Investigation of the long-term sustainability of changes in appetite after weight loss

Abstract

Background/ObjectiveDiet-induced weight loss (WL) leads to a compensatory increase in appetite and changes in the plasma concentration of appetite-regulating hormones are likely to play a role. Whether these changes are transient or sustained remains unclear. This study aimed to assess if changes in subjective and objective appetite markers observed with WL are sustained after 1 year (1Y).Subjects/MethodsIn total 100 (45 males) individuals with obesity (BMI: 37 ± 4 kg/m2, age: 43 ± 10 years) underwent 8 weeks (wks) of a very-low energy diet (VLED), followed by 4 wks refeeding, and a 1Y maintenance program. Fasting/postprandial subjective ratings of hunger, fullness, desire to eat, and prospective food consumption (PFC) were assessed, and plasma concentration of active ghrelin (AG), total peptide YY (PYY), active glucagon-like peptide 1, cholecystokinin (CCK), and insulin measured, at baseline, week 13 (Wk13) and 1Y.ResultsAt Wk13, 16% WL (−18 ± 1 kg, P < 0.001) was associated with a significant increase in fasting and postprandial hunger ratings (P < 0.01 and P < 0.05, respectively), and postprandial fullness (P < 0.01) combined with a reduction in PFC (P < 0.001). These were accompanied by a significant rise in basal and postprandial AG concentrations (P < 0.001, for both), a reduction in postprandial CCK (P < 0.01) and in basal and postprandial insulin (P < 0.001). At 1Y follow-up, with sustained WL (15%; −16 ± 1 kg, P < 0.001), fasting hunger and postprandial fullness ratings remained increased (P < 0.05 for both), and postprandial PFC reduced (P < 0.001). Basal and postprandial AG remained elevated and insulin reduced (P < 0.001, for all), while postprandial CCK was increased (P < 0.01) and PYY decreased (P < 0.001).ConclusionWith a 15% sustained WL at 1Y, the drive to eat in the fasting state is increased, but this may be balanced out by raised postprandial feelings of fullness. To assist with WL maintenance, new strategies are required to manage increased hunger and drive to eat.

Physiological Predictors of Weight Regain at 1‐Year Follow‐Up in Weight‐Reduced Adults with Obesity

“…This again adds evidence to our new hypothesis by showing that WL would lead to a normalization of the secretion of GLP‐1 and PYY, two satiety hormones, toward what is seen in those with a lower healthier body weight, in this case by increasing their secretion, which is well known to be blunted in individuals with obesity . In line with this, postprandial fullness has been reported not to change or to increase in response to diet‐induced WL .…”

“…Studies measuring total GLP‐1 and PYY 3‐36 , fractions that better reflect the physiological actions of these hormones on appetite , have reported an increase in the postprandial release of these peptides with WL . This is in contrast with studies that have measured active GLP‐1, in which no change with WL was found , and those measuring total PYY, in which either no change or a reduction was reported. This again adds evidence to our new hypothesis by showing that WL would lead to a normalization of the secretion of GLP‐1 and PYY, two satiety hormones, toward what is seen in those with a lower healthier body weight, in this case by increasing their secretion, which is well known to be blunted in individuals with obesity .…”

“…However, they reported no significant correlations between the increase in appetite (either subjective appetite feelings or plasma concentration of AG, CCK, total PYY, active GLP‐1, and insulin) seen with WL and weight regain at 1‐year follow‐up in their Supporting Information . We recently reported that, in adults with 15% sustained WL at 1‐year follow‐up, the drive to eat (subjective hunger feelings and ghrelin plasma concentrations) were increased, but postprandial fullness feelings were also increased . In their systematic review, Strohacker et al reported that the increase in ghrelin and reduction in insulin and plasma concentrations seen with WL were not predictive of weight regain in free‐living humans .…”

“…The reduction in resting metabolic rate (RMR) seen with WL may be attenuated after a period of weight stabilization . However, the reduction in TEE (falling below predicted values in some individuals, a mechanism known as adaptive thermogenesis), as well as the increase in hunger feelings and ghrelin secretion, appears to persist in the long term .…”

Associations between the rate, amount, and composition of weight loss as predictors of spontaneous weight regain in adults achieving clinically significant weight loss: A systematic review and meta‐regression

“…However, these factors are only part of a complex network of physiological, psychological, and behavioural mechanisms which each influences weight regain . Indeed, reductions in energy expenditure due to changes in body composition, alongside potentially greater‐than‐predicted reductions caused by a series of adaptive responses such as reductions in leptin, thyroid, and adrenal hormones, are also likely to contribute to weight regain, as are increases in energy intake through appetitive and behavioural changes which may be sustained for over 1 to 6 years following weight loss …”