Despite intensive research, the causes of the obesity epidemic remain incompletely understood and conventional calorie-restricted diets continue to lack long-term efficacy. According to the carbohydrate-insulin model (CIM) of obesity, recent increases in the consumption of processed, high–glycemic-load carbohydrates produce hormonal changes that promote calorie deposition in adipose tissue, exacerbate hunger, and lower energy expenditure. Basic and genetic research provides mechanistic evidence in support of the CIM. In animals, dietary composition has been clearly demonstrated to affect metabolism and body composition, independently of calorie intake, consistent with CIM predictions. Meta-analyses of behavioral trials report greater weight loss with reduced-glycemic load vs low-fat diets, though these studies characteristically suffer from poor long-term compliance. Feeding studies have lacked the rigor and duration to test the CIM, but the longest such studies tend to show metabolic advantages for low-glycemic load vs low-fat diets. Beyond the type and amount of carbohydrate consumed, the CIM provides a conceptual framework for understanding how many dietary and nondietary exposures might alter hormones, metabolism, and adipocyte biology in ways that could predispose to obesity. Pending definitive studies, the principles of a low-glycemic load diet offer a practical alternative to the conventional focus on dietary fat and calorie restriction.
[Sorry to keep reposting this, I've had to move communities 3 times in the last month, it makes linking references a chore]
The importance of this cannot be understated, humans are amazing hormonal machines. Hormones control every aspect of our biology. The hormonal insulin model has dramatic application to human health and specifically obesity / insulin resistance / metabolic health.
TLDR: Insulin is the cause of almost all obesity you see. Carbohydrates drive blood sugar, blood sugar drives insulin, insulin drives weight gain. As a good example - T1Ds who don’t take their insulin wont gain weight, no matter how much they eat..
Notes:
Insulin is a super hormone, when its elevated the body stops feeding itself and stores everything.
Carbs/Sugars drive weight gain and hunger, its a vicious cycle.
People eating a high carb diet are always hungry because all of their internal stored energy (fat) is unavailable to them. They are always starving even though they have plenty of fat.
CICO / Eat Less Move More - Would say that the food doesnt matter, but in animals adding insulin without changing the diet causes weight gain! This disproves the simplistic CICO advice of weight loss.
If the insulin is elevated (carbs/sugar in the diet) even calorie restriction does not prevent obesity in animals.
Just to clarify: insulin is bad yes, but only because the body releases it as a response to high blood sugar levels (it is what controls the blood sugar levels and you can't live without it) which you got because of high sugar intake (or refined sugar intake).
So IMO it's sugar (raw, refined, etc) that's the culprit. I'm also a keto fan so take that information for what it is.
I think it's unusual to say that insulin is bad. Chronic insulin resistance is surely a sign of poor metabolic health, because it means that the body has had to secrete a lot of it to address persistently high levels of glucose in the bloodstream, which is caused by eating too much sugar in any of its forms. Sugar (and by extension carbohydrates) is what is bad.
Like you said, it's a critical hormone and we cannot function without it. T1D is an inability to secrete enough insulin and those affected waste away very quickly without medical aid.
I'd add carbohydrates to the list of culprits. Sugar (raw, refined, etc) and Carbohydrates both end up in the blood stream as glucose, so as far as insulin response goes they are equivalent.
Can someone consume carbohydrates and maintain health? Sure! Is it helping them do so? not so much.
Totally, pasta bread lots of stuff.
Edit: more refined sugars/carbs spikes the blood sugar levels more and makes a worse insulinet response though.
It's funny, Dr. Barry Sears (Biochem PhD, not MD) wrote about all this in the early 90's in "The Zone" (with references).
It's all about keeping glucose stable, so the type and quality of calories matters.
He remarked that diabetes doctors knew this in the 1930's.
How the hell did the medical community go so sideways since then?
From what i've read the doctors who were uncovering the hormonal model of health in the 1930s were German and publishing in German based literature. After the world unpaused in the 1940s there wasn't much enthusiasm in the west for German publications.
Would you recommend reading that book?