Is Obesity a Multifactorial Disease?


  1. The view that obesity is "multifactorial" 
  2. Various factors intertwined...
    The bottom line

1. The view that obesity is "multifactorial" 

It is said that obesity is related to many factors, but why? I will quote an interesting description that is relevant to my blog.

“What causes weight gain? Contending theories abound:

・Calories ・Food reward・Food addiction
・Sugar・Sleep deprivation ・Stress
・Refined carbohydrates・Wheat
・Low fiber intake・All carbohydrates 
・Genetics・Dietary fat ・Red meat
・Poverty ・All meat
・Dairy products・Gut microbiome
・Snacking・Childhood obesity 

Childhood obesity

The various theories fight among themselves, as if they are all mutually exclusive and there is only one true cause of obesity. For example, recent trials that compare a low-calorie to a low-carbohydrate diet assume that if one is correct, the other is not. Most obesity research is conducted in this manner.

This approach is wrong, since these theories all contain some element of truth." 
(Jason Fung. The Obesity Code. Greystone Books, 2016, Page 70.)

Foods that make us fat

"THE MULTIFACTORIAL NATURE of obesity is the crucial missing link. There is no one single cause of obesity.

Do calories cause obesity? Yes, partially.
Do carbohydrates cause obesity? Yes, partially.
Does fiber protect us from obesity? Yes, partially.
Does insulin resistance cause obesity? Yes, partially. Does sugar cause obesity? Yes, partially. 


What we need is a frame work, a structure, a coherent theory to understand how all its factors fit together. Too often, our current model of obesity assumes that there is only one single true cause, and that all others are pretenders to the throne. Endless debates ensue.

Too many calories cause obesity. No, too many carbohydrates. No,
too much saturated fat. No, too much red meat. No,
too much processed foods. No, too much high fat dairy. No,
too much wheat. No, too much sugar. No,
too much highly palatable foods.No, too much eating out. No

It goes on and on. They are all partially correct.  (*snip*)

All diets work because they all address a different aspect of the disease. But none of them work for very long, because none of them address the totality of the disease.
Without understanding the multifactorial nature of obesity-which is critical -we are doomed to an endless cycle of blame."

(Jason Fung. The Obesity Code. Pages 216-217.)


I think the author provides a keen insight into the multifactorial nature of obesity. We must first understand that being overweight is not as simple as "it happens when we consume more calories than we expend," but is caused by a complex interplay of various factors.

However, what I want to say is that based on my intestinal starvation idea, the various factors can be aggregated to some extent, which means that
obesity can be complicated and intertwined with factors and theories we can see, and cannot be completely explained, but when we focus on the unseen workings of the intestines, the cause of weight gain would be mostly specific.

2. Various factors intertwined...

As I’ve already explained, please understand that the phrase “gaining weight” has two meanings.

【related article】
Two Meanings to the Phrase "Gaining Weight"

The mechanism that many people refer to as “get fat by eating a lot” is in the range of (A) in the graph below. I think that most of the Intervention studies on obesity so far have only been comparative studies that involve reducing the intake of calories, regulating the amount of carbs or fat, or increasing exercise, etc. The experiment  they are doing is also in the range of (A). 


Two meaning to the phrase 'gaining weight'

Of course, everyone will lose some weight if they reduce their caloric intake and incorporate exercise, although individual differences may vary.

However, that is not the fundamental way to deal with being overweight, as Dr. Fung mentioned, so regaining weight (the rebound effect) is inevitable if you eat as before.

In contrast, when (B) the base weight value goes up by intestinal starvation, there are various interrelated factors.

For instance, it is said that the following affects weight gain:
・Skipping breakfast  ・Late dinner ・How many meals you eat
・Refined carbohydrates ・Processed food 
・Lack of fiber intake  ・Unbalanced diets

These are some of factors that are related to part (B) of the graph.

The important thing here is that each of these factors seems to be linked to weight gain, but there is no causality between each factor and outcome. Rather, they are related to inducing intestinal starvation. (In this case, some may say intestinal starvation can be “confounding factors.”)

As I’ve already explained in another article, a combination of some of these factors below (from  category 1 to 4 of the table) happening simultaneously or overlapping, can cause intestinal starvation, and
the occurrence of intestinal starvation may be pinpointed in the unseen workings of the entire intestinal track (or it may be the small intestine only).

[Related article] 
Three (+one) Factors to Accelerate “Intestinal Starvation”


3 factors +1

The bottom line

(1) Many theories that are believed to make us fat fight among themselves, as if there is only one true cause of obesity, as Dr. Fung mentioned. Researchers may be well versed in their own areas of research (e.g. resistant starch, the value of eating breakfast, the effects of carbohydrate restriction, hormones, gut bacteria, etc.), but that does not necessarily capture obesity as a whole, so each theory can stand alone.

What we need now is a framework for how each theory is intertwined, and I'd like to believe my theory can be helpful in that regard.

(2) The root cause of being overweight, I believe, is the increased base weight value, which is caused by intestinal starvation.
Intestinal starvation is caused by a combination of at least four factors, and since "what kind of food we eat" and "how we eat them (lifestyle)" are such important factors, many things seem to have something to do with weight gain-intestinal starvation can be a "confounding factor."

In other words, I believe the causes of weight gain would be mostly specific in the unseen workings of the intestines.