The 4BE quinqunx: A model for obesity pathogenesis Authors Sanjay Kalra Department of Endocrinology, Bharti Hospital, Karnal, India; University Centre for Research & Development, Chandigarh University, Mohali, India Madhur Verma Department of Community/Family Medicine, All India Institute of Medical Sciences, Bathinda, India Nitin Kapoor Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, India; Non-communicable disease unit, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia DOI: https://doi.org/10.47391/JPMA.25-46 Abstract For obesity management to be effective, one mustappreciate its causes and consequences. To do so, theseemingly complex science of obesity must be madesimpler. A model which helps us explain its causes,contributory factors, as well as potential correctivemeasures, is needed. We share the 4BE winged quincunxmodel of obesity etiopathogenesis. Four central players -the Brain, Bowel, Beta/alpha cell and Bulk (adipose tissue)-form a causative quadruple, with four wings-Environmental determinants, Endocrine factors, Entericmicrobiome and Extraneous limitations. The centre of thequincunx is occupied, in a stylish manner, by the ABC ofweight management: Attitude, Behaviour and Choices.The 4BE concept makes it easy for health careprofessionals to understand, and explain, obesity.KEYWORDS: Biochemistry, endocrinology, obesity,overweight, pathogenesis, person centred care,therapeutic patient education Downloads Full Text Article Published 2025-06-01 How to Cite Sanjay Kalra, Madhur Verma, & Nitin Kapoor. (2025). The 4BE quinqunx: A model for obesity pathogenesis. Journal of the Pakistan Medical Association, 74(06), 1002–1003. https://doi.org/10.47391/JPMA.25-46 More Citation Formats ACM ACS APA ABNT Chicago Harvard IEEE MLA Turabian Vancouver Download Citation Endnote/Zotero/Mendeley (RIS) BibTeX Issue Vol. 74 No. 06 (2025): JUNE Section BAROCRINOLOGY License Copyright (c) 2025 Journal of the Pakistan Medical Association This work is licensed under a Creative Commons Attribution 4.0 International License.