Normal-weight women frequently restrict their caloric intake and exercise, but little is known about the effects on body weight, body composition and metabolic adaptations in this population.
We conducted a secondary analysis of data from a randomized controlled trial in sedentary normal-weight women. Women were assigned to a severe energy deficit (SEV: −1062±80 kcal per day; n=9), a moderate energy deficit (MOD: −633±71 kcal per day; n=7) or energy balance (BAL; n=9) while exercising five times per week for 3 months. Outcome variables included changes in body weight, body composition, resting metabolic rate (RMR) and metabolic hormones associated with energy conservation.
Weight loss occurred in SEV (−3.7±0.9 kg, P<0.001) and MOD (−2.7±0.8 kg; P=0.003), but weight loss was significantly less than predicted (SEV: −11.1±1.0 kg; MOD: −6.5±1.1 kg; both P<0.001 vs actual). Fat mass declined in SEV (P<0.001) and MOD (P=0.006), whereas fat-free mass remained unchanged in all groups (P>0.33). RMR decreased by −6±2% in MOD (P=0.020). In SEV, RMR did not change on a group level (P=0.66), but participants whose RMR declined lost more weight (P=0.020) and had a higher baseline RMR (P=0.026) than those whose RMR did not decrease. Characteristic changes in leptin (P=0.003), tri-iodothyronine (P=0.013), insulin-like growth factor-1 (P=0.016) and ghrelin (P=0.049) occurred only in SEV. The energy deficit and adaptive changes in RMR explained 54% of the observed weight loss.
In normal-weight women, caloric restriction and exercise resulted in less-than-predicted weight loss. In contrast to previous literature, weight loss consisted almost exclusively of fat mass, whereas fat-free mass was preserved.
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Hill JO . Understanding and addressing the epidemic of obesity: an energy balance perspective. Endocr Rev 2006; 27: 750–761.
Donnelly JE, Blair SN, Jakicic JM, Manore MM, Rankin JW, Smith BK . American College of Sports Medicine Position Stand. Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults. Med Sci Sports Exerc 2009; 41: 459–471.
Seagle HM, Strain GW, Makris A, Reeves RS . Position of the American Dietetic Association: weight management. J Am Diet Assoc 2009; 109: 330–346.
Fayet F, Petocz P, Samman S . Prevalence and correlates of dieting in college women: a cross sectional study. Int J Womens Health 2012; 4: 405–411.
Kruger J, Galuska DA, Serdula MK, Jones DA . Attempting to lose weight: specific practices among U.S. adults. Am J Prev Med 2004; 26: 402–406.
Bosy-Westphal A, Muller MJ . Measuring the impact of weight cycling on body composition: a methodological challenge. Curr Opin Clin Nutr Metab Care 2014; 17: 396–400.
Dulloo AG, Jacquet J, Montani JP, Schutz Y . How dieting makes the lean fatter: from a perspective of body composition autoregulation through adipostats and proteinstats awaiting discovery. Obes Rev 2015; 16 (Suppl 1), 25–35.
Wishnofsky M . Caloric equivalents of gained or lost weight. Am J Clin Nutr 1958; 6: 542–546.
Hall KD, Sacks G, Chandramohan D, Chow CC, Wang YC, Gortmaker SL et al. Quantification of the effect of energy imbalance on bodyweight. Lancet 2011; 378: 826–837.
Weinheimer EM, Sands LP, Campbell WW . A systematic review of the separate and combined effects of energy restriction and exercise on fat-free mass in middle-aged and older adults: implications for sarcopenic obesity. Nutr Rev 2010; 68: 375–388.
Forbes GB . Lean body mass-body fat interrelationships in humans. Nutr Rev 1987; 45: 225–231.
Thomas DM, Bouchard C, Church T, Slentz C, Kraus WE, Redman LM et al. Why do individuals not lose more weight from an exercise intervention at a defined dose? An energy balance analysis. Obes Rev 2012; 13: 835–847.
