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Physical Activity Energy Expenditure and Total Daily Energy Expenditure in Successful Weight Loss Maintainers

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Objective The objective of this study was to compare physical activity energy expenditure (PAEE) and total daily energy expenditure (TDEE) in successful weight loss maintainers (WLM) with normal weight controls (NC) and controls with overweight/obesity (OC). Methods Participants were recruited in three groups: WLM (n = 25, BMI 24.1 ± 2.3 kg/m²; maintaining ≥ 13.6‐kg weight loss for ≥ 1 year), NC (n = 27, BMI 23.0 ± 2.0 kg/m²; similar to current BMI of WLM), and OC (n = 28, BMI 34.3 ± 4.8 kg/m²; similar to pre–weight loss BMI of WLM). TDEE was measured using the doubly labeled water method. Resting energy expenditure (REE) was measured using indirect calorimetry. PAEE was calculated as (TDEE − [0.1 × TDEE] − REE). Results PAEE in WLM (812 ± 268 kcal/d, mean ± SD) was significantly higher compared with that in both NC (621 ± 285 kcal/d, P < 0.01) and OC (637 ± 271 kcal/d, P = 0.02). As a result, TDEE in WLM (2,495 ± 366 kcal/d) was higher compared with that in NC (2,195 ± 521 kcal/d, P = 0.01) but was not significantly different from that in OC (2,573 ± 391 kcal/d). Conclusions The high levels of PAEE and TDEE observed in individuals maintaining a substantial weight loss (−26.2 ± 9.8 kg maintained for 9.0 ± 10.2 years) suggest that this group relies on high levels of energy expended in physical activity to remain in energy balance (and avoid weight regain) at a reduced body weight.

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... [5,7 IC95%: 0.8-10,6] x 10 5 ; p: 0,024) y SOD (coeficiente beta. [8,7;IC95%: 2,[7][8][9][10][11][12][13][14]8] x 10 5 ; p: 0,006). El tiempo realizando actividades de intensidad leve (1,5 METS) fue asociado con PON1 (coeficiente beta. ...
... The number of steps was correlated with higher levels of antioxidants SOD (r: 0,477; p: 0,006) and CAT (r: 0,417; p: 0,018); time spent on light-intensity activities was associated with lower levels of PON1 (r: -0,44; p: 0,01); total energy expenditure correlated with levels of SOD (r: 0,596; p: 0,001) and SH (r: 0,491; p: 0,011); and time spent on vigorous physical activity was associated with levels of NOX (r: 0,38; p: 0,03). Associations were observed between the number of steps and levels of CAT (beta coefficient [5,7; 95% CI: 0,8-10,6] x 10^5; p: 0,024) and SOD (beta coefficient [8,7;95% CI: 2,[7][8][9][10][11][12][13][14]8] x 10^5; p: 0,006). Time spent on light-intensity activities (1,5 METs) was associated with PON1 (beta coefficient [-1,9; 95% CI: -3,9 to -0,1] x 10^4; p: 0,006). ...
... Además del número de pasos, la intensidad de las actividades realizadas a diferentes METS podría influenciar en la salud de las personas mayores 10 . De la misma manera la evaluación del gasto energético total (GET) podría ser una variable importante a considerar para la evaluación de la condición física de los adultos mayores 11 . Por otro lado, una manera de evaluar el nivel de actividad física son los monitores de actividad física, los cuales miden de manera objetiva la cantidad e intensidad de los movimientos realizados por un individuo 12 . ...
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Introducción: En el proceso de envejecimiento, el equilibrio entre la producción de proteínas por las especies reactivas de oxígeno y la capacidad antioxidante se desestabiliza, lo que provoca el envejecimiento celular y molecular. Sin embargo, la actividad física puede mejorar la capacidad antioxidante y reducir el estrés oxidativo. Objetivo: Analizar la correlación entre la actividad física con marcadores oxidativos y marcadores antioxidantes en adultos mayores de la comunidad. Método: Se realizó un estudio transversal con 34 adultos mayores de la comunidad (57% varones, edad media 69±6 años). Las variables de actividad física (número de pasos, tiempo realizando diversas actividades, gasto energético total) fueron evaluadas con un acelerómetro. Adicionalmente, los marcadores antioxidantes SOD, PON1, CAT y SH, y los oxidativos NOX, LOOH y AOPP en muestras de sangre tomadas después de 10 horas de ayuno fueron analizados. Se utilizó el coeficiente de correlación de Pearson y Spearman para verificar la relación entre las variables de actividad física y los marcadores oxidativos y antioxidantes. Adicionalmente, un análisis de regresión logística fue utilizado para explorar la asociación entre los marcadores oxidativos y antioxidantes con las variables de actividad física. Resultados: El número de pasos fue correlacionado con mayores niveles de antioxidantes SOD (r: 0,477; p: 0,006) y CAT (r: 0,417; p: 0,018); el tiempo de actividades de intensidad leve con menores niveles de PON1 (r: -0,44; p: 0,01); el gasto energético total con los niveles de SOD (r: 0,596; p: 0,001) y SH (r: 0,491; p: 0,011); el tiempo en actividad física vigorosa con los niveles de NOX (r: 0,38; p: 0,03). Se observaron asociaciones entre número de pasos con los niveles de CAT (coeficiente beta. [5,7 IC95%: 0.8-10,6] x 105; p: 0,024) y SOD (coeficiente beta. [8,7; IC95%: 2,7-14,8] x 105; p: 0,006). El tiempo realizando actividades de intensidad leve (1,5 METS) fue asociado con PON1 (coeficiente beta. [-1.9; IC95%: -3,9- -0,1] x 104; p: 0,006). Conclusiones: Existe una correlación entre la actividad física con marcadores oxidativos y antioxidantes en adultos mayores de la comunidad. El número de pasos y el tiempo que dedica el adulto mayor a las actividades físicas son las principales variables asociadas con los marcadores de estrés oxidativo.
