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Singh S, Mayer L, Rosenbaum M, Lowe MR. Weight History Correlates of Resting Energy Expenditure in Women With Bulimia Nervosa. Int J Eat Disord 2024. [PMID: 38949507 DOI: 10.1002/eat.24250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 06/07/2024] [Accepted: 06/10/2024] [Indexed: 07/02/2024]
Abstract
OBJECTIVE Among those with bulimia nervosa, weight suppression has been associated with illness severity and treatment prognosis. Although significant weight loss is known to reduce metabolic rate, the relation between weight suppression and resting energy expenditure (REE) in bulimia nervosa has not been examined. This study tested the hypothesis of an inverse relation between weight suppression and REE in a sample of women with bulimia nervosa (N = 84). METHODS In primary analyses, linear regressions were conducted between weight suppression and REE, corrected for fat-free mass. In follow-up, exploratory analyses, stepwise linear regressions were conducted to explore the main and interaction effects of weight history and weight suppression on REE. RESULTS Neither traditional (TWS) nor developmental weight suppression (DWS) correlated with REE. Results from exploratory analyses, however, revealed a medium-to-large inverse relation between several weight history variables and REE (highest past weight, sr2 = 0.05; lowest postmorbid weight, sr2 = 0.07; current weight, sr2 = 0.05). Additionally, DWS interacted with current (sr2 = 0.08) and highest premorbid (sr2 = 0.05) z-BMI to influence REE with a medium-to-large effect. For individuals low in current and premorbid z-BMIs, higher DWS associated with lower REE levels. However, for individuals at higher premorbid z-BMIs, higher DWS unexpectedly associated with greater REE levels. DISCUSSION In this sample of women with bulimia nervosa, reduced REE associated with higher weights across all timepoints. If the interaction effect between DWS and z-BMI history persists in future studies, this may indicate unique challenges faced by individuals low in z-BMI and high in DWS related to weight gain and normalization of eating.
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Affiliation(s)
- Simar Singh
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, USA
- Department of Psychological and Brain Sciences, Drexel University, Philadelphia, USA
| | - Laurel Mayer
- Department of Psychiatry, Columbia University Irving Medical Center, New York City, USA
| | - Michael Rosenbaum
- Department of Pediatrics, Columbia University Irving Medical Center, New York City, USA
- Columbia University Clinical and Translational Science Award Program, New York City, USA
| | - Michael R Lowe
- Department of Psychological and Brain Sciences, Drexel University, Philadelphia, USA
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Гусейнова РМ, Доровских АВ, Васюкова ОВ, Шестакова ЕА, Окороков ПЛ, Мокрышева НГ. [The causes of obesity relapse after weight loss]. PROBLEMY ENDOKRINOLOGII 2023; 70:67-73. [PMID: 39069774 PMCID: PMC11334232 DOI: 10.14341/probl13275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 03/11/2024] [Accepted: 11/03/2023] [Indexed: 07/30/2024]
Abstract
The main problem of obesity treatment is the difficulty of long-term weight maintenance. From one point of view, it can easily be explained by patients' low compliance and absence of self-control. From another point of view, body weight is regulated not only by persons will, but also by multiple physiological mechanisms. Moreover, studies demonstrate that the attempts to reduce body weight stimulate the activation of adaptive biological process that block weight reduction.Despite the variety of obesity treatment methods, only few patients are able to achieve significant (at least 5-7%) weight loss and maintain the result. In most cases people return to the initial weight in about 3-5 years. Therefore it is relevant to study weight regain mechanisms in order to identify new effective obesity treatment strategies.The objective of this review is to summarize the information about the main issues of central, peripheral and behavioral pathogenic mechanisms which lead to disease relapse after obesity treatment and ideas for future strategies to resolve them.
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Affiliation(s)
- Р. М. Гусейнова
- Национальный медицинский исследовательский центр эндокринологии
| | - А. В. Доровских
- Национальный медицинский исследовательский центр эндокринологии
| | - О. В. Васюкова
- Национальный медицинский исследовательский центр эндокринологии
| | - Е. А. Шестакова
- Национальный медицинский исследовательский центр эндокринологии
| | - П. Л. Окороков
- Национальный медицинский исследовательский центр эндокринологии
| | - Н. Г. Мокрышева
- Национальный медицинский исследовательский центр эндокринологии
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Martins C, Gower BA, Hunter GR. Metabolic adaptation delays time to reach weight loss goals. Obesity (Silver Spring) 2022; 30:400-406. [PMID: 35088553 PMCID: PMC8852805 DOI: 10.1002/oby.23333] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 09/29/2021] [Accepted: 10/14/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The aim of this study was to determine whether metabolic adaptation, at the level of resting metabolic rate, was associated with time to reach weight loss goals, after adjusting for confounders. METHODS A total of 65 premenopausal women with overweight (BMI: 28.6 ± 1.5 kg/m2 ; age: 36.4 ± 5.9 years; 36 were White, and 29 were Black) followed an 800-kcal/d diet until BMI ≤25 kg/m2 . Body weight and composition were measured at baseline and after weight loss. Dietary adherence was calculated from total energy expenditure, determined by double labeled water, and body composition changes. Metabolic adaptation was defined as a significantly lower measured versus predicted resting metabolic rate (from own regression model). A regression model to predict time to reach weight loss goals was developed including target weight loss, energy deficit, dietary adherence, and metabolic adaptation as predictors. RESULTS Participants lost on average 12.5 ± 3.1 kg (16.1% ± 3.4%) over 155.1 ± 49.2 days. Average dietary adherence was 63.6% ± 31.0%. There was significant metabolic adaptation after weight loss (-46 ± 113 kcal/d, p = 0.002) and this variable was a significant predictor of time to reach weight loss goals (β = -0.1, p = 0.041), even after adjusting for confounders (R2 adjusted = 0.63, p < 0.001). CONCLUSION In premenopausal women with overweight, metabolic adaptation after a 16% weight loss increases the length of time necessary to achieve weight loss goals.
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Affiliation(s)
- Catia Martins
- Obesity Research Group, Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Centre for Obesity and Innovation (ObeCe), Clinic of Surgery, St. Olav University Hospital, Trondheim, Norway
- Department of Nutrition Sciences, University of Alabama at Birmingham, USA
| | - Barbara A Gower
- Department of Nutrition Sciences, University of Alabama at Birmingham, USA
| | - Gary R Hunter
- Department of Nutrition Sciences, University of Alabama at Birmingham, USA
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Abstract
The observation that 64% of English adults are overweight or obese despite a rising prevalence in weight-loss attempts suggests our understanding of energy balance is fundamentally flawed. Weight-loss is induced through a negative energy balance; however, we typically view weight change as a static function, in that energy intake and energy expenditure are independent variables, resulting in a fixed rate of weight-loss assuming a constant energy deficit. Such static modelling provides the basis for the clinical assumption that a 14644 kJ (3500 kcal) deficit translates to a 1 lb weight-loss. However, this '3500 kcal (14644 kJ) rule' is consistently shown to significantly overestimate weight-loss. Static modelling disregards obligatory changes in energy expenditure associated with the loss of metabolically active tissue, i.e. skeletal muscle. Additionally, it disregards the presence of adaptive thermogenesis, the underfeeding-associated fall in resting energy expenditure beyond that caused by loss of fat-free mass. This metabolic manipulation of energy expenditure is observed from the onset of energy restriction to maintain weight at a genetically pre-determined set point. As a result, the observed magnitude of weight-loss is disproportionally less, followed by earlier weight plateau, despite strict compliance to a dietary intervention. By simulating dynamic changes in energy expenditure associated with underfeeding, mathematical modelling may provide a more accurate method of weight-loss prediction. However, accuracy at an individual level is limited due to difficulty estimating energy requirements, physical activity and dietary intake in free-living individuals. In the present paper, we aim to outline the contribution of dynamic changes in energy expenditure to weight-loss resistance and weight plateau.
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A longitudinal study of the antilipolytic effect of insulin in women following bariatric surgery. Int J Obes (Lond) 2021; 45:2675-2678. [PMID: 34321614 PMCID: PMC8606310 DOI: 10.1038/s41366-021-00914-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 07/07/2021] [Accepted: 07/08/2021] [Indexed: 11/08/2022]
Abstract
Insulin resistance of glucose utilization is fully restored following BMI normalization after bariatric surgery. We investigated if this also pertains to insulin-induced effects on fatty acid handling. Forty-three women with obesity (OB) were investigated before and 2 years after Roux-en-Y gastric by-pass when BMI was <30 kg/m2 (PO) and compared with 26 never obese women (NO). The Adipo-IR index was used as measure of insulin antilipolytic sensitivity. Changes (delta) in circulating glycerol and fatty acid levels during hyperinsulinemic euglycemic clamp represented the insulin maximum antilipolytic effect. Overall fatty acid utilization was reflected by delta fatty acids minus 3 × delta glycerol. Adipo-IR was higher in OB than in NO and PO (p < 0.0001), the latter two groups having similar values. Insulin lowered glycerol levels by about 70% in all groups, but delta glycerol was 30% larger in PO than in NO (p = 0.04). Delta adds and adds utilization were similar in all groups. We conclude that women with obesity, whose BMI is normalized after bariatric surgery, have improved maximum in vivo antilipolytic effect of insulin above expected in absolute but not relative terms as regards glycerol changes, while the handling of circulating fatty acids is changed to the normal state.
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Martins C, Roekenes J, Hunter GR, Gower BA. Association between ketosis and metabolic adaptation at the level of resting metabolic rate. Clin Nutr 2021; 40:4824-4829. [PMID: 34358822 DOI: 10.1016/j.clnu.2021.06.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 05/18/2021] [Accepted: 06/28/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND The ketone body β-hydroxybutyrate (βHB) has been shown to act as a signaling molecule that regulates metabolism and energy homeostasis during starvation in animal models. A potential association between βHB and metabolic adaptation (a reduction in energy expenditure below predicted levels) in humans has never been explored. OBJECTIVE To determine if metabolic adaptation at the level of resting metabolic rate (RMR) was associated with the magnitude of ketosis induced by a very-low energy diet (VLED). A secondary aim was to investigate if the association was modulated by sex. METHODS Sixty-four individuals with obesity (BMI: 34.5 ± 3.4 kg/m2; age: 45.7 ± 8.0 years; 31 males) enrolled in a 1000 kcal/day diet for 8 weeks. Body weight/composition, RMR and βHB (as a measure of ketosis) were determined at baseline and week 9 (W9). Metabolic adaptation was defined as a significantly lower measured versus predicted RMR (from own regression model). RESULTS Participants lost on average 14.0 ± 3.9 kg and were ketotic (βHB: 0.76 ± 0.51 mM) at W9. A significant metabolic adaptation was seen (-84 ± 106 kcal/day, P < 0.001), with no significant differences between sexes. [βHB] was positively correlated with the magnitude of metabolic adaptation in females (r = 0.432, P = 0.012, n = 33), but not in males (r = 0.089, P = 0.634, n = 31). CONCLUSION In females with obesity, but not males, the larger the [βHB] under VLED, the greater the metabolic adaptation at the level of RMR. More studies are needed to confirm these findings and to explore the mechanisms behind the sex difference in the association between ketosis and metabolic adaptation. TRIAL REGISTRATION NAME Clinicaltrials.gov. STUDY REGISTRATION ID NCT02944253. URL: https://clinicaltrials.gov/ct2/show/NCT02944253.