Hall KD . What is the required energy deficit per unit weight loss? Int J Obes 2008; 32: 573–576.
Martin CK, Heilbronn LK, de Jonge L, DeLany JP, Volaufova J, Anton SD et al. Effect of calorie restriction on resting metabolic rate and spontaneous physical activity. Obesity 2007; 15: 2964–2973.
Redman LM, Heilbronn LK, Martin CK, de Jonge L, Williamson DA, DeLany JP et al. Metabolic and behavioral compensations in response to caloric restriction: implications for the maintenance of weight loss. PLoS One 2009; 4: e4377.
Blüher S, Mantzoros CS . Leptin in humans: lessons from translational research. Am J Clin Nutr 2009; 89: 991S–997S.
Loucks AB . Energy balance and body composition in sports and exercise. J Sports Sci 2004; 22: 1–14.
Cummings DE . Ghrelin and the short- and long-term regulation of appetite and body weight. Physiol Behav 2006; 89: 71–84.
Loucks AB, Kiens B, Wright HH . Energy availability in athletes. J Sports Sci 2011; 29 (Suppl 1), S7–15.
Williams NI, Leidy HJ, Hill BR, Lieberman JL, Legro RS, Souza MJ . Magnitude of daily energy deficit predicts frequency but not severity of menstrual disturbances associated with exercise and caloric restriction. Am J Physiol Endocrinol Metab 2015; 308: E29–E39.
Crujeiras AB, Goyenechea E, Abete I, Lage M, Carreira MC, Martinez JA et al. Weight regain after a diet-induced loss is predicted by higher baseline leptin and lower ghrelin plasma levels. J Clin Endocrinol Metab 2010; 95: 5037–5044.
Haas V, Onur S, Paul T, Nutzinger DO, Bosy-Westphal A, Hauer M et al. Leptin and body weight regulation in patients with anorexia nervosa before and during weight recovery. Am J Clin Nutr 2005; 81: 889–896.
Burger KS, Berner LA . A functional neuroimaging review of obesity, appetitive hormones and ingestive behavior. Physiol Behav 2014; 136: 121–127.
Reinehr T . Obesity and thyroid function. Mol Cell Endocrinol 2010; 316: 165–171.
Onur S, Haas V, Bosy-Westphal A, Hauer M, Paul T, Nutzinger D et al. L-tri-iodothyronine is a major determinant of resting energy expenditure in underweight patients with anorexia nervosa and during weight gain. Eur J Endocrinol 2005; 152: 179–184.
Ihle R, Loucks AB . Dose-response relationships between energy availability and bone turnover in young exercising women. J Bone Miner Res 2004; 19: 1231–1240.
Williams NI, Reed JL, Leidy HJ, Legro RS, Souza MJ . Estrogen and progesterone exposure is reduced in response to energy deficiency in women aged 25-40 years. Hum Reprod 2010; 25: 2328–2339.
Leidy HJ, Gardner JK, Frye BR, Snook ML, Schuchert MK, Richard EL et al. Circulating ghrelin is sensitive to changes in body weight during a diet and exercise program in normal-weight young women. J Clin Endocrinol Metab 2004; 89: 2659–2664.
Gardner JK, McConnell H, Frye BR, Dougherty KA, Parrott TS, Richard EL et al. Validation of an improved method to estimate energy requirements in college-aged women: the PERK method. Med Sci Sports Exerc 2004; 36: 79.
Spurr GB, Dufour DL, Reina JC, Haught TA . Daily energy expenditure of women by factorial and heart rate methods. Med Sci Sports Exerc 1997; 29: 1255–1262.
Brozek J, Grande F, Anderson JT, Keys A . Densitometric analysis of body composition: revision of some quantitative assumptions. Ann N Y Acad Sci 1963; 110: 113–140.
