Holistic approaches to explain and combat obesity

Obesity is a global health problem related to the Western lifestyle. Lifestyle is biological but also non-biological, and so requires more than studies of diet, exercise and mechanisms of cellular metabolism. The recent Perspective by Magkos et al.¹ provides an excellent overview of leading causal models in metabolic obesity research and new areas for future exploration. Specifically, they contrast the energy balance model (EBM) and the carbohydrate–insulin model (CIM). The latter can be considered a version of the fuel partitioning model (FPM)². We draw attention to the need for holistic, interdisciplinary approaches, with potential new ontological perspectives, to explain and combat obesity beyond what is currently considered within said existing biological models. The World Health Organization’s 1946 definition of health as “… complete physical, mental, and social well-being” points to such a holistic understanding of health. Over the past decades, spirituality has been suggested as a necessary fourth dimension of human health³. Although Magkos et al. include “psychosocial” among “other factors” in their model, they hardly discuss mental or social factors and leave out spirituality.

Drawing on experience from palliative care, spirituality is widely defined as the “dynamic and intrinsic aspect of humanity through which persons seek ultimate meaning, purpose, and transcendence, and experience relationship to self, family, others, community, society, nature, and the significant or sacred. Spirituality is expressed through beliefs, values, traditions, and practices”⁵. Recent epidemiological studies show robust associations between spirituality and health outcomes⁶. Such relations are challenging to explain entirely by altered metabolism or psychosocial factors, and the observed effects may be partly determined by independent effects of spirituality⁷. The majority of the global population expresses faith convictions in some form (spiritual, religious, secular and/or existential)^6,7,8. Spiritual needs and expressions are common, including in modern, secular cultures⁸. Hence, personal or communal spirituality may influence how people understand and relate to their body, food and eating⁹. Beyond psychosocial issues, existential anxiety may stimulate appetite and fat storage, in line with conventional EBM and FPM theories.