title: Energy balance and obesity: what are the main drivers?
abstract: The aim of this paper is to review the evidence of the association between energy balance and obesity.
  
  
  
  In December 2015, the International Agency for Research on Cancer (IARC), Lyon, France convened a Working Group of international experts to review the evidence regarding energy balance and obesity, with a focus on Low and Middle Income Countries (LMIC).
  
  
  
  The global epidemic of obesity and the double burden, in LMICs, of malnutrition (coexistence of undernutrition and overnutrition) are both related to poor quality diet and unbalanced energy intake. Dietary patterns consistent with a traditional Mediterranean diet and other measures of diet quality can contribute to long-term weight control. Limiting consumption of sugar-sweetened beverages has a particularly important role in weight control. Genetic factors alone cannot explain the global epidemic of obesity. However, genetic, epigenetic factors and the microbiota could influence individual responses to diet and physical activity.
  
  
  
  Energy intake that exceeds energy expenditure is the main driver of weight gain. The quality of the diet may exert its effect on energy balance through complex hormonal and neurological pathways that influence satiety and possibly through other mechanisms. The food environment, marketing of unhealthy foods and urbanization, and reduction in sedentary behaviors and physical activity play important roles. Most of the evidence comes from High Income Countries and more research is needed in LMICs.
authors.affiliation: Nutrition and Metabolism Section, International Agency for Research on Cancer, 150 cours Albert Thomas, 69372, Lyon Cedex 08, France. romieu@iarc.fr.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Romieu
authors.affiliation: Nutrition and Metabolism Section, International Agency for Research on Cancer, 150 cours Albert Thomas, 69372, Lyon Cedex 08, France.
authors.forename: Laure
authors.initials: L
authors.lastname: Dossus
authors.affiliation: Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Cuernavaca, Mexico.
authors.forename: Simón
authors.initials: S
authors.lastname: Barquera
authors.affiliation: Micalis Institute, MGP MetagenoPolis, INRA, AgroParisTech, Université Paris-Saclay, Jouy-en-Josas, France.
authors.forename: Hervé M
authors.initials: HM
authors.lastname: Blottière
authors.affiliation: Genetic and Molecular Epidemiology Unit, Lund University Diabetes Centre, CRC, University hospital Malmö, Malmö, Sweden.
authors.forename: Paul W
authors.initials: PW
authors.lastname: Franks
authors.affiliation: Nutrition and Metabolism Section, International Agency for Research on Cancer, 150 cours Albert Thomas, 69372, Lyon Cedex 08, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Gunter
authors.affiliation: Faculty of Agricultural and Food Science, American University of Beirut, Beirut, Lebanon.
authors.forename: Nahla
authors.initials: N
authors.lastname: Hwalla
authors.affiliation: Department of Nutrition and the Nutrition Research Institute, The University of North Carolina, Chapel Hill, USA.
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Hursting
authors.affiliation: Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Leitzmann
authors.affiliation: Faculty of Medicine, Southampton General Hospital, University of Southampton, Southampton, UK.
authors.forename: Barrie
authors.initials: B
authors.lastname: Margetts
authors.affiliation: Nutrition Policy and Scientific Advice (NPU), Department of Nutrition for Health and Development (NHD), World Health Organization (WHO), Geneva, Switzerland.
authors.forename: Chizuru
authors.initials: C
authors.lastname: Nishida
authors.affiliation: Office of the Associate Director, Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, USA.
authors.forename: Nancy
authors.initials: N
authors.lastname: Potischman
authors.affiliation: Faculty of Earth and Life Sciences, Department of Health Sciences, University Amsterdam, Amsterdam, The Netherlands.
authors.forename: Jacob
authors.initials: J
authors.lastname: Seidell
authors.affiliation: Nutrition and Metabolism Section, International Agency for Research on Cancer, 150 cours Albert Thomas, 69372, Lyon Cedex 08, France.
authors.forename: Magdalena
authors.initials: M
authors.lastname: Stepien
authors.affiliation: Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, Joint Appointments, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, USA.
authors.forename: Youfa
authors.initials: Y
authors.lastname: Wang
authors.affiliation: NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands.
authors.forename: Klaas
authors.initials: K
authors.lastname: Westerterp
authors.affiliation: Institute of Nutrition, Mahidol University Salaya, Nakhon Pathom, Thailand.
authors.forename: Pattanee
authors.initials: P
authors.lastname: Winichagoon
authors.affiliation: World Cancer Research Fund International, London, UK.
authors.forename: Martin
authors.initials: M
authors.lastname: Wiseman
authors.affiliation: Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, USA.
authors.forename: Walter C
authors.initials: WC
authors.lastname: Willett
mesh_terms: D001628:Beverages; D003106:Colon / Q000382:microbiology; D003906:Developing Countries / Q000706:statistics & numerical data; D002149:Energy Intake; D004734:Energy Metabolism; D015444:Exercise; D005247:Feeding Behavior; D006801:Humans; D007182:Income; D044342:Malnutrition / Q000453:epidemiology; D064307:Microbiota / Q000502:physiology; D009765:Obesity / Q000453:epidemiology* / Q000235:genetics / Q000382:microbiology; D015430:Weight Gain
keywords: Diet; Energy balance; Energy expenditure; Energy intake; Obesity; Satiety