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Affiliation(s)
- Catia Martins
- Obesity Research Group, Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Centre for Obesity and Innovation (ObeCe), Clinic of Surgery, St. Olav University Hospital, Trondheim, Norway; Department of Nutrition Sciences, University of Alabama at Birmingham, USA.
| | - Jessica Roekenes
- Obesity Research Group, Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Gary R Hunter
- Department of Nutrition Sciences, University of Alabama at Birmingham, USA
| | - Barbara A Gower
- Department of Nutrition Sciences, University of Alabama at Birmingham, USA
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Martins C, Roekenes J, Gower BA, Hunter GR. Metabolic adaptation is associated with less weight and fat mass loss in response to low-energy diets. Nutr Metab (Lond) 2021; 18:60. [PMID: 34116675 PMCID: PMC8196522 DOI: 10.1186/s12986-021-00587-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 06/03/2021] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND The practical relevance of metabolic adaptation remains a controversial issue. To the best of our knowledge, no study has properly evaluated the role of metabolic adaptation in modulating weight loss outcomes. Therefore, the aim of this study was to determine the association between metabolic adaptation, at the level of resting metabolic rate (RMR), and weight and fat mass (FM) loss after low-energy diets (LED), after adjusting for dietary adherence and other confounders. METHODS 71 individuals with obesity (BMI: 34.6 ± 3.4 kg/m2; age: 45.4 ± 8.2 years; 33 males) were randomized to one of three 1000 kcal/day diets for 8 weeks. Body weight, FM and fat-free mass (FFM) (air displacement plethysmography), RMR (indirect calorimetry) and physical activity level (PAL) (armbands) were measured at baseline and at week 9. Metabolic adaptation at week 9 was defined as measured RMR minus predicted RMR at week 9. An equation to predict RMR was derived from baseline data of all participants that were part of this analysis and included age, sex, FM and FFM as predictors. Dietary adherence was calculated from RMR, PAL and body composition changes. Linear regression was used to assess the potential role of metabolic adaptation in predicting weight and FM loss after adjusting for dietary adherence, average PAL, sex, baseline FM and FFM and randomization group. RESULTS Participants lost on average 14 ± 4 kg of body weight (13 ± 3%) and presented with metabolic adaptation (-92 ± 110 kcal/day, P < 0.001). Metabolic adaptation was a significant predictor of both weight (β = -0.009, P < 0.001) and FM loss (β = -0.008, P < 0.001), even after adjusting for confounders (R2 = 0.88, 0.93, respectively, P < 0.001 for both). On average, an increase in metabolic adaptation of 50 kcal/day was associated with a 0.5 kg lower weight and FM loss in response to the LED. CONCLUSION In individuals with obesity, metabolic adaptation at the level of RMR is associated with less weight and FM loss in response to LED. Trial registration ID: NCT02944253.
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Affiliation(s)
- Catia Martins
- Obesity Research Group, Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Forsyningssenteret, Prinsesse Kristinas Gate 5, 7030, Trondheim, Norway.
- Centre for Obesity and Innovation (ObeCe), Clinic of Surgery, St. Olav University Hospital, Trondheim, Norway.
- Department of Nutrition Sciences, University of Alabama At Birmingham, Birmingham, USA.
| | - Jessica Roekenes
- Obesity Research Group, Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Forsyningssenteret, Prinsesse Kristinas Gate 5, 7030, Trondheim, Norway
| | - Barbara A Gower
- Department of Nutrition Sciences, University of Alabama At Birmingham, Birmingham, USA
| | - Gary R Hunter
- Department of Nutrition Sciences, University of Alabama At Birmingham, Birmingham, USA
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Heymsfield SB, Smith B, Dahle J, Kennedy S, Fearnbach N, Thomas DM, Bosy-Westphal A, Müller MJ. Resting Energy Expenditure: From Cellular to Whole-Body Level, a Mechanistic Historical Perspective. Obesity (Silver Spring) 2021; 29:500-511. [PMID: 33624441 DOI: 10.1002/oby.23090] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 11/13/2020] [Accepted: 11/16/2020] [Indexed: 12/12/2022]
Abstract
The basis of heat generated by the human body has been a source of speculation and research for more than 2,000 years. Basal heat production, now usually referred to as resting energy expenditure (REE), is currently recognized as deriving from biochemical reactions at subcellular and cellular levels that are expressed in the energy expended by the body's 78 organs and tissues. These organs and tissues, and the 11 systems to which they belong, influence body size and shape. Connecting these subcellular-/cellular-level reactions to organs and tissues, and then on to body size and shape, provides a comprehensive understanding of individual differences in REE, a contemporary topic of interest in obesity research and clinical practice. This review critically examines these linkages, their association with widely used statistical and physiological REE prediction formulas, and often-unappreciated aspects of measuring basal heat production in humans.
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Affiliation(s)
| | - Brooke Smith
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Jared Dahle
- Integrated Physiology Program, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Samantha Kennedy
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Nicole Fearnbach
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Diana M Thomas
- Department of Mathematical Sciences, United States Military Academy West Point, New York, USA
| | - Anja Bosy-Westphal
- Department of Human Nutrition and Food Science, Christian-Albrecht University of Kiel, Kiel, Germany
| | - Manfred J Müller
- Department of Human Nutrition and Food Science, Christian-Albrecht University of Kiel, Kiel, Germany
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Martins C, Roekenes J, Salamati S, Gower BA, Hunter GR. Metabolic adaptation is an illusion, only present when participants are in negative energy balance. Am J Clin Nutr 2020; 112:1212-1218. [PMID: 32844188 PMCID: PMC7657334 DOI: 10.1093/ajcn/nqaa220] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 07/10/2020] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND The existence of metabolic adaptation, following weight loss, remains a controversial issue. To our knowledge, no study has evaluated the role of energy balance (EB) in modulating metabolic adaptation. OBJECTIVES The aim of this study was to determine if metabolic adaptation, at the level of resting metabolic rate (RMR), is modulated by participants' EB status. A secondary aim was to investigate if metabolic adaptation was associated with weight regain. METHODS Seventy-one individuals with obesity (BMI: 34.6 ± 3.4 kg/m2; age: 45.4 ± 8.2 y; 33 men) enrolled in a 1000-kcal/d diet for 8 wk, followed by 4 wk of weight stabilization and a 9-mo weight loss maintenance program. Body weight/composition and RMR were measured at baseline, week 9 (W9), week 13 (W13), and 1 y (1Y). Metabolic adaptation was defined as a significantly different (lower or higher) measured compared with predicted RMR. RESULTS Participants lost on average 14 kg by W9, followed by weight stabilization at W13, and regained 29% of their initial weight loss at 1Y. Metabolic adaptation was found at W9 (-92 ± 110 kcal/d, P < 0.001) and W13 (-38 ± 124 kcal/d, P = 0.011) but was not correlated with weight regain. A significant reduction in metabolic adaptation was seen between W9 and W13 (-53 ± 101 kcal/d, P < 0.001). In a subset of participants who gained weight between W9 and W13 (n = 33), no metabolic adaptation was seen at W13 (-26.8 ± 121.5 kcal/d, P = 0.214). In a subset of participants with data at all time points (n = 45), metabolic adaptation was present at W9 and W13 (-107 ± 102 kcal/d, P < 0.001 and -49 ± 128 kcal/d, P = 0.013) but not at 1Y (-7 ± 129, P = 0.701). CONCLUSION After weight loss, metabolic adaptation at the level of RMR is dependent on the EB status of the participants, being reduced to half after a period of weight stabilization. Moreover, metabolic adaptation does not predict weight regain at 1Y follow-up. These trials were registered at clinicaltrials.gov as NCT02944253 and NCT03287726.
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Affiliation(s)
- Catia Martins
- Obesity Research Group, Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Centre for Obesity and Innovation (ObeCe), Clinic of Surgery, St. Olav University Hospital, Trondheim, Norway
- Department of Nutrition Sciences, University of Alabama, Birmingham, AL, USA
| | - Jessica Roekenes
- Obesity Research Group, Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Saideh Salamati
- Centre for Obesity and Innovation (ObeCe), Clinic of Surgery, St. Olav University Hospital, Trondheim, Norway
| | - Barbara A Gower
- Department of Nutrition Sciences, University of Alabama, Birmingham, AL, USA
| | - Gary R Hunter
- Department of Nutrition Sciences, University of Alabama, Birmingham, AL, USA
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Martins C, Dutton GR, Hunter GR, Gower BA. Revisiting the Compensatory Theory as an explanatory model for relapse in obesity management. Am J Clin Nutr 2020; 112:1170-1179. [PMID: 32936896 PMCID: PMC7657332 DOI: 10.1093/ajcn/nqaa243] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 08/04/2020] [Indexed: 12/21/2022] Open
Abstract
Weight regain remains the main challenge in obesity management, and its etiology remains elusive. The aim of the present review was to revise the available evidence regarding the "Compensatory Theory," which is an explanatory model of relapse in obesity treatment, and to propose alternative mechanisms that can contribute to weight regain. It has been proposed, and generally accepted as true, that when a person loses weight the body fights back, with physiological adaptations on both sides of the energy balance equation that try to bring body weight back to its original state: this is the Compensatory Theory. This theory proposes that the increased orexigenic drive to eat and the reduced energy expenditure that follow weight loss are the main drivers of relapse. However, evidence showing a link between these physiological adaptations to weight loss and weight regain is lacking. Here, we propose that the physiological adaptations to weight loss, both at the level of the homeostatic appetite control system and energy expenditure, are in fact a normalization to a lower body weight and not drivers of weight regain. In light of this we explore other potential mechanisms, both physiological and behavioral, that can contribute to the high incidence of relapse in obesity management. More research is needed to clearly ascertain whether the changes in energy expenditure and homeostatic appetite markers seen in reduced-obese individuals are a compensatory mechanism that drives relapse or a normalization towards a lower body weight, and to explore alternative hypotheses that explain relapse in obesity management.
