Changes in Energy Expenditure Resulting from Altered Body Weight

Leibel, Rudolph L.; Rosenbaum, Michael; Hirsch, Jules

doi:10.1056/nejm199503093321001

Cited by 1,768 publications

(1,488 citation statements)

References 29 publications

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“…The beneficial effects of the fitness program are however supported by the wellknown failure to maintain weight loss in obese patients at the end of any weight reducing program. 4,5 This was also observed in our subjects at the end of CBT and has been previously reported in an extensive revision of the results attained in our institution. 17 The fitness program promoted a further weight loss after CBT, and body weight remained on average stable during a 1-year follow-up in subjects who completed this long-term observation period.…”

Section: Discussionsupporting

confidence: 86%

“…3 This contributes to difficulties in weight loss maintenance; the majority of patients completely regain weight over 3 years, and only a subgroup maintains initial weight loss over a 4-year period. 4,5 Physical activity has been advocated as a key behavioral component in the prevention of weight regain. 1,6 It improves long-term weight loss maintenance both by increasing lean body mass and by promoting total energy expenditure.…”

Section: Introductionmentioning

confidence: 99%

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A physical activity program to reinforce weight maintenance following a behavior program in overweight/obese subjects

et al. 2005

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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/m 2 ). 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 ( þ 7.5%), in spite of further weight loss (À1.8%). 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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Section: Discussionsupporting

confidence: 86%

Section: Introductionmentioning

confidence: 99%

A physical activity program to reinforce weight maintenance following a behavior program in overweight/obese subjects

et al. 2005

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“…Such a calculation fails to account for how an individual's energy expenditure adapts to the energy deficit and decreasing body weight and she will therefore not reach her weight loss goal. The magnitude of the expected energy expenditure adaptation during weight loss is a much debated issue [32][33][34][35][36] and has not been addressed in the present study.…”

mentioning

confidence: 93%

What is the required energy deficit per unit weight loss?

2007

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One of the most pervasive weight loss rules is that a cumulative energy deficit of 3500 kcal is required per pound of body weight loss, or equivalently 32.2 MJ kg À1 . Under what conditions is it appropriate to use this rule of thumb and what are the factors that determine the cumulative energy deficit required per unit weight loss? Here, I examine this question using a modification of the classic Forbes equation that predicts the composition of weight loss as a function of the initial body fat and magnitude of weight loss. The resulting model predicts that a larger cumulative energy deficit is required per unit weight loss for people with greater initial body fatFa prediction supported by published weight loss data from obese and lean subjects. This may also explain why men can lose more weight than women for a given energy deficit since women typically have more body fat than men of similar body weight. Furthermore, additional weight loss is predicted to be associated with a lower average cumulative energy deficit since a greater proportion of the weight loss is predicted to result from loss of lean body mass, which has a relatively low energy density in comparison with body fat. The rule of thumb approximately matches the predicted energy density of lost weight in obese subjects with an initial body fat above 30 kg but overestimates the cumulative energy deficit required per unit weight loss for people with lower initial body fat. International Journal of Obesity (2008) When energy intake does not meet energy requirements, the deficit is accounted for by metabolism of stored energy in the form of body fat, protein and glycogen. Since energy is conserved, the metabolizable energy content of the lost tissue is equivalent to the energy deficit required to produce that weight loss. The metabolizable energy density of the lost tissue is therefore determined by its chemical composition. Loss of body water results in a significant mass change, but contributes nothing to the metabolizable energy content. In contrast, the metabolizable energy densities of body glycogen, protein and fat are 17.6, 19.7 and 39.5 MJ kg À1 , respectively. 5 Recently, I developed a modification of the classic Forbes equation 3,4 predicting the proportion of weight loss accounted for by loss of lean body mass as a nonlinear function of both the initial body fat as well as the magnitude of weight loss. 6 On the basis of this equation, the energy density of weight loss can be predicted once the metabolizable energy densities for the lean body mass loss, DL, and body fat mass loss, DF, have been determined.The energy density of the body fat mass change, r F ¼ 39.5 MJ kg À1 is the same as the energy density of fat. It is important to note that the change of body fat, DF, is not equivalent to the loss of adipose tissue, which includes a variable contribution of fluid and protein in addition to triglyceride. 7,8 Rather, DF is the amount of endogenous fat metabolized by the body to meet the energy deficit. Similarly, the energy density of the lea...

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“…Measurements of lean body mass derived from routine CT-Scan obtained at the level of the third lumbar vertebra (L3), allows to calculate the total skeletal muscles area at this body level, but does not measure whole body composition, and it's capacity to predict the total body lean mass remains to be proven. Finally, BW does not take into account the impact on EE of preexisting metabolism alterations [24] as well as metabolic alterations secondary to the injury response [25].…”

Section: Body Weight Measurement Is Inaccuratementioning

confidence: 99%

Energy expenditure in mechanically ventilated patients: The weight of body weight!

et al. 2017

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Background & aims: Optimal nutritional care for intensive care unit (ICU) patients requires precise determination of energy expenditure (EE) to avoid deleterious under-or overfeeding. The reference method, indirect calorimetry (IC), is rarely accessible and inconstantly feasible. Various equations for predicting EE based on body weight (BW) are available. This study aims at determining the best prediction strategy unless IC is available. Methods: Mechanically ventilated patients staying !72 h in the ICU were included, except those with contraindications for IC measurements. IC and BW measurements were routinely performed. EE was predicted by the ESPEN formula and other predictive equations using BW (i.e. anamnestic (AN), measured (MES), adjusted for cumulated water balance (ADJ), calculated for a body mass index (BMI) of 22.5). Comparisons were made using Pearson correlation and Bland & Altman plots. Results: 85 patients (57 ± 19 y, 61 men, SAPS II 43 ± 16) were included. Correlations between IC and predicted EE using the ESPEN formula with different BW (BW AN , BW MES , BW ADJ , and BW BMI22.5 ) were 0.44, 0.40, 0.36, and 0.47, respectively. Bland & Altman plots showed wide and inconsistent variations. Predictive equations including body temperature and minute ventilation showed the best correlations, but when using various BWs, differences in predicted EE were observed. Conclusion: No EE predictive equation, regardless of the BW used, gives statistically identical results to IC. If IC cannot be performed, predictive equations including minute ventilation and body temperature should be preferred. BW has a significant impact on estimated EE and the use of measured BW MES or BW BMI 22.5 is associated with the best EE prediction. Clinical trial registration number on ClinicalTrial.gov: NCT02552446. Ethical committee number: CE-14-070.

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Changes in Energy Expenditure Resulting from Altered Body Weight

Cited by 1,768 publications

References 29 publications

A physical activity program to reinforce weight maintenance following a behavior program in overweight/obese subjects

A physical activity program to reinforce weight maintenance following a behavior program in overweight/obese subjects

What is the required energy deficit per unit weight loss?

Energy expenditure in mechanically ventilated patients: The weight of body weight!

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