Effect of Weight Loss via Severe vs Moderate Energy Restriction on Lean Mass and Body Composition Among Postmenopausal Women With Obesity

Abstract

Key PointsQuestionWhat are the long-term effects of severe vs moderate energy restriction on lean mass and other aspects of body composition?FindingsThis randomized clinical trial included 101 postmenopausal women with obesity. At 12 months, participants who had undergone severe energy restriction experienced approximately 2-fold greater weight and fat loss, approximately 1.5 times as much loss of whole-body lean mass (proportional to total weight lost), and approximately 2.5 times as much loss of total hip bone mineral density compared with participants who had undergone moderate energy restriction.MeaningAlthough severe energy restriction is an effective obesity treatment, caution is necessary when implementing it in postmenopausal women, especially those with osteopenia or osteoporosis.

Very Low-Energy Diets—Opportunity for Greater Weight Loss, but Risk of Bone Loss

“…Trial now adds to accumulating evidence that VLEDs can help achieve greater weight loss than moderate dietary interventions alone, well after the use of VLEDs is ended. 2,4 The estimated mean 15.3 kg (95% CI, 12.5-18.1 kg) reduction in total body weight in the severe group is within the range previously reported with VLEDs, 4 and almost twice that achieved with moderate caloric restriction. 2 The finding that more than 80% of women in the severe group achieved 10% or greater weight loss is encouraging, as this can provide clinically meaningful health benefits.…”

“…4 Handgrip strength was not significantly reduced in either intervention group after 1 year. 2 Loss of hip BMD and possibly lumbar spine BMD, but not whole-body BMD, have previously been found with caloric restriction-induced weight loss, 5 but little is known about the effect of severity of caloric restriction on bone loss. Seimon et al 2 now advance the literature by providing one of the first direct comparisons of severe vs moderate caloric restriction.…”

“…Importantly, the 21% higher retention in the severe intervention should not be overlooked. 2 Indeed, the rapid weight loss, satiety, and feasibility of VLED use may contribute to improved adherence. 4 Successful weight loss and maintenance with VLEDs is generally reported when VLEDs are accompanied by additional weight loss maintenance support.…”

“…Dietary protein, calcium, and vitamin D may help attenuate bone loss, particularly in combination, as dietary protein and vitamin D may both counteract the reduced calcium absorption efficiency due to energy restriction 6. In the TEMPO Diet Trial, the target protein intake was 1 g/kg of body weight in both groups, and VLEDs in the severe group provided 1200 mg of calcium and 15 μg of vitamin D. Unfortunately, physical activity and dietary intake data were not presented 2. This leaves us to speculate not only about adherence to the intervention diets, but also on how nutrient intake levels compared between groups.…”

Very Low-Calorie Ketogenic Diet: A Safe and Effective Tool for Weight Loss in Patients with Obesity and Mild Kidney Failure

“…The observed elevation in albumin levels point in the same direction. Second, calcium and phosphorus levels could also be increased following bone loss, as it was previously observed in patients on severely calorie-restricted regimens with profound weight reduction [26]. Of note, PTH levels were not altered by the intervention, suggesting that bone metabolism was unaffected, and adequate protein intake and electrolytes supplementation were provided throughout the study, making the latter option less plausible.…”