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Affiliation(s)
| | - Gareth R Dutton
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Gary R Hunter
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL
| | - Barbara A Gower
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL
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Martins C, Gower BA, Hill JO, Hunter GR. Metabolic adaptation is not a major barrier to weight-loss maintenance. Am J Clin Nutr 2020; 112:558-565. [PMID: 32386226 PMCID: PMC7458773 DOI: 10.1093/ajcn/nqaa086] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 04/06/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The existence of metabolic adaptation, at the level of resting metabolic rate (RMR), remains highly controversial, likely due to lack of standardization of participants' energy balance. Moreover, its role as a driver of relapse remains unproven. OBJECTIVE The main aim was to determine if metabolic adaptation at the level of RMR was present after weight loss and at 1- and 2-y follow-up, with measurements taken under condition of weight stability. A secondary aim was to investigate race differences in metabolic adaptation after weight loss and if this phenomenon was associated with weight regain. METHODS A total of 171 overweight women [BMI (kg/m2): 28.3 ± 1.3; age: 35.2 ± 6.3 y; 88 whites and 83 blacks] enrolled in a weight-loss program to achieve a BMI <25, and were followed for 2 y. Body weight and composition (4-compartment model) and RMR (indirect calorimetry) were measured after 4 wk of weight stability at baseline, after weight loss and at 1 and 2 y. Metabolic adaptation was defined as a significantly lower measured compared with predicted RMR (from own regression model). RESULTS Participants lost, on average, 12 ± 2.6 kg and regained 52% ± 38% and 89% ± 54% of their initial weight lost at 1 and 2 y follow-up, respectively. Metabolic adaptation was found after weight loss (-54 ± 105 kcal/d; P < 0.001), with no difference between races and was positively correlated with fat-mass loss, but not with weight regain, overall. In a subset of women (n = 46) with data at all time points, metabolic adaptation was present after weight loss, but not at 1- or 2-y follow-up (-43 ± 119, P = 0.019; -18 ± 134, P = 0.380; and - 19 ± 166, P = 0.438 kcal/day respectively). CONCLUSIONS In overweight women, metabolic adaptation at the level of RMR is minimal when measurements are taken under conditions of weight stability and does not predict weight regain up to 2 years follow-up.The JULIET study is registered at https://clinicaltrials.gov/ct2/show/NCT00067873 as NCT00067873.
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Affiliation(s)
| | - Barbara A Gower
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
| | - James O Hill
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Gary R Hunter
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
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Paixão C, Dias CM, Jorge R, Carraça EV, Yannakoulia M, de Zwaan M, Soini S, Hill JO, Teixeira PJ, Santos I. Successful weight loss maintenance: A systematic review of weight control registries. Obes Rev 2020; 21:e13003. [PMID: 32048787 PMCID: PMC9105823 DOI: 10.1111/obr.13003] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 01/09/2020] [Accepted: 01/10/2020] [Indexed: 12/25/2022]
Abstract
Weight loss maintenance is a major challenge for obesity treatment. Weight control registries can be useful in identifying psychological and behavioural factors that could contribute to better long-term success. The objective of this study is to describe the existing weight control registries and their participants and identify correlates of weight loss maintenance. A comprehensive search of peer-reviewed articles published until November 2018 was conducted in PubMed, Web of Science, and Scopus. Studies that reported results from weight control registries were considered. Fifty-two articles, corresponding to five registries (the United States, Portugal, Germany, Finland, and Greece), were included. Registries differed in inclusion criteria and procedures. Of 51 identified weight loss and maintenance strategies, grouped in 14 domains of the Oxford Food and Activity Behaviors taxonomy, the following were the most frequently reported: having healthy foods available at home, regular breakfast intake, increasing vegetable consumption, decreasing sugary and fatty foods, limiting certain foods, and reducing fat in meals. Increased physical activity was the most consistent positive correlate of weight loss maintenance. To our knowledge, this is the first systematic review of information about successful weight loss maintenance obtained from weight control registries. Key common influential characteristics of success were identified, which can inform future prospective studies and weight management initiatives.
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Affiliation(s)
- Catarina Paixão
- Centro Interdisciplinar para o Estudo da Performance Humana, Faculdade de Motricidade Humana, Universidade de Lisboa, Cruz Quebrada Dafundo, Portugal
| | - Carlos M Dias
- Centro de Investigação em Saúde Pública (CISP), NOVA-Escola Nacional de Saúde Pública, Lisbon, Portugal.,Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal
| | - Rui Jorge
- Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Universitário Egas Moniz, Almada, Portugal.,Unidade de Investigação do Instituto Politécnico de Santarém, Escola Superior Agrária, Instituto Politécnico de Santarém, Santarém, Portugal
| | - Eliana V Carraça
- Centro Interdisciplinar para o Estudo da Performance Humana, Faculdade de Motricidade Humana, Universidade de Lisboa, Cruz Quebrada Dafundo, Portugal
| | - Mary Yannakoulia
- Department of Nutrition and Dietetics, Harokopio University, Athens, Greece
| | - Martina de Zwaan
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Sirpa Soini
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland
| | - James O Hill
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, Alabama
| | - Pedro J Teixeira
- Centro Interdisciplinar para o Estudo da Performance Humana, Faculdade de Motricidade Humana, Universidade de Lisboa, Cruz Quebrada Dafundo, Portugal
| | - Inês Santos
- Centro Interdisciplinar para o Estudo da Performance Humana, Faculdade de Motricidade Humana, Universidade de Lisboa, Cruz Quebrada Dafundo, Portugal.,Laboratório de Nutrição, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
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13
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Péronnet F, Haman F. Low capacity to oxidize fat and body weight. Obes Rev 2019; 20:1367-1383. [PMID: 31353786 DOI: 10.1111/obr.12910] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 06/09/2019] [Accepted: 06/10/2019] [Indexed: 12/16/2022]
Abstract
For a given positive energy balance, a low capacity to oxidize fat could contribute to weight gain (low fat oxidation hypothesis). This hypothesis is based on the arguments that for a given stable diet and food quotient (FQ), the respiratory quotient (RQ) is higher in obesity prone (OP) than in obesity resistant individuals (OR) and that a high RQ predicts higher future weight gain. A review of 42 studies shows that there is no convincing experimental support to these arguments and thus for the low fat oxidation hypothesis. A power analysis also shows that this hypothesis might be impossible to experimentally confirm because very large numbers of subjects would be needed to reject the null hypotheses that the 24-h RQ is not different in OP and OR or that future weight gain is not different in individuals with a low and high 24-h RQ at baseline. A re-examination of the significance of the 24-hour and fasting RQ also shows that the assumption underlying the low fat oxidation hypothesis that a high RQ reflects a low capacity to oxidize fat is not valid: For a stable diet, the 24-h RQ entirely depends on FQ and energy balance, and the fasting RQ mainly depends on the FQ and energy balance and on the size of glycogen stores.
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Affiliation(s)
- François Péronnet
- École de kinésiologie et des sciences de l'activité physique, Faculté de Médecine, Université de Montréal, Montréal, QC, Canada
| | - François Haman
- École des sciences de l'activité physique, Faculté des sciences de la santé, Université d'Ottawa, Ottawa, ON, Canada
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14
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Ostendorf DM, Melanson EL, Caldwell AE, Creasy SA, Pan Z, MacLean PS, Wyatt HR, Hill JO, Catenacci VA. No consistent evidence of a disproportionately low resting energy expenditure in long-term successful weight-loss maintainers. Am J Clin Nutr 2018; 108:658-666. [PMID: 30321282 PMCID: PMC6186213 DOI: 10.1093/ajcn/nqy179] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 07/06/2018] [Indexed: 12/20/2022] Open
Abstract
Background Evidence in humans is equivocal in regards to whether resting energy expenditure (REE) decreases to a greater extent than predicted for the loss of body mass with weight loss, and whether this disproportionate decrease in REE persists with weight-loss maintenance. Objectives We aimed to1) determine if a lower-than-predicted REE is present in a sample of successful weight-loss maintainers (WLMs) and 2) determine if amount of weight loss or duration of weight-loss maintenance are correlated with a lower-than-predicted REE in WLMs. Design Participants (18-65 y old) were recruited in 3 groups: WLMs (maintaining ≥13.6 kg weight loss for ≥1 y, n = 34), normal-weight controls [NCs, body mass index (BMI; in kg/m2) similar to current BMI of WLMs, n = 35], and controls with overweight/obesity (OCs, BMI similar to pre-weight-loss maximum BMI of WLMs, n = 33). REE was measured (REEm) with indirect calorimetry. Predicted REE (REEp) was determined via 1) a best-fit linear regression developed with the use of REEm, age, sex, fat-free mass, and fat mass from our control groups and 2) three standard predictive equations. Results REEm in WLMs was accurately predicted by equations developed from NCs and OCs (±1%) and by 3 standard predictive equations (±3%). In WLMs, individual differences between REEm and REEp ranged from -257 to +163 kcal/d. A lower REEm compared with REEp was correlated with amount of weight lost (r = 0.36, P < 0.05) but was not correlated with duration of weight-loss maintenance (r = 0.04, P = 0.81). Conclusions We found no consistent evidence of a significantly lower REE than predicted in a sample of long-term WLMs based on predictive equations developed from NCs and OCs as well as 3 standard predictive equations. Results suggest that sustained weight loss may not always result in a substantial, disproportionately low REE. This trial was registered at clinicaltrials.gov as NCT03422380.
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Affiliation(s)
- Danielle M Ostendorf
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO,Anschutz Health and Wellness Center, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO,Address correspondence to DMO (e-mail: )
| | - Edward L Melanson
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO,Division of Geriatric Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO,Eastern Colorado VA Geriatric Research, Education, and Clinical Center, Denver, CO
| | - Ann E Caldwell
- Anschutz Health and Wellness Center, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Seth A Creasy
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Zhaoxing Pan
- Department of Biostatistics and Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Paul S MacLean
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Holly R Wyatt
- Anschutz Health and Wellness Center, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO,Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - James O Hill
- Anschutz Health and Wellness Center, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Victoria A Catenacci
- Anschutz Health and Wellness Center, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO,Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
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15
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Wan Y, Bao X, Huang J, Zhang X, Liu W, Cui Q, Jiang D, Wang Z, Liu R, Wang Q. Novel GLP-1 Analog Supaglutide Reduces HFD-Induced Obesity Associated with Increased Ucp-1 in White Adipose Tissue in Mice. Front Physiol 2017; 8:294. [PMID: 28555111 PMCID: PMC5430033 DOI: 10.3389/fphys.2017.00294] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 04/24/2017] [Indexed: 12/14/2022] Open
Abstract
GLP-1, an important incretin hormone plays an important role in the regulation of glucose homeostasis. However, the therapeutic use of native GLP-1 is limited due to its short half-life. We recently developed a novel GLP-1 mimetics (supaglutide) by genetically engineering recombinant fusion protein production techniques. We demonstrated that this formulation possessed long-lasting GLP-1 actions and was effective in glycemic control in both type 1 and type 2 diabetes rodent models. Here, we investigated the effects of supaglutide in regulating energy homeostasis in obese mice. Mice were fed with high-fat diet (HFD) for 6 months to induce obesity and then subjected to supaglutide treatment (300 μg/kg, bi-weekly for 4 weeks), and placebo as control. Metabolic conditions were monitored and energy expenditure was assessed by indirect calorimetry (CLAMS). Cold tolerance test was performed to evaluate brown-adipose tissue (BAT) activities in response to cold challenge. Glucose tolerance and insulin resistance were evaluated by intraperitoneal glucose tolerance test and insulin tolerance tests. Liver and adipose tissues were collected for histology analysis. Expression of uncoupling protein 1(Ucp1) in adipose tissues was evaluated by Western blotting. We found that supaglutide treatment reduced body weight, which was associated with reduced food intake. Compared to the placebo control, supaglutide treatment improved lipid profile, i.e., significantly decreased circulating total cholesterol levels, declined serum triglyceride, and free fatty acid levels. Importantly, the intervention significantly reduced fatty liver, decreased liver triglyceride content, and concomitantly ameliorated liver injury exemplified by declined hepatic alanine aminotransferase (ALT) and aspartic transaminase (AST) content. Remarkably, supaglutide reduced hepatic lipid accumulation and altered morphometry in favor of small adipocytes in fat. This is consistent with the observation that supaglutide increased tolerance of the mice to cold environment associated with up-regulation of Ucp1 in the inguinal fat. Furthermore, supaglutide improved glucose tolerance, and insulin sensitivity in the obese mice suggesting improved glucose and energy homeostasis. Our findings suggest that supaglutide exerts beneficial effect on established obesity through reducing energy intake and is associated with brown remodeling of white adipose tissue.