... Previous studies that analyzed self-reported data from weight loss maintainers have suggested they achieve long-term energy balance by decreasing EI (15)(16)(17)(18) and increasing physical activity (PA) (19)(20)(21)(22). The doubly labeled water (DLW) method for estimating total daily energy expenditure (TDEE) (23), along with increasingly sophisticated accelerometer technology, has provided compelling objective evidence to verify the high levels of self-reported PA in weight loss maintainers (24)(25)(26). However, far less attention has been given to verifying their self-reported EI (10,20). ...
... In a study that included 11 "successful slimmers" (maintaining 27.7 ± 12.5-kg weight loss), Black et al. (10,27) compared DLW TDEE with food records and found evidence of underreporting in 55% of participants, but 2 subjects had maintained weight loss for only 1 mo and the sample size was small. In a previous study using DLW, we showed that TDEE in weight-loss maintainers was similar to TDEE in individuals with overweight and obesity of a substantially higher body weight (25). These results suggest that successful maintainers use high levels of PA (rather than chronic restriction of EI) to achieve longterm energy balance at a reduced body weight and raise significant concerns about the reliability of self-reported EI data in this population. ...
... The primary aim of the present study was to use DLW-derived measures of TDEE to assess the accuracy of self-reported EI in successful weight loss maintainers compared with controls of normal body weight and controls with overweight/obesity. Given the similar TDEE in weight loss maintainers and individuals with overweight/obesity in our prior study (25), we hypothesized that weight loss maintainers would more closely resemble individuals with overweight/obesity than individuals of normal weight in both the degree and prevalence of underreporting of EI. As a secondary aim, we sought to identify potential drivers of underreporting by examining the correlation between underreporting of EI and other behavioral parameters, including self-reported macronutrient intake, eating behavior (cognitive restraint, disinhibition, and hunger), and device-measured PA and sedentary behavior. ...
Article
Background Individuals with overweight or obesity commonly underreport energy intake (EI), but it is unknown if the tendency to underreport persists in formerly obese individuals who lose significant weight and maintain their weight loss over long periods of time. Objective Assess the accuracy of self-reported EI in successful weight loss maintainers (WLM) compared with controls of normal body weight (NC) and controls with overweight/obesity (OC). Methods Participants for this case-controlled study were recruited in 3 groups: WLM [n = 26, BMI (in kg/m2) 24.1 ± 2.3; maintaining ≥13.6 kg weight loss for ≥1 y], NC (n = 33, BMI 22.7 ± 1.9; similar to current BMI of WLM), and OC (n = 32, BMI 34.0 ± 4.6; similar to pre–weight loss BMI of WLM). Total daily energy expenditure (TDEE) was measured over 7 d using the doubly labeled water (DLW) method, and self-reported EI was concurrently measured from 3-d diet diaries. DLW TDEE and self-reported EI were compared to determine accuracy of self-reported EI. Results WLM underreported EI (median, interquartile range) (–605, –915 to –314 kcal/d) to a greater degree than NC (–308, –471 to –68 kcal/d; P < 0.01) but not more than OC (–310, –970 to 18 kcal/d; P = 0.21). WLM also showed a greater degree of relative underreporting (–25.3%, –32.9% to –12.5%) compared with NC (–14.3%, –19.6% to –3.1%; P = 0.02) but not OC (–11.2%, –34.1% to –0.7%; P = 0.16). A greater proportion of WLM was classified as underreporters (30.8%) than NC (9.1%; P = 0.05) but not OC (28.1%; P = 1.00). Conclusions WLM underreported EI in both absolute and relative terms to a greater extent than NC but not OC. These findings call into question the accuracy of self-reported EI in WLM published in previous studies and align with recent data suggesting that WLM rely less on chronic EI restriction and more on high levels of physical activity to maintain weight loss. This trial was registered at clinicaltrials.gov as NCT03422380.
... Therefore, PAEE can potentially play an important role toward the WL and long-term maintenance (Ostendorf et al., 2019). In fact, whereas REE and thermic effect of food provide similar levels of contribution to the TDEE variance, PAEE (specially NEAT) depicts a greater variation in TDEE within and between individuals (accounting for 5-50% of TDEE), due to the large variability in NEPA (von Loeffelholz & Birkenfeld, 2000). ...
... Despite the expected substantial decrease in PAEE due to a lowering in body mass with dieting (Levine et al., 2001;Ostendorf et al., 2019), decreases in NEPA will consequently lead to a decrease in NEAT. Thus, reducing NEPA might lead to a decrease in TDEE, affecting the initially created negative EB and consequently, the ability to lose weight. ...
Article
Lack of efficacy of weight loss(WