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Paul Franks

Paul Franks

Principal investigator

Paul Franks

Energy balance and obesity : what are the main drivers?


  • Isabelle Romieu
  • Laure Dossus
  • Simón Barquera
  • Hervé M. Blottière
  • Paul W. Franks
  • Marc Gunter
  • Nahla Hwalla
  • Stephen D. Hursting
  • Michael Leitzmann
  • Barrie Margetts
  • Chizuru Nishida
  • Nancy Potischman
  • Jacob Seidell
  • Magdalena Stepien
  • Youfa Wang
  • Klaas Westerterp
  • Pattanee Winichagoon
  • Martin Wiseman
  • Walter C Willett

Summary, in English

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.


  • Genetic and Molecular Epidemiology
  • EXODIAB: Excellence in Diabetes Research in Sweden
  • EpiHealth: Epidemiology for Health

Publishing year







Cancer Causes and Control





Document type

Journal article




  • Endocrinology and Diabetes


  • Diet
  • Energy balance
  • Energy expenditure
  • Energy intake
  • Obesity
  • Satiety



Research group

  • Genetic and Molecular Epidemiology
  • LUDC (Lund University Diabetes Centre)


  • ISSN: 0957-5243