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Clinical Research

Reduced metabolic efficiency in sedentary eucaloric conditions predicts greater weight regain in adults with obesity following sustained weight loss

International Journal of Obesity volume 45, pages 840–849 (2021)Cite this article

Subjects

Abstract

Background

Successful long-term weight loss maintenance after caloric restriction (CR) is rarely achieved. Besides known metabolic, behavioural, and cognitive factors, 24-hour energy expenditure (24hEE) relative to body size (i.e., metabolic efficiency) might influence subsequent weight loss maintenance.

Methods

Eleven participants with obesity (BMI = 39.0 ± 8.7 kg/m2, body fat = 36.1 ± 6.4%) had 24hEE measured in a whole-room indirect calorimeter during eucaloric conditions and weight stability prior to starting a 6-week inpatient CR study (50% of daily energy needs). Twenty-four-hour energy expenditure was adjusted via regression analysis for fat free mass (FFM) and fat mass (FM) by DXA. Body composition was reassessed at the end of CR and after 1-year follow-up. Free-living weight was assessed by monthly weight measurements during 12 months.

Results

After 6-week CR, participants lost 8.5 ± 2.7% weight (FFM: –6.3 ± 3.6 kg, FM: –3.4 ± 1.2 kg) but regained 5.1 ± 8.0% 1 year following CR, which was mostly due to FFM regain (+5.7 ± 5.5 kg) and unchanged FM. A relatively higher 24hEE by 100 kcal/day prior to CR was associated with an average greater rate of weight regain by +0.3 kg/month during follow-up and a greater final weight regain by +5.1 kg after 1 year of follow-up.

Conclusion

These results suggest that reduced metabolic efficiency in 24hEE during eucaloric, sedentary conditions may predict greater weight regain after CR-induced weight loss.

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Fig. 1: Higher adjusted 24hEE prior to CR, but not CR-induced losses in FFM and FM, predicted greater weight regain one year after 6-week inpatient CR.
Fig. 2: Higher adjusted 24hEE prior to CR predicted greater fat mass and fat-free mass regain one year after 6-week inpatient CR.
Fig. 3: Individuals with higher adjusted 24hEE prior to CR showed greater regain of body weight, fat mass, and fat-free mass one year after 6-week CR.

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Acknowledgements

We thank the participants and the clinical staff of the Phoenix Epidemiology and Clinical Research Branch for conducting the examinations. The technical and logistic support of Susan Bonfiglio, PA, in performing procedures and collecting data is gratefully acknowledged.

Funding

This research was supported by the Intramural Research Program of the NIH, The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). PP was supported by the program “Rita Levi Montalcini for young researchers” from the Italian Minister of Education and Research (Ministero dell’Istruzione, dell’Università e della Ricerca).

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Authors and Affiliations

  1. Obesity and Diabetes Clinical Research Section, Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ, USA

    Tim Hollstein, Alessio Basolo, Jonathan Krakoff, Susanne B. Votruba & Paolo Piaggi

  2. Division of Endocrinology, Diabetology and Clinical Nutrition, Department of Internal Medicine 1, University of Kiel, Kiel, Germany

    Tim Hollstein

  3. Department of Internal Medicine, Clinic for Endocrinology and Nephrology, University of Leipzig, Leipzig, Germany

    Sascha Heinitz

  4. Helmholtz Institute for Metabolic, Obesity and Vascular Research (HI-MAG) of the Helmholtz Zentrum München at the University of Leipzig and University Hospital Leipzig, Leipzig, Germany

    Sascha Heinitz

  5. Department of Information Engineering, University of Pisa, Pisa, Italy

    Paolo Piaggi

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Contributions

TH, SH, and PP wrote the manuscript. TH, SH, and PP performed data analyses. SBV and JK designed the clinical protocol. AB, JK, and SBV reviewed the manuscript. PP is the guarantor of this work and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

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Correspondence to Paolo Piaggi.

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Hollstein, T., Heinitz, S., Basolo, A. et al. Reduced metabolic efficiency in sedentary eucaloric conditions predicts greater weight regain in adults with obesity following sustained weight loss. Int J Obes 45, 840–849 (2021). https://doi.org/10.1038/s41366-021-00748-y

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