Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Mar;28(3):247-258.
doi: 10.1007/s10552-017-0869-z. Epub 2017 Feb 17.

Energy Balance and Obesity: What Are the Main Drivers?

Free PMC article

Energy Balance and Obesity: What Are the Main Drivers?

Isabelle Romieu et al. Cancer Causes Control. .
Free PMC article


Purpose: The aim of this paper is to review the evidence of the association between energy balance and obesity.

Methods: 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).

Results: 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.

Conclusion: 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.

Keywords: Diet; Energy balance; Energy expenditure; Energy intake; Obesity; Satiety.


Fig. 1
Fig. 1
Prevalence of obesity, ages 18+, both sexes, 2014 (age-standardized estimates)—source: WHO

Similar articles

See all similar articles

Cited by 47 articles

See all "Cited by" articles


    1. Anderson AS, Key TJ, Norat T, Scoccianti C, Cecchini M, Berrino F et al. European code against cancer 4th edition: obesity, body fatness and cancer. Cancer Epidemiol. 2015 - PubMed
    1. World Health Organization (2014) Global status report on noncommunicable diseases: World Health Organization, Geneva.
    1. World Cancer Research Fund/American Institute for Cancer Research . Food, nutrition, physical activity, and the prevention of cancer: a global perspective. Washington DC: AICR; 2007.
    1. World Cancer Research Fund/American Institute for Cancer Research (2009) Policy and action for cancer prevention. Food, nutrition, and physical activity: a global perspective
    1. Ng M, Fleming T, Robinson M, Thomson B, Graetz N, Margono C, et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014;384(9945):766–781. doi: 10.1016/S0140-6736(14)60460-8. - DOI - PMC - PubMed