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Affiliation(s)
- Yun Wan
- Department of Endocrinology and Metabolism, Huashan Hospital, Fudan UniversityShanghai, China
| | - Xi Bao
- Yinnuo Pharmaceutical Technology Co. Ltd.Shanghai, China
| | - Jiabao Huang
- Yinnuo Pharmaceutical Technology Co. Ltd.Shanghai, China
| | - Xiangyu Zhang
- Yinnuo Pharmaceutical Technology Co. Ltd.Shanghai, China
| | - Wenjuan Liu
- Department of Endocrinology and Metabolism, Huashan Hospital, Fudan UniversityShanghai, China.,Division of Endocrinology and Metabolism, Keenan Research Centre for Biomedical Science, St. Michael's HospitalToronto, ON, Canada
| | - Qiaoli Cui
- Department of Endocrinology and Metabolism, Huashan Hospital, Fudan UniversityShanghai, China
| | - Dongdong Jiang
- Department of Endocrinology and Metabolism, Huashan Hospital, Fudan UniversityShanghai, China
| | - Zhihong Wang
- Department of Endocrinology and Metabolism, Huashan Hospital, Fudan UniversityShanghai, China
| | - Rui Liu
- Department of Endocrinology and Metabolism, Huashan Hospital, Fudan UniversityShanghai, China
| | - Qinghua Wang
- Department of Endocrinology and Metabolism, Huashan Hospital, Fudan UniversityShanghai, China.,Yinnuo Pharmaceutical Technology Co. Ltd.Shanghai, China.,Division of Endocrinology and Metabolism, Keenan Research Centre for Biomedical Science, St. Michael's HospitalToronto, ON, Canada.,Departments of Physiology and Medicine, Faculty of Medicine, University of TorontoON, Canada
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16
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Pappa GL, Cunha TO, Bicalho PV, Ribeiro A, Couto Silva AP, Meira W, Beleigoli AMR. Factors Associated With Weight Change in Online Weight Management Communities: A Case Study in the LoseIt Reddit Community. J Med Internet Res 2017; 19:e17. [PMID: 28093378 PMCID: PMC5282451 DOI: 10.2196/jmir.5816] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 09/05/2016] [Accepted: 10/22/2016] [Indexed: 11/23/2022] Open
Abstract
Background Recent research has shown that of the 72% of American Internet users who have looked for health information online, 22% have searched for help to lose or control weight. This demand for information has given rise to many online weight management communities, where users support one another throughout their weight loss process. Whether and how user engagement in online communities relates to weight change is not totally understood. Objective We investigated the activity behavior and analyze the semantic content of the messages of active users in LoseIt (r/loseit), a weight management community of the online social network Reddit. We then explored whether these features are associated with weight loss in this online social network. Methods A data collection tool was used to collect English posts, comments, and other public metadata of active users (ie, users with at least one post or comment) on LoseIt from August 2010 to November 2014. Analyses of frequency and intensity of user interaction in the community were performed together with a semantic analysis of the messages, done by a latent Dirichlet allocation method. The association between weight loss and online user activity patterns, the semantics of the messages, and real-world variables was found by a linear regression model using 30-day weight change as the dependent variable. Results We collected posts and comments of 107,886 unique users. Among these, 101,003 (93.62%) wrote at least one comment and 38,981 (36.13%) wrote at least one post. Median percentage of days online was 3.81 (IQR 9.51). The 10 most-discussed semantic topics on posts were related to healthy food, clothing, calorie counting, workouts, looks, habits, support, and unhealthy food. In the subset of 754 users who had gender, age, and 30-day weight change data available, women were predominant and 92.9% (701/754) lost weight. Female gender, body mass index (BMI) at baseline, high levels of online activity, the number of upvotes received per post, and topics discussed within the community were independently associated with weight change. Conclusions Our findings suggest that among active users of a weight management community, self-declaration of higher BMI levels (which may represent greater dissatisfaction with excess weight), high online activity, and engagement in discussions that might provide social support are associated with greater weight loss. These findings have the potential to aid health professionals to assist patients in online interventions by focusing efforts on increasing engagement and/or starting discussions on topics of higher impact on weight change.
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Affiliation(s)
- Gisele Lobo Pappa
- Computer Science Department, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Tiago Oliveira Cunha
- Computer Science Department, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Paulo Viana Bicalho
- Computer Science Department, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Antonio Ribeiro
- Internal Medicine Department, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,Centro de Telessaúde do Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Ana Paula Couto Silva
- Computer Science Department, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Wagner Meira
- Computer Science Department, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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17
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Anastasiou CA, Karfopoulou E, Yannakoulia M. Weight regaining: From statistics and behaviors to physiology and metabolism. Metabolism 2015; 64:1395-407. [PMID: 26362728 DOI: 10.1016/j.metabol.2015.08.006] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 08/09/2015] [Accepted: 08/11/2015] [Indexed: 12/31/2022]
Abstract
Achieving maintenance of weight loss is crucial to combat obesity. However, most individuals tend to regain weight. Data from successful maintainers show that they remain vigilant and constantly apply techniques to oppose the course of regaining. On the other hand, current advances in obesity research show that the reduced obese state is a state of altered physiology in terms of energy balance. This review describes the physiological adaptations occurring after weight loss that predispose to regaining. Specifically, changes regarding body composition, hormonal background, energy expenditure and control of food intake are discussed. Moreover, metabolites that can act as regain predictors and dietary techniques to oppose regaining are presented.
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Affiliation(s)
- Costas A Anastasiou
- Department of Nutrition and Dietetics, Harokopio University, Athens, Greece.
| | - Eleni Karfopoulou
- Department of Nutrition and Dietetics, Harokopio University, Athens, Greece
| | - Mary Yannakoulia
- Department of Nutrition and Dietetics, Harokopio University, Athens, Greece
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18
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Hennecke M, Freund AM. Identifying success on the process level reduces negative effects of prior weight loss on subsequent weight loss during a low-calorie diet. Appl Psychol Health Well Being 2013; 6:48-66. [PMID: 24259439 DOI: 10.1111/aphw.12021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Dieters often show weight cycling, i.e. prior successful weight loss is followed by weight gain. The current study examined how goal progress during a diet (i.e. weight loss) impacts subsequent weight loss depending on whether success is identified on the process level or the outcome level of dieting. METHODS A short-term longitudinal study examined lagged effects of weight loss and identifications of success in one week on weight loss in the subsequent week. Across 6 weeks, N = 126 overweight women reported their weekly weight and the degree to which they considered themselves as successful regarding the process of dieting (e.g. changing eating behavior) and the desired dieting outcomes (e.g. improving appearance). RESULTS Successful weight loss in one week negatively affected weight loss in the subsequent week. However, identifying success on the process level reduced this negative effect. DISCUSSION Although people might feel generally that goal progress licenses subsequent goal-inconsistent behavior, identifying successful goal-pursuit on the process rather than the outcome level of a goal may counteract the subsequent loss of dieting motivation.
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19
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Sabounchi NS, Rahmandad H, Ammerman A. Best-fitting prediction equations for basal metabolic rate: informing obesity interventions in diverse populations. Int J Obes (Lond) 2013; 37:1364-70. [PMID: 23318720 PMCID: PMC4278349 DOI: 10.1038/ijo.2012.218] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Revised: 11/28/2012] [Accepted: 12/02/2012] [Indexed: 11/09/2022]
Abstract
Basal metabolic rate (BMR) represents the largest component of total energy expenditure and is a major contributor to energy balance. Therefore, accurately estimating BMR is critical for developing rigorous obesity prevention and control strategies. Over the past several decades, numerous BMR formulas have been developed targeted to different population groups. A comprehensive literature search revealed 248 BMR estimation equations developed using diverse ranges of age, gender, race, fat-free mass, fat mass, height, waist-to-hip ratio, body mass index and weight. A subset of 47 studies included enough detail to allow for development of meta-regression equations. Utilizing these studies, meta-equations were developed targeted to 20 specific population groups. This review provides a comprehensive summary of available BMR equations and an estimate of their accuracy. An accompanying online BMR prediction tool (available at http://www.sdl.ise.vt.edu/tutorials.html) was developed to automatically estimate BMR based on the most appropriate equation after user-entry of individual age, race, gender and weight.
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Affiliation(s)
- Nasim S. Sabounchi
- George Warren Brown School of Social Work, Washington University in St.
Louis
| | | | - Alice Ammerman
- Department of Nutrition, Gillings School of Global Public Health, and the
Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel
Hill
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20
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Silva TR, Alves BC, Maturana MA, Spritzer PM. Healthier Dietary Pattern and Lower Risk of Metabolic Syndrome in Physically Active Postmenopausal Women. J Am Coll Nutr 2013; 32:287-95. [DOI: 10.1080/07315724.2013.826111] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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21
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Ochner CN, Barrios DM, Lee CD, Pi-Sunyer FX. Biological mechanisms that promote weight regain following weight loss in obese humans. Physiol Behav 2013; 120:106-13. [PMID: 23911805 DOI: 10.1016/j.physbeh.2013.07.009] [Citation(s) in RCA: 119] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2012] [Revised: 04/05/2013] [Accepted: 07/23/2013] [Indexed: 01/25/2023]
Abstract
Weight loss dieting remains the treatment of choice for the vast majority of obese individuals, despite the limited long-term success of behavioral weight loss interventions. The reasons for the near universal unsustainability of behavioral weight loss in [formerly] obese individuals have not been fully elucidated, relegating researchers to making educated guesses about how to improve obesity treatment, as opposed to developing interventions targeting the causes of weight regain. This article discusses research on several factors that may contribute to weight regain following weight loss achieved through behavioral interventions, including adipose cellularity, endocrine function, energy metabolism, neural responsivity, and addiction-like neural mechanisms. All of these mechanisms are engaged prior to weight loss, suggesting that these so called "anti-starvation" mechanisms are activated via reductions in energy intake, rather than depletion of energy stores. Evidence suggests that these mechanisms are not necessarily part of a homeostatic feedback system designed to regulate body weight, or even anti-starvation mechanisms per se. Although they may have evolved to prevent starvation, they appear to be more accurately described as anti-weight loss mechanisms, engaged with caloric restriction irrespective of the adequacy of energy stores. It is hypothesized that these factors may combine to create a biological disposition that fosters the maintenance of an elevated body weight and works to restore the highest sustained body weight, thus precluding the long-term success of behavioral weight loss. It may be necessary to develop interventions that attenuate these biological mechanisms in order to achieve long-term weight reduction in obese individuals.
