ABSTRACT
Obesity and related metabolic diseases are recent phenomena, products of our increasingly industrialized world. Our Paleolithic hunter-gatherer ancestors and the subsistence farming communities that succeeded them were largely protected from these diseases. Here, we discuss how our evolutionary legacy as hunter-gatherers leaves us vulnerable to obesity and cardiometabolic disease in industrialized societies. Hunting and gathering, as well as subsistence farming, require high levels of daily physical activity. Hunter-gatherer diets are remarkably variable across time and geography, but typically include a balance of plant and animal foods. Human physiology is therefore adapted to high levels of daily physical activity and a wide range of diets. The sedentary behavior and heavily processed foods typical of modern societies are evolutionarily novel and promote poor health. Exercise is essential for cardiometabolic health but is less effective as a weight loss tool, and societal changes in physical activity do not appear to have contributed substantially to the modern obesity pandemic. Instead, recent changes in diet, particularly the growing prevalence of ultra-processed foods, have likely been the primary societal drivers of the obesity pandemic.
