ). For example, the preva-lence of obesity has increased recently in both Brazil and China, especially in urban areas but also in very low -income families such as those living in shantytowns (Sawaya et al. , 1995, 1998 ; Popkin et al. , 1996 ). In addi-tion to being associated with increased risks of type 2 diabetes, osteoarthritis, angina, and hypertension, obesity is also associated with premature death and increased health - care costs (Uauy and Diaz, 2005 ). The estimated number of deaths attributable to obesity in the United States alone is ∼ 300,000 per year.
The excess weight gain that accumulates in obesity results from energy intake exceeding energy expenditure over a considerable period of time and has both genetic and environmental origins. This positive energy balance can occur because energy expenditure is low or energy intake is high, or a combination of these two factors. The importance of energy expenditure is suggested by several (Ravussin et al. , 1988 ; Roberts et al. , 1988 ; DeLany, 1998 ; Goran et al. , 1998 ) though not all (Stunkard et al. , 1999 ) prospective studies showing that low energy expenditure
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equipped to handle the caloric load and may be at risk of developing obesity.
Future Directions
Energy expenditure for resting metabolism, the thermic effect of feeding, and physical activity and arousal will balance energy intake in individuals maintaining energy balance, and are contributors to energy dysregulation in the obese state. Determinants of energy expenditure are the subject of considerable research but further studies are needed to accurately quantify the relative importance of genetic inheritance, early life infl uences, and current envi-ronmental factors in the prevention, development, and treatment of obesity.
Suggestions for Further Reading
Brooks, S.P.J. ( 2001) Fasting and refeeding: models of changes in metabolic effi ciency . In K.B. Storey and J.M. Storey (eds), Cell and Molecular Response to Stress. Elsevier , Amsterdam, pp. 111–127.
Felber , J.-P. and Golay , A. ( 1995) Regulation of nutrient metabolism and energy expenditure . Metabolism 44, 4–9.
Flatt, J.P. ( 1987) Dietary fat, carbohydrate balance, and weight maintenance: effects of exercise . Am J Clin Nutr 45, 296–306.
Maughan, R.J., Fallah, J., and Coyle, E.F. ( 2010) The effects of fasting on metabolism and performance . Br J Sports Med 44, 490–494.
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