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Affiliation(s)
- Christopher N Ochner
- New York Obesity Nutrition Research Center, St. Luke's Roosevelt Hospital, Columbia University College of Physicians and Surgeons, New York, NY, USA; Mount Sinai Adolescent Health Center, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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22
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The effects of short-term overfeeding on energy expenditure and nutrient oxidation in obesity-prone and obesity-resistant individuals. Int J Obes (Lond) 2012; 37:1192-7. [PMID: 23229737 PMCID: PMC3770765 DOI: 10.1038/ijo.2012.202] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Revised: 10/29/2012] [Accepted: 11/09/2012] [Indexed: 02/08/2023]
Abstract
Objective The roles that energy expenditure (EE) and nutrient oxidation play in a predisposition for weight gain in humans remains unclear. Subjects We measured EE and respiratory exchange ratio (RER) in non-obese obesity prone (OP; n=22) and obesity resistant (OR; n=30) men and women following a eucaloric diet and after 3 days of overfeeding (1.4x basal energy). Results Twenty four hour EE, adjusted for fat free mass and sex, measured while consuming a eucaloric diet was not different between OP and OR subjects (2367 ± 80 vs. 2285 ± 98 kcals; p=0.53). Following overfeeding, EE increased in both OP and OR (OP: 2506 ± 63.7, p<0.01; OR: 2386 ± 99 kcals, p<0.05). Overfeeding resulted in an increase in 24h RER (OP: 0.857 ± 0.01 to 0.893 ± 0.01, p=0.01; OR: 0.852 ± 0.01 to 0.886 ± 0.01, p=0.005), with no difference between groups in either the eucaloric or overfeeding conditions (p>0.05). Nighttime RER (~10pm-6:30am) did not change with overfeeding in OR (0.823 ± 0.02 vs. 0.837 ± 0.01, p=0.29), but increased significantly in OP subjects (0.798 ± 0.15 to 0.839 ± 0.15, p<0.05), suggesting that fat oxidation during the night was down-regulated to a greater extent in OP subjects following a brief period of overfeeding, as compared to OR subjects who appeared to maintain their usual rate of fat oxidation. Protein oxidation increased significantly in both OP (p<0.001) and OR (p<0.01) with overfeeding, with no differences between OP and OR. Conclusion These results support the idea that overfeeding a mixed diet results in increases in EE and RER, but these increases in EE and RER are likely not responsible for obesity resistance. Adaptive responses to overfeeding that occur during the night may play a role in opposing weight gain.
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Abstract
Obesity is typically associated with abnormal eating behaviors. Brain imaging studies in humans implicate the involvement of dopamine (DA)-modulated circuits in pathologic eating behavior(s). Food cues increase striatal extracellular DA, providing evidence for the involvement of DA in the nonhedonic motivational properties of food. Food cues also increase metabolism in the orbitofrontal cortex indicating the association of this region with the motivation for food consumption. Similar to drug-addicted subjects, striatal DA D2 receptor availability is reduced in obese subjects, which may predispose obese subjects to seek food as a means to temporarily compensate for understimulated reward circuits. Decreased DA D2 receptors in the obese subjects are also associated with decreased metabolism in prefrontal regions involved in inhibitory control, which may underlie their inability to control food intake. Gastric stimulation in obese subjects activates cortical and limbic regions involved with self-control, motivation, and memory. These brain regions are also activated during drug craving in drug-addicted subjects. Obese subjects have increased metabolism in the somatosensory cortex, which suggests an enhanced sensitivity to the sensory properties of food. The reduction in DA D2 receptors in obese subjects coupled with the enhanced sensitivity to food palatability could make food their most salient reinforcer putting them at risk for compulsive eating and obesity. The results from these studies suggest that multiple but similar brain circuits are disrupted in obesity and drug addiction and suggest that strategies aimed at improving DA function might be beneficial in the treatment and prevention of obesity.
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Cornier MA, Marshall JA, Hill JO, Maahs DM, Eckel RH. Prevention of Overweight/Obesity as a Strategy to Optimize Cardiovascular Health. Circulation 2011; 124:840-50. [DOI: 10.1161/circulationaha.110.968461] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Marc-Andre Cornier
- From the Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine (M.C., R.H.E.), Department of Epidemiology (J.A.M.), Anschutz Health and Wellness Center (J.O.H.), and Barbara Davis Center for Childhood Diabetes, The Children's Hospital Denver (D.M.M.), University of Colorado Denver, Aurora
| | - Julie A. Marshall
- From the Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine (M.C., R.H.E.), Department of Epidemiology (J.A.M.), Anschutz Health and Wellness Center (J.O.H.), and Barbara Davis Center for Childhood Diabetes, The Children's Hospital Denver (D.M.M.), University of Colorado Denver, Aurora
| | - James O. Hill
- From the Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine (M.C., R.H.E.), Department of Epidemiology (J.A.M.), Anschutz Health and Wellness Center (J.O.H.), and Barbara Davis Center for Childhood Diabetes, The Children's Hospital Denver (D.M.M.), University of Colorado Denver, Aurora
| | - David M. Maahs
- From the Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine (M.C., R.H.E.), Department of Epidemiology (J.A.M.), Anschutz Health and Wellness Center (J.O.H.), and Barbara Davis Center for Childhood Diabetes, The Children's Hospital Denver (D.M.M.), University of Colorado Denver, Aurora
| | - Robert H. Eckel
- From the Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine (M.C., R.H.E.), Department of Epidemiology (J.A.M.), Anschutz Health and Wellness Center (J.O.H.), and Barbara Davis Center for Childhood Diabetes, The Children's Hospital Denver (D.M.M.), University of Colorado Denver, Aurora
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25
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Targeting thermogenesis and related pathways in anti-obesity drug discovery. Pharmacol Ther 2011; 131:295-308. [PMID: 21514319 DOI: 10.1016/j.pharmthera.2011.04.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2011] [Accepted: 03/29/2011] [Indexed: 01/12/2023]
Abstract
The health consequences of the obesity epidemic are a huge burden on patients and society. Yet it remains an unmet therapeutic need. Lifestyle or behaviour modification, although desirable, seems to benefit only a few and bariatric surgery is not an option for all and not without risks. Nevertheless, bariatric surgery is currently the gold standard in terms of weight loss therapy and any weight loss agent will be in combination with management of lifestyle modification. Sadly, there is a poor history for the pharmacological treatment of obesity and repeated safety concerns have attracted intense regulatory scrutiny. Indeed, recent market withdrawals leave us with just one agent approved for the long term treatment of obesity and that is only mildly efficacious in terms of weight loss, although it is beneficial in terms of metabolic health. There are two broad pharmacological approaches that can be applied in obesity drug discovery: reduce intake (or absorption) or increase expenditure (thermogenesis) of calories. In this review we will look at the latter approach. We will cover regulatory requirements and the rationale for this approach. We believe that post-obese subjects display abnormal metabolic responses to weight loss that almost inevitably leads to weight regain. We will then explore a number of approaches that potentially increase thermogenesis in humans. The challenge we have is in accumulating enough human data to validate this approach using drugs.
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Stuckey HL, Boan J, Kraschnewski JL, Miller-Day M, Lehman EB, Sciamanna CN. Using positive deviance for determining successful weight-control practices. QUALITATIVE HEALTH RESEARCH 2011; 21:563-79. [PMID: 20956609 PMCID: PMC3612888 DOI: 10.1177/1049732310386623] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Based on positive deviance (examining the practices of successful individuals), we identified five primary themes from 36 strategies that help to maintain long-term weight loss (weight control) in 61 people. We conducted in-depth interviews to determine what successful individuals did and/or thought about regularly to control their weight. The themes included weight-control practices related to (a) nutrition: increase water, fruit, and vegetable intake, and consistent meal timing and content; (b) physical activity: follow and track an exercise routine at least 3x/week; (c) restraint: practice restraint by limiting and/or avoiding unhealthy foods; (d) self-monitor: plan meals, and track calories/weight progress; and (e) motivation: participate in motivational programs and cognitive processes that affect weight-control behavior. Using the extensive data involving both the practices and practice implementation, we used positive deviance to create a comprehensive list of practices to develop interventions for individuals to control their weight.
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Affiliation(s)
- Heather L Stuckey
- Department of Medicine, Penn State Hershey College of Medicine, Hershey, Pennsylvania 17033, USA.
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Kaiyala KJ, Schwartz MW. Toward a more complete (and less controversial) understanding of energy expenditure and its role in obesity pathogenesis. Diabetes 2011; 60:17-23. [PMID: 21193735 PMCID: PMC3012169 DOI: 10.2337/db10-0909] [Citation(s) in RCA: 127] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Karl J Kaiyala
- Department of Dental Public Health Sciences, University of Washington, Seattle, USA.
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Wiklund M, Olsén MF, Willén C. Physical activity as viewed by adults with severe obesity, awaiting gastric bypass surgery. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2010; 16:179-86. [PMID: 21061456 DOI: 10.1002/pri.497] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2010] [Revised: 08/26/2010] [Accepted: 09/25/2010] [Indexed: 11/11/2022]
Abstract
BACKGROUND AND PURPOSE Today, it is known that adults suffering from obesity benefit from physical activity. There is however lack of research with regard to how patients with severe obesity experience physical activity. It is important to explore this topic in order to be able to improve communication with and to tailor information and exercise programmes for patients suffering with obesity. The aim of the present qualitative study was to describe how adults with severe obesity, awaiting gastric bypass surgery experience physical activity. METHODS A qualitative method inspired by a phenomenographic approach was used to analyze the data. Data collection was performed by in-depth semi-structured interviews with 18 patients. All patients were aged between 18 and 65 years, suffered from severe obesity and were scheduled for laparoscopic Roux-en Y gastric bypass surgery at Sahlgrenska University Hospital in Sweden. RESULTS The analysis resulted in nine qualitatively different categories that were then divided into four aspects: 'the obese body', 'the mind', 'knowledge' and 'the environment'. Many patients experienced well-being after physical activity, but most patients were uncomfortable with appearing in public wearing exercise clothing. The excess weight itself was considered an obstacle, and weight loss was assumed to facilitate physical activity. Exercising together with someone at the same level of fitness increased motivation. A white lie about training was sometimes used to satisfy the need to be seen as capable. CONCLUSION Physical activity is experienced positively among adults with severe obesity, but many obstacles exist that influence their capacity and their will. Support is necessary in different ways, not only to initiate physical activity, but also to maintain it.
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Affiliation(s)
- Malin Wiklund
- Department of Physical Therapy, Sahlgrenska University Hospital and Institute of Neuroscience and Physiology/Physical Therapy, The Sahlgrenska Academy at Göteborg University, Göteborg, Sweden.
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Kaiyala KJ, Morton GJ, Leroux BG, Ogimoto K, Wisse B, Schwartz MW. Identification of body fat mass as a major determinant of metabolic rate in mice. Diabetes 2010; 59:1657-66. [PMID: 20413511 PMCID: PMC2889765 DOI: 10.2337/db09-1582] [Citation(s) in RCA: 129] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Analysis of energy expenditure (EE) in mice is essential to obesity research. Since EE varies with body mass, comparisons between lean and obese mice are confounded unless EE is normalized to account for body mass differences. We 1) assessed the validity of ratio-based EE normalization involving division of EE by either total body mass (TBM) or lean body mass (LBM), 2) compared the independent contributions of LBM and fat mass (FM) to EE, and 3) investigated whether leptin contributes to the link between FM and EE. RESEARCH DESIGN AND METHODS We used regression modeling of calorimetry and body composition data in 137 mice to estimate the independent contributions of LBM and FM to EE. Subcutaneous administration of leptin or vehicle to 28 obese ob/ob mice and 32 fasting wild-type mice was used to determine if FM affects EE via a leptin-dependent mechanism. RESULTS Division of EE by either TBM or LBM is confounded by body mass variation. The contribution of FM to EE is comparable to that of LBM in normal mice (expressed per gram of tissue) but is absent in leptin-deficient ob/ob mice. When leptin is administered at physiological doses, the plasma leptin concentration supplants FM as an independent determinant of EE in both ob/ob mice and normal mice rendered leptin-deficient by fasting. CONCLUSIONS The contribution of FM to EE is substantially greater than predicted from the metabolic cost of adipose tissue per se, and the mechanism underlying this effect is leptin dependent. Regression-based approaches that account for variation in both FM and LBM are recommended for normalization of EE in mice.
