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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

European Journal of Clinical Nutrition volume 74, pages 622–632 (2020)Cite this article

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A Correction to this article was published on 15 April 2021

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Abstract

Background/objectives

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.

Subjects/methods

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.

Results

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 negatively correlated 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.

Conclusions

Weight regain is more likely with lower fasting GLP-1 at baseline and following 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.
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Acknowledgements

We thank all participants for their time and commitment and Cambridge Weight Plan (Northants, UK) for providing meal replacement products.

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Authors and Affiliations

  1. Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK

    George Thom, Naomi Brosnahan, Michael E. J. Lean & Dalia Malkova

  2. Faculty of Kinesiology, University of New Brunswick, Fredericton, NB, Canada

    Stephan U. Dombrowski

  3. Department of Clinical Nutrition, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia

    Yasmin Y. Algindan

  4. Department of Radiology, Glasgow Royal Infirmary, Glasgow, UK

    M. Rosario Lopez-Gonzalez & Giles Roditi

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  1. George Thom
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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). https://doi.org/10.1038/s41430-020-0568-9

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