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Principles of energy metabolism * Body energy stores of lean 70-kg man Energy is stored in the body in the form of triglyceride and glycogen within adipose tissue, liver, and skeletal muscle. Triglyceride present within adipose tissue is the body’s major fuel reserve. A lean adult has approximately 35 billion adipocytes, and each adipocyte contains about 0.4 to 0.6 μg of triglyceride. An extremely obese adult can have 4 times as many adipocytes, each containing up to twice as much lipid [1]. Intramuscular glycogen and triglyceride provide an important source of fuel for working muscles during exercise. Triglycerides are a fivefold better fuel per unit mass than glycogen, because triglycerides are stored compactly as an oil within adipocytes and liberate 9.3 kcal/g when oxidized, whereas glycogen is stored intracellularly as a gel, containing 2 g of water for every 1 g of glycogen, and liberate 4.1 kcal/g when oxidized. Hirsch J, Knittle JL. Cellularity of obese and non-obese human adipose tissue. Fed Proc 1970;29:1516-1521. * Obesity is caused by long-term positive energy balance Obesity is caused by ingesting more energy than is expended over a long period of time. The excess calories that are consumed lead to an accumulation of body fat either by being stored as fat or preventing the mobilization and oxidation of endogenous fat. In general, ingesting 3500 kcal more (or less) than expended will lead to a gain (or loss) of approximately 1 lb of fat. Genetic factors may influence the amount of weight gained with overfeeding. In one study, weight gain varied greatly among 12 monozygotic twin pairs who were chronically overfed 1000 kcal/d [1]. However, weight gains were very similar within each member of a twin pair. In another study, body fat gain after 8 weeks of overfeeding also varied among study subjects but was inversely related to changes in non-volitional energy expenditure, such as fidgeting, which may be determined genetically [2]. Bouchard C,