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Affiliation(s)
- Karl J Kaiyala
- Department of Dental Public Health Sciences, School of Dentistry, University of Washington, Seattle, Washington, USA.
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Levin BE. Developmental gene x environment interactions affecting systems regulating energy homeostasis and obesity. Front Neuroendocrinol 2010; 31:270-83. [PMID: 20206200 PMCID: PMC2903638 DOI: 10.1016/j.yfrne.2010.02.005] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2010] [Revised: 02/25/2010] [Accepted: 02/25/2010] [Indexed: 11/25/2022]
Abstract
Most human obesity is inherited as a polygenic trait which is largely refractory to medical therapy because obese individuals avidly defend their elevated body weight set-point. This set-point is mediated by an integrated neural network that controls energy homeostasis. Epidemiological studies suggest that perinatal and pre-pubertal environmental factors can promote offspring obesity. Rodent studies demonstrate the important interactions between genetic predisposition and environmental factors in promoting obesity. This review covers issues of development and function of neural systems involved in the regulation of energy homeostasis and the roles of leptin and insulin in these processes, the ways in which interventions at various phases from gestation, lactation and pre-pubertal stages of development can favorably and unfavorably alter the development of obesity n offspring. These studies suggest that early identification of obesity-prone humans and of the factors that can prevent them from becoming obese could provide an effective strategy for preventing the world-wide epidemic of obesity.
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Affiliation(s)
- Barry E Levin
- Neurology Service, VA Medical Center, E. Orange, NJ 07018-1095, USA.
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Sénéchal M, Arguin H, Bouchard DR, Carpentier AC, Ardilouze JL, Dionne IJ, Brochu M. Interindividual variations in resting metabolic rate during weight loss in obese postmenopausal women A pilot study. Metabolism 2010; 59:478-85. [PMID: 19846179 DOI: 10.1016/j.metabol.2009.07.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2008] [Accepted: 07/03/2009] [Indexed: 12/25/2022]
Abstract
The objective of the study was to examine if decreases in resting metabolic rate (RMR) take place early in the weight loss process and if they remain throughout the duration of the weight loss intervention. Twenty obese postmenopausal women (61.8 +/- 5.9 years) participated in a 15-week weight loss program. After the fifth week, subjects were characterized as having an increased (>5%) or a decreased (<5%) RMR based on baseline values. Afterward, they were followed for an additional 10 weeks. Outcome measures were as follows: fat mass ([FM] total, trunk), lean body mass (total, trunk), RMR, resting heart rate (RHR), and physical activity level. After 5 weeks, significant decreases were observed for lean body mass, FM, and RHR (P < .05), whereas no overall changes in physical activity level and RMR were observed. However, on an individual basis, large variations in RMR were observed (ranging from -320 to +330 kcal/d). Analyses showed that subjects characterized as either having an increased or a decreased RMR after the fifth week maintained these adaptations at the end of intervention. Finally, subjects displaying a decreased RMR during weight loss had a significantly higher RMR and lower FM accumulations at baseline (total and trunk) compared with those with an increased RMR. Interindividual variations in RMR took place early in the weight loss process and were maintained over the duration of the weight loss program in our cohort of obese postmenopausal women. Baseline RMR, changes in RHR, and FM accumulations (total and trunk) seem to be important factors to consider when studying the effects of weight loss on RMR.
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Affiliation(s)
- Martin Sénéchal
- Research Centre on Aging, Social Services and Health Centre-University Institute of Geriatrics of Sherbrooke, Canada J1H 4C4.
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Levin BE. Interaction of perinatal and pre-pubertal factors with genetic predisposition in the development of neural pathways involved in the regulation of energy homeostasis. Brain Res 2010; 1350:10-7. [PMID: 20059985 DOI: 10.1016/j.brainres.2009.12.085] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2009] [Revised: 12/28/2009] [Accepted: 12/29/2009] [Indexed: 12/26/2022]
Abstract
A majority of human obesity is inherited as a polygenic trait. Once obesity develops, over 90% of individuals repeatedly regain lost weight after dieting. Only surgical interventions offer long lasting weight loss. Thus, clinical data suggest that some individuals have a predisposition to develop and maintain an elevated body weight set-point once they are provided with sufficient calories to gain weight. This set-point is mediated by an integrated neural network that controls energy homeostasis. Unfortunately, currently available tools for identifying obesity-prone individuals and examining the functioning of these neural systems have insufficient resolution to identify specific neural factors that cause humans to develop and maintain the obese state. However, rodent models of polygenically inherited obesity allow us to investigate the factors that both predispose them to become obese and that prevent or enhance the development of such obesity. Maternal obesity during gestation and lactation in obesity-prone rodents enhances offspring obesity and alters their neural pathways involved in energy homeostasis regulation. Early postnatal exposure of obesity-resistant offspring to the milk of genetically obese dams alters their hypothalamic pathways involved in energy homeostasis causing them to become obese when fed a high fat diet as adults. Finally, short-term exercise begun in the early post-weaning period increases the sensitivity to the anorectic effects of leptin and protects obesity-prone offspring from becoming obese for months exercise cessation. Such studies suggest that early identification of obesity-prone humans and of the factors that can prevent them from becoming obese could provide an effective strategy for preventing the world wide epidemic of obesity.
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Affiliation(s)
- Barry E Levin
- Neurology Service (127C), Veterans Administration Medical Center, and Department of Neurology and Neurosciences, New Jersey Medical School, E. Orange, Newark, NJ 07018-1095, USA.
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Wang X, Lyles MF, You T, Berry MJ, Rejeski WJ, Nicklas BJ. Weight regain is related to decreases in physical activity during weight loss. Med Sci Sports Exerc 2008; 40:1781-8. [PMID: 18799988 DOI: 10.1249/mss.0b013e31817d8176] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE To examine whether adaptations in physical activity energy expenditure (PAEE) and resting metabolic rate (RMR) during weight loss were associated with future weight regain in overweight/obese, older women. RESEARCH METHODS AND PROCEDURES Thirty-four overweight/obese (BMI = 25-40 kg x m(-2)), postmenopausal women underwent a 20-wk weight loss intervention of hypocaloric diet with (low- or high-intensity) or without treadmill walking (weekly caloric deficit was approximately 11,760 kJ), with a subsequent 12-month follow-up. RMR (via indirect calorimetry), PAEE (by RT3 accelerometer), and body composition (by dual-energy x-ray absorptiometry) were measured before and after intervention. Body weight and self-reported information on physical activity were collected after intervention and at 6 and 12 months after intervention. RESULTS The intervention resulted in decreases in body weight, lean mass, fat mass, percent body fat, RMR, and PAEE (P < 0.001 for all). Weight regain was 2.9 +/- 3.3 kg (-3.1 to +9.2 kg) at 6 months and 5.2 +/- 5.0 kg (-2.3 to +21.7 kg) at 12 months after intervention. The amount of weight regained after 6 and 12 months was inversely associated with decreases in PAEE during the weight loss intervention (r = -0.521, P = 0.002 and r = -0.404, P = 0.018, respectively), such that women with larger declines in PAEE during weight loss experienced greater weight regain during follow-up. Weight regain was not associated with changes in RMR during intervention or with self-reported physical activity during follow-up. CONCLUSION This study demonstrates that although both RMR and PAEE decreased during weight loss in postmenopausal women, maintaining high levels of daily physical activity during weight loss may be important to mitigate weight regain after weight loss.
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Affiliation(s)
- Xuewen Wang
- Section on Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA.
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Hall KD, Jordan PN. Modeling weight-loss maintenance to help prevent body weight regain. Am J Clin Nutr 2008; 88:1495-503. [PMID: 19064508 DOI: 10.3945/ajcn.2008.26333] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Lifestyle intervention can successfully induce weight loss in obese persons, at least temporarily. However, there currently is no way to quantitatively estimate the changes of diet or physical activity required to prevent weight regain. Such a tool would be helpful for goal-setting, because obese patients and their physicians could assess at the outset of an intervention whether long-term adherence to the calculated lifestyle change is realistic. OBJECTIVE We aimed to calculate the expected change of steady-state body weight arising from a given change in dietary energy intake and, conversely, to calculate the modification of energy intake required to maintain a particular body-weight change. DESIGN We developed a mathematical model using data from 8 longitudinal weight-loss studies representing 157 subjects with initial body weights ranging from 68 to 160 kg and stable weight losses between 7 and 54 kg. RESULTS Model calculations closely matched the change data (R(2) = 0.83, chi(2) = 2.1, P < 0.01 for weight changes; R(2) = 0.91, chi(2) = 0.87, P < 0.0004 for energy intake changes). Our model performed significantly better than the previous models for which chi(2) values were 10-fold those of our model. The model also accurately predicted the proportion of weight change resulting from the loss of body fat (R(2) = 0.90). CONCLUSIONS Our model provides realistic calculations of body-weight change and of the dietary modifications required for weight-loss maintenance. Because the model was implemented by using standard spreadsheet software, it can be widely used by physicians and weight-management professionals.
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Affiliation(s)
- Kevin D Hall
- Laboratory of Biological Modeling, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892-5621, USA.
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Phelan S, Wing RR, Raynor HA, Dibello J, Nedeau K, Peng W. Holiday weight management by successful weight losers and normal weight individuals. J Consult Clin Psychol 2008; 76:442-8. [PMID: 18540737 DOI: 10.1037/0022-006x.76.3.442] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This study compared weight control strategies during the winter holidays among successful weight losers (SWL) in the National Weight Control Registry and normal weight individuals (NW) with no history of obesity. SWL (n = 178) had lost a mean of 34.9 kg and had kept > or = 13.6 kg off for a mean of 5.9 years. NW (n = 101) had a body mass index of 18.5-24.9 kg/m(2). More SWL than NW reported plans to be extremely strict in maintaining their usual dietary routine (27.3% vs. 0%) and exercise routine (59.1% vs. 14.3%) over the holidays. Main effects for group indicated that SWL maintained greater exercise, greater attention to weight and eating, greater stimulus control, and greater dietary restraint, both before and during the holidays. A Group x Time interaction indicated that, over the holidays, attention to weight and eating declined significantly more in SW than in NW. More SWL (38.9%) than NW (16.7%) gained > or = 1 kg over the holidays, and this effect persisted 1 month later (28.3% and 10.7%, respectively). SWL worked harder than NW did to manage their weight, but they appeared more vulnerable to weight gain during the holidays.