Weir JB . New methods for calculating metabolic rate with special reference to protein metabolism. J Physiol 1949; 109: 1–9.
Cunningham JJ . Body composition as a determinant of energy expenditure: a synthetic review and a proposed general prediction equation. Am J Clin Nutr 1991; 54: 963–969.
Levine JA . Measurement of energy expenditure. Public Health Nutr 2005; 8: 1123–1132.
Crouter SE, Albright C, Bassett DR Jr . Accuracy of polar S410 heart rate monitor to estimate energy cost of exercise. Med Sci Sports Exerc 2004; 36: 1433–1439.
Maddison R, Jiang Y, Hoorn SV, Mhurchu CN, Lawes CM, Rodgers A et al. Estimating energy expenditure with the RT3 triaxial accelerometer. Res Q Exerc Sport 2009; 80: 249–256.
Rowlands AV, Thomas PW, Eston RG, Topping R . Validation of the RT3 triaxial accelerometer for the assessment of physical activity. Med Sci Sports Exerc 2004; 36: 518–524.
National Institute of Diabetes and Digestive and Kidney Diseases. Body weight planner. United States Department of Health and Human Services..
Byrne NM, Wood RE, Schutz Y, Hills AP . Does metabolic compensation explain the majority of less-than-expected weight loss in obese adults during a short-term severe diet and exercise intervention? Int J Obes 2012; 36: 1472–1478.
Del Corral P, Chandler-Laney PC, Casazza K, Gower BA, Hunter GR . Effect of dietary adherence with or without exercise on weight loss: a mechanistic approach to a global problem. J Clin Endocrinol Metab 2009; 94: 1602–1607.
Moreira EA, Most M, Howard J, Ravussin E . Dietary adherence to long-term controlled feeding in a calorie-restriction study in overweight men and women. Nutr Clin Pract 2011; 26: 309–315.
Goele K, Bosy-Westphal A, Rumcker B, Lagerpusch M, Muller MJ . Influence of changes in body composition and adaptive thermogenesis on the difference between measured and predicted weight loss in obese women. Obes Facts 2009; 2: 105–109.
Kosmiski L, Schmiege SJ, Mascolo M, Gaudiani J, Mehler PS . Chronic starvation secondary to anorexia nervosa is associated with an adaptive suppression of resting energy expenditure. J Clin Endocrinol Metab 2014; 99: 908–914.
Muller MJ, Bosy-Westphal A . Adaptive thermogenesis with weight loss in humans. Obesity 2013; 21: 218–228.
Muller MJ, Enderle J, Pourhassan M, Braun W, Eggeling B, Lagerpusch M et al. Metabolic adaptation to caloric restriction and subsequent refeeding: the Minnesota Starvation Experiment revisited. Am J Clin Nutr 2015; 102: 807–819.
Wade GN, Schneider JE, Li HY . Control of fertility by metabolic cues. Am J Physiol 1996; 270 (1 Pt 1), E1–19.
Vyver E, Steinegger C, Katzman DK . Eating disorders and menstrual dysfunction in adolescents. Ann N Y Acad Sci 2008; 1135: 253–264.
Gibbs JC, Williams NI, De Souza MJ . Prevalence of individual and combined components of the female athlete triad. Med Sci Sports Exerc 2013; 45: 985–996.
This study was supported by the National Institutes of Health Grants RO1-HD-39245-01 (NIW) and M01-RR-10732, and the Department of Kinesiology, Women’s Health and Exercise Laboratory, Penn State University. KK was supported through a Research Fellowship awarded by the German Academic Exchange Service (DAAD).
The authors declare no conflict of interest.
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Koehler, K., De Souza, M. & Williams, N. Less-than-expected weight loss in normal-weight women undergoing caloric restriction and exercise is accompanied by preservation of fat-free mass and metabolic adaptations. Eur J Clin Nutr 71, 365–371 (2017). https://doi.org/10.1038/ejcn.2016.203
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