Body composition, energy expenditure and physical activity

The role of appetite-related hormones, adaptive thermogenesis, perceived hunger and stress in long-term weight-loss maintenance: a mixed-methods study



Weight-loss maintenance is challenging, and few succeed in the long term. This study aimed to explain how appetite-related hormones, adaptive thermogenesis, perceived hunger and stress influence weight-loss maintenance.


Fifteen adult women (age, 46.3 ± 9.5 years; BMI, 39.4 ± 4.3 kg/m2) participated in a 24-month intervention, which included 3–5 months total diet replacement (825–853 kcal/d). Body weight and composition (Magnetic Resonance Imaging), resting metabolic rate (indirect calorimetry), and fasting plasma concentration of leptin, ghrelin, glucagon-like peptide-1 (GLP-1), peptide YY (PYY), and growth differentiation factor 15 (GDF-15) were measured at baseline and after weight loss, around 6 months. Perceptions relating to weight-loss maintenance were explored using qualitative interviews.


Mean (SD) changes in body weight (−13.8 ± 6.3 kg) and total adipose tissue (−11.5 ± 4.9 kg) were significant (P < 0.001). Weight loss was associated with a significant reduction in resting metabolic rate (−291 ± 226 kcal/day, P < 0.001) and adaptive thermogenesis (−150 ± 162 kcal/day, P = 0.003), reduction in leptin (P < 0.001) and GLP-1 (P = 0.015), an increase in ghrelin (P < 0.001), and no changes in PYY and GDF-15. Weight regain between 6 and 24 months (6.1 ± 6.3 kg, P < 0.05) was correlated positively with change in GLP-1 (r = 0.5, P = 0.037) and negatively with GLP-1 at baseline (r = −0.7, P = 0.003) and after weight loss (r = −0.7, P = 0.005). Participants did not report increased hunger after weight loss, and stress-related/emotional eating was perceived as the main reason for regain.


Weight regain is more likely with lower fasting GLP-1 and greater reduction in GLP-1 after weight loss, but psychological aspects of eating behaviour appear as important in attenuating weight-loss maintenance.

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Fig. 1: Study flow chart: screening, enrolment and retention.
Fig. 2: Individual changes in body weight (kg) between a) 0–6 months and b) 6–24 months. Grey dashed lines indicate mean value (- - -).
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We thank all participants for their time and commitment and Cambridge Weight Plan (Northants, UK) for providing meal replacement products.

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Correspondence to Dalia Malkova.

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Conflict of interest

GT and NB have received funding from Cambridge Weight Plan for conference attendance and for other departmental research. NB has shares in Counterweight Ltd, and is a previous employee of Counterweight Ltd. MEJL reports personal fees from Counterweight Ltd, grants and personal fees from Novo Nordisk, personal fees from Novartis, personal fees from Eli Lilly, and non-financial support from Cambridge Weight Plan, outside the submitted work. The other study authors declare no conflict of interest.

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Thom, G., Dombrowski, S.U., Brosnahan, N. et al. The role of appetite-related hormones, adaptive thermogenesis, perceived hunger and stress in long-term weight-loss maintenance: a mixed-methods study. Eur J Clin Nutr 74, 622–632 (2020).

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