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Affiliation(s)
- Suzanne Phelan
- Department of Psychiatry and Human Behavior, Brown Medical School, Providence, RI 02903, USA.
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Larrouy D, Barbe P, Valle C, Déjean S, Pelloux V, Thalamas C, Bastard JP, Le Bouil A, Diquet B, Clément K, Langin D, Viguerie N. Gene expression profiling of human skeletal muscle in response to stabilized weight loss. Am J Clin Nutr 2008; 88:125-32. [PMID: 18614732 DOI: 10.1093/ajcn/88.1.125] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Diet-induced weight reduction promotes a decrease in resting energy expenditure that could partly explain the difficulty in maintaining reduced body mass. Whether this reduction remains after stabilized weight loss is still controversial, and the molecular mechanisms are unknown. OBJECTIVE The objective was to investigate the effect of a stabilized 10% weight loss on body composition, metabolic profile, and skeletal muscle gene expression profiling. DESIGN Obese women were assigned to a 4-wk very-low-calorie diet, a 3-6-wk low-calorie diet, and a 4-wk weight-maintenance program to achieve a 10% weight loss. Resting energy expenditure, body composition, plasma variables, and skeletal muscle transcriptome were compared before weight loss and during stabilized weight reduction. RESULTS Energy restriction caused an 11% weight loss. Stabilization to the new weight was accompanied by an 11% decrease in the resting metabolic rate normalized to the body cellular mass. A large number of genes were regulated with a narrow range of regulation. The main regulated genes were slow/oxidative fiber markers, which were overexpressed, and the gene encoding the glucose metabolism inhibitor PDK4, which tended to be down-regulated. The knowledge-based approach gene set enrichment analysis showed that a set of genes related to long-term calorie restriction was up-regulated, whereas sets of genes related to insulin, interleukin 6, and ubiquitin-mediated proteolysis were down regulated. CONCLUSIONS Weight loss-induced decreases in resting metabolic rate persist after weight stabilization. Changes in skeletal muscle gene expression indicate a shift toward oxidative metabolism.
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Affiliation(s)
- Dominique Larrouy
- INSERM, U858, Obesity Research Laboratory, Institut de Médecine Moléculaire de Rangueil, Toulouse, France
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de Castro Cesar M, de Lima Montebelo MI, Rasera I, de Oliveira AV, Gomes Gonelli PR, Aparecida Cardoso G. Effects of Roux-en-Y Gastric Bypass on Resting Energy Expenditure in Women. Obes Surg 2008; 18:1376-80. [DOI: 10.1007/s11695-008-9460-8] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2008] [Accepted: 02/01/2008] [Indexed: 11/30/2022]
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Addy C, Wright H, Van Laere K, Gantz I, Erondu N, Musser BJ, Lu K, Yuan J, Sanabria-Bohórquez SM, Stoch A, Stevens C, Fong TM, De Lepeleire I, Cilissen C, Cote J, Rosko K, Gendrano IN, Nguyen AM, Gumbiner B, Rothenberg P, de Hoon J, Bormans G, Depré M, Eng WS, Ravussin E, Klein S, Blundell J, Herman GA, Burns HD, Hargreaves RJ, Wagner J, Gottesdiener K, Amatruda JM, Heymsfield SB. The acyclic CB1R inverse agonist taranabant mediates weight loss by increasing energy expenditure and decreasing caloric intake. Cell Metab 2008; 7:68-78. [PMID: 18177726 DOI: 10.1016/j.cmet.2007.11.012] [Citation(s) in RCA: 153] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2007] [Revised: 09/30/2007] [Accepted: 11/20/2007] [Indexed: 11/28/2022]
Abstract
Cannabinoid 1 receptor (CB1R) inverse agonists are emerging as a potential obesity therapy. However, the physiological mechanisms by which these agents modulate human energy balance are incompletely elucidated. Here, we describe a comprehensive clinical research study of taranabant, a structurally novel acyclic CB1R inverse agonist. Positron emission tomography imaging using the selective CB1R tracer [(18)F]MK-9470 confirmed central nervous system receptor occupancy levels ( approximately 10%-40%) associated with energy balance/weight-loss effects in animals. In a 12-week weight-loss study, taranabant induced statistically significant weight loss compared to placebo in obese subjects over the entire range of evaluated doses (0.5, 2, 4, and 6 mg once per day) (p < 0.001). Taranabant treatment was associated with dose-related increased incidence of clinical adverse events, including mild to moderate gastrointestinal and psychiatric effects. Mechanism-of-action studies suggest that engagement of the CB1R by taranabant leads to weight loss by reducing food intake and increasing energy expenditure and fat oxidation.
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Affiliation(s)
- Carol Addy
- Merck Research Laboratories, Boston, MA 02115, USA
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Metabolic Adaptations in Roux-en-Y Gastric Bypass Patients After a Significant Weight Loss. TOP CLIN NUTR 2008. [DOI: 10.1097/01.tin.0000312081.30705.96] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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del Genio F, Alfonsi L, Marra M, Finelli C, del Genio G, Rossetti G, del Genio A, Contaldo F, Pasanisi F. Metabolic and nutritional status changes after 10% weight loss in severely obese patients treated with laparoscopic surgery vs integrated medical treatment. Obes Surg 2007; 17:1592-8. [PMID: 18000718 DOI: 10.1007/s11695-007-9286-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2007] [Accepted: 07/17/2007] [Indexed: 02/07/2023]
Abstract
BACKGROUND Bariatric surgery is considered the most effective treatment for reducing excess body weight and maintaining weight loss (WL) in severely obese patients. There are limited data evaluating metabolic and body composition changes after different treatments in type III obese (body mass index [BMI] > 40 kg/m(2)). METHODS Twenty patients (9 males, 11 females; 37.6 +/- 8 years; BMI = 50.1 +/- 8 kg/m(2)) treated with dietary therapy and lifestyle correction (group 1) have been compared with 20 matched patients (41.8 +/- 6 years; BMI = 50.4 +/- 6 kg/m(2)) treated with laparoscopic gastric bypass (LGBP; group 2). Patients have been evaluated before treatment and after >10% WL obtained on average 6 weeks after LGBP and 30 weeks after integrated medical treatment. Metabolic syndrome (MS) was evaluated using the Adult Treatment Panel III/America Heart Association (ATP III/AHA) criteria. Resting metabolic rate (RMR) and respiratory quotient (RQ) was assessed with indirect calorimetry; body composition with bioimpedance analysis. RESULTS At entry, RMR/fat-free mass (FFM) was 34.2 +/- 7 kcal/24 h.kg in group 1 and 35.1 +/- 8 kcal/24 h.kg in group 2 and did not decrease in both groups after 10% WL (31.8 +/- 6 vs 34.0 +/- 6). Percent FFM and fat mass (FM) was 50.7 +/- 7% and 49.3 +/- 7% in group 1 and 52.1 +/- 6% and 47.9 +/- 6% in group 2, respectively (p = n.s.). After WL, body composition significantly changed only in group 1 (% FFM increased to 55.9 +/- 6 and % FM decreased to 44.1 +/- 6; p = 0.002). CONCLUSION After >10% WL, MS prevalence decreases precociously in surgically treated patients; some improvements in body composition are observed in nonsurgically treated patients only. Further investigations are needed to evaluate long-term effects of bariatric surgery on body composition and RMR after stable WL.
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Affiliation(s)
- Federica del Genio
- Interuniversity Center for Obesity and Eating Disorder (CISRO), Department of Clinical and Experimental Medicine, Federico II School of Medicine, Via Pansini 5, 80131 Naples, Italy
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Martin CK, Heilbronn LK, de Jonge L, DeLany JP, Volaufova J, Anton SD, Redman LM, Smith SR, Ravussin E. Effect of calorie restriction on resting metabolic rate and spontaneous physical activity. Obesity (Silver Spring) 2007; 15:2964-73. [PMID: 18198305 DOI: 10.1038/oby.2007.354] [Citation(s) in RCA: 158] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE It is unclear if resting metabolic rate (RMR) and spontaneous physical activity (SPA) decrease in weight-reduced non-obese participants. Additionally, it is unknown if changes in SPA, measured in a respiratory chamber, reflect changes in free-living physical activity level (PAL). RESEARCH METHODS AND PROCEDURES Participants (N = 48) were randomized into 4 groups for 6 months: calorie restriction (CR, 25% restriction), CR plus structured exercise (CR+EX, 12.5% restriction plus 12.5% increased energy expenditure via exercise), low-calorie diet (LCD, 890 kcal/d supplement diet until 15% weight loss, then weight maintenance), and control (weight maintenance). Measurements were collected at baseline, Month 3, and Month 6. Body composition and RMR were measured by DXA and indirect calorimetry, respectively. Two measures of SPA were collected in a respiratory chamber (percent of time active and kcal/d). Free-living PAL (PAL = total daily energy expenditure by doubly labeled water/RMR) was also measured. Regression equations at baseline were used to adjust RMR for fat-free mass and SPA (kcal/d) for body weight. RESULTS Adjusted RMR decreased at Month 3 in the CR group and at Month 6 in the CR+EX and LCD groups. Neither measure of SPA decreased significantly in any group. PAL decreased at Month 3 in the CR and LCD groups, but not in the CR+EX group, who engaged in structured exercise. Changes in SPA in the chamber and free-living PAL were not related. DISCUSSION Body weight is defended in non-obese participants during modest caloric restriction, evidenced by metabolic adaptation of RMR and reduced energy expenditure through physical activity.
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Affiliation(s)
- Corby K Martin
- Department of Health Psychology, Pennington Biomedical Research Center, 6400 Perkins Rd., Baton Rouge, LA 70808, USA.
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Patterson CM, Dunn-Meynell AA, Levin BE. Three weeks of early-onset exercise prolongs obesity resistance in DIO rats after exercise cessation. Am J Physiol Regul Integr Comp Physiol 2007; 294:R290-301. [PMID: 17989137 DOI: 10.1152/ajpregu.00661.2007] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We assessed the effect of early-onset exercise as a means of preventing childhood obesity using juvenile male rats selectively bred to develop diet-induced obesity (DIO) or to be diet resistant (DR) when fed a 31% fat high-energy diet. Voluntary wheel running begun at 36 days of age selectively reduced adiposity in DIO vs. DR rats. Other 4-wk-old DIO rats fed a high-energy diet and exercised (Ex) for 13 wk increased their core temperature, gained 22% less body weight, and had 39% lighter fat pads compared with sedentary (Sed) rats. When wheels were removed after 6 wk (6 wk Ex/7 wk Sed), rats gained less body weight over the next 7 wk than Sed rats and still had comparable adipose pad weights to 13-wk-exercised rats. In fact, only 3 wk of exercise sufficed to prevent obesity for 10 wk after wheel removal. Terminally, the 6-wk-Ex/7-wk-Sed rats had a 55% increase in arcuate nucleus proopiomelanocortin mRNA expression vs. Sed rats, suggesting that this contributed to their sustained obesity resistance. Finally, when Sed rats were calorically restricted for 6 wk to weight match them to Ex rats (6 wk Rstr/7 wk Al), they increased their intake and body weight when fed ad libitum and, after 7 wk more, had higher leptin levels and adiposity than Sed rats. Thus, early-onset exercise may favorably alter, while early caloric restriction may unfavorably influence, the development of the hypothalamic pathways controlling energy homeostasis during brain development.
