The role of dietary carbohydrates in the development of obesity and associated metabolic dysfunction has recently been questioned. Within the last decade, the Scientific Advisory Committee on Nutrition carried out a comprehensive evaluation of the role of dietary carbohydrates in human health. The current review aims to complement and extend this report by providing specific consideration of the effects of the component parts of energy balance, their interactions, and their culmination on energy storage and health. PubMed was searched for all published trials that had a minimum follow-up period of 3 months and were designed to manipulate dietary carbohydrate intake, irrespective of resultant differences in absolute carbohydrate dose (grams per day). Dietary carbohydrate manipulation has little effect on the individual components of energy balance that have been assessed. However, the role of dietary carbohydrates in influencing physical activity has yet to be assessed using gold-standard measurement tools. Moreover, adherence to a diet of modified carbohydrate content has not been found to result in a consistent pattern of changes in weight or indirect measures of metabolic health. However, certain markers of cardiovascular disease risk (ie, blood triglycerides and high-density lipoprotein cholesterol) may respond positively to a reduction in dietary carbohydrates.