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Heymsfield SB, Harp JB, Reitman ML, Beetsch JW, Schoeller DA, Erondu N, Pietrobelli A. Why do obese patients not lose more weight when treated with low-calorie diets? A mechanistic perspective. Am J Clin Nutr 2007; 85:346-54. [PMID: 17284728 DOI: 10.1093/ajcn/85.2.346] [Citation(s) in RCA: 132] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Maximal weight loss observed in low-calorie diet (LCD) studies tends to be small, and the mechanisms leading to this low treatment efficacy have not been clarified. Less-than-expected weight loss with LCDs can arise from an increase in fractional energy absorption (FEA), adaptations in energy expenditure, or incomplete patient diet adherence. We systematically reviewed studies of FEA and total energy expenditure (TEE) in obese patients undergoing weight loss with LCDs and in patients with reduced obesity (RO), respectively. This information was used to support an energy balance model that was then applied to examine patient adherence to prescribed LCD treatment programs. In the limited available literature, FEA was unchanged from baseline in short-term (<12 wk) treatment studies with LCDs; no long-term (>or=26 wk) studies were found. Review of doubly labeled water and respiratory chamber studies identified 10 reports of TEE in RO patients (n = 150) with long-term weight loss. These patients, who were weight stable, had a TEE almost identical to measured or predicted values in never-obese subjects (weighted mean difference: 1.3%; range: -1.7-8.5%). Modeling of energy balance, as supported by reviewed FEA and TEE studies, suggests that obese subjects participating in LCD programs have a weight loss less than half of that predicted. The small maximal weight loss observed with LCD treatments thus is likely not due to gastrointestinal adaptations but may be attributed, by deduction, to difficulties with patient adherence or, to a lesser degree, to metabolic adaptations induced by negative energy balance that are not captured by the current models.
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Abstract
The intent of this paper is to address the obesity epidemic, which is a term used to describe the sudden and rapid increase in obesity rates that began in the 1980s and continues unabated today. Since 1980, the entire population, regardless of starting weight, is gradually gaining weight. This has led to escalating obesity rates and to obesity being considered one of the most serious public health challenges facing the world. At one level, the obesity epidemic is a classic gene-environment interaction where the human genotype is susceptible to environmental influences that affect energy intake and energy expenditure. It is also a problem of energy balance. Understanding the etiology of obesity requires the study of how behavioral and environmental factors have interacted to produce positive energy balance and weight gain. Reversing the epidemic of obesity will require modifying some combination of these factors to help the population achieve energy balance at a healthy body weight. While body weight is strongly influenced by biological and behavioral factors, changes in the environment promoting positive energy balance have been most responsible for the obesity epidemic. Our best strategy for reversing the obesity epidemic is to focus on preventing positive energy balance in the population through small changes in diet and physical activity that take advantage of our biological systems for regulating energy balance. Simultaneously, we must address the environment to make it easier to make better food and physical activity choices. This is a very long-term strategy for first stopping and then reversing the escalating obesity rates, but one that can, over time, return obesity rates to pre-1980s levels.
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Affiliation(s)
- James O Hill
- Center for Human Nutrition, University of Colorado School of Medicine, Denver, Colorado 80262, USA.
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Vanhecke TE, Franklin BA, Lillystone MA, Sandberg KR, deJong AT, Krause KR, Chengelis DL, McCullough PA. Caloric expenditure in the morbidly obese using dual energy X-ray absorptiometry. J Clin Densitom 2006; 9:438-44. [PMID: 17097530 DOI: 10.1016/j.jocd.2006.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2006] [Revised: 09/01/2006] [Accepted: 09/01/2006] [Indexed: 01/23/2023]
Abstract
Total caloric expenditure is the sum of resting energy expenditure (REE) and caloric expenditure during physical activity. In this study, we examined total caloric expenditure in 25 morbidly obese patients (body mass index>or=35 kg/m(2)) using dual energy X-ray absorptiometry (DXA) scanning and cardiorespiratory exercise testing. Our results show average REE for all individuals was 2027+/-276 kcal/d and mean net caloric expenditure during 30 min of exercise was 115+/-16 kcals. Assuming the mean of all input values, a strict 1500 kcal/d diet combined with 150 min per wk of structured physical activity, the projected weight change was -7% (8.8+/-6.2 kg) for 6 mo. We conclude that morbidly obese individuals should be able to achieve only a modest weight loss by following minimal national guidelines. These data suggest that more aggressive energy expenditure and caloric restriction targets for long periods of time are needed to result in significant weight loss in this population.
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Affiliation(s)
- Thomas E Vanhecke
- Department of Medicine, Divisions of Cardiology, Nutrition and Preventive Medicine, William Beaumont Hospital, Royal Oak, MI 48073, USA.
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Wynne K, Park AJ, Small CJ, Meeran K, Ghatei MA, Frost GS, Bloom SR. Oxyntomodulin increases energy expenditure in addition to decreasing energy intake in overweight and obese humans: a randomised controlled trial. Int J Obes (Lond) 2006; 30:1729-36. [PMID: 16619056 DOI: 10.1038/sj.ijo.0803344] [Citation(s) in RCA: 238] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Oxyntomodulin has recently been found to decrease body-weight in obese humans and may be a potential anti-obesity therapy. OBJECTIVE To determine whether oxyntomodulin alters energy expenditure, in addition to reducing energy intake, in 'free-living' overweight and obese volunteers. DESIGN Randomized double-blind controlled cross-over trial. SETTING Community and hospital-based. PARTICIPANTS Fifteen healthy overweight and obese men and women (age: 23-49 years, BMI: 25.1-39.0 kg/m(2)). All volunteers completed the study protocol. INTERVENTIONS Four-day subcutaneous self-administration of pre-prandial oxyntomodulin, three times daily. Participants were advised to maintain their normal dietary and exercise regimen. MEASUREMENTS (1) Energy expenditure, measured by indirect calorimetry and combined heart rate and movement monitoring; (2) energy intake, measured during a study meal. RESULTS Oxyntomodulin administration reduced energy intake at the study meal by 128+/-29 kcal (P=0.0006) or 17.3+/-5.5% (P=0.0071), with no change in meal palatability. Oxyntomodulin did not alter resting energy expenditure; but increased activity-related energy expenditure by 143+/-109 kcal/day or 26.2+/-9.9% (P=0.0221); total energy expenditure by 9.4+/-4.8% (P=0.0454) and physical activity level by 9.5+/-4.6% (P=0.0495). A reduction in body weight of 0.5+/-0.2% was observed during the oxyntomodulin administration period (P=0.0232). CONCLUSION Oxyntomodulin increases energy expenditure while reducing energy intake resulting in negative energy balance. This data supports the role of oxyntomodulin as a potential anti-obesity therapy.
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Affiliation(s)
- K Wynne
- Department of Metabolic Medicine, Imperial College London, Hammersmith Hospital, London, UK
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Abstract
Obesity is an established risk factor for numerous chronic diseases, and successful treatment will have an important impact on medical resources utilization, health care costs, and patient quality of life. With over 60% of our population being overweight, physicians face a major challenge in assisting patients in the process of weight loss and weight-loss maintenance. Low-calorie diets can lower total body weight by an average of 8% in the short term. These diets are well-tolerated and characterize successful strategies in maintaining significant weight loss over a 5-year period. Very-low-calorie diets produce a more rapid weight loss but should only be used for fewer than 16 weeks because of clinical adverse effects. Diets that are severely restricted in carbohydrates (3%-10% of total energy intake) and do not emphasize a reduction of energy intake may be effective in reducing weight in the short term, but there is no evidence that they are sustainable or innocuous in the long term because their high saturated-fat content may be atherogenic. Fat restriction in a weight-loss regimen is beneficial, but the optimal percentage has yet to be determined. Longitudinal trials are needed to resolve these issues. In this article I discuss the evidence for and pitfalls of various types of weight-loss diets and identify issues that physicians need to address in weight loss and weight-loss maintenance.
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Affiliation(s)
- Irene Strychar
- Department of Nutrition, Faculty of Medicine, and the Research Centre of Notre-Dame Hospital, Centre hospitalier de l'Université de Montréal, Université de Montréal
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Villanova N, Pasqui F, Burzacchini S, Forlani G, Manini R, Suppini A, Melchionda N, Marchesini G. A physical activity program to reinforce weight maintenance following a behavior program in overweight/obese subjects. Int J Obes (Lond) 2005; 30:697-703. [PMID: 16314874 DOI: 10.1038/sj.ijo.0803185] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To investigate the effects of a specific program to implement physical activity (fitness program) on weight loss maintenance, activity level and resting energy expenditure (REE). DESIGN Observational study of subjects completing a behavioral program. SUBJECTS In total, 200 overweight/obese subjects (36 males, aged 20-66 years; average BMI, 35.2 kg/m2). Program and measurements:The fitness program consisted of 12 bimonthly sessions, chaired by doctors and dietitians, involving groups of 8-12 subjects. Patients entered the program approximately 9 months after the end of behavioral treatment, during a weight loss maintenance period. The goal was set at a light-to-moderate daily physical activity (brisk walking), quantitatively measured by a pedometer; REE was measured before and after the fitness program by indirect calorimetry in a subset of patients. RESULTS The fitness program restarted the process of weight loss in over 60% of subjects. At the end of the study, 84% of patients walked at least 5000 steps per day, compared with 24% at the beginning of the study. The probability of losing from 5 to 10% of initial body weight increased by 20% for any 1000 steps/day (OR, 1.20; 95% CI (confidence interval), 1.07-1.35), and that of losing more than 10% by over 30% (OR, 1.33; 95% CI, 1.19-1.49). REE increased significantly by 100 kcal/day (+7.5%), in spite of further weight loss (-1.8%). CONCLUSION A specific fitness program in the weight maintenance phase after a behavioral program may significantly improve the long-term control of obesity.
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Affiliation(s)
- N Villanova
- Department Internal Medicine and Gastroenterology, Unit of Metabolic Diseases, Alma Mater Studiorum University of Bologna, Bologna, Italy
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Hill JO, Wyatt H, Phelan S, Wing R. The National Weight Control Registry: is it useful in helping deal with our obesity epidemic? JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2005; 37:206-10. [PMID: 16029692 DOI: 10.1016/s1499-4046(06)60248-0] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
The National Weight Control Registry (NWCR) consists of over 4800 individuals who have been successful in long-term weight loss maintenance. The purpose of establishing the NWCR was to identify the common characteristics of those who succeed in long-term weight loss maintenance. We found very little similarity in how these individuals lost weight but some common behaviors in how they are keeping their weight off. To maintain their weight loss NWCR participants report eating a relatively low-fat diet, eating breakfast almost every day, weighing themselves regularly, and engaging in high levels (about 1 hour/day) of physical activity. Because this is not a random sample of those who attempt weight loss, the results have limited generalizability to the entire population of overweight and obese individuals. The value of this project lies in identifying potential strategies that may help others be more successful in keeping weight off.
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Affiliation(s)
- James O Hill
- Center for Human Nutrition, University of Colorado Health Sciences Center, Denver 80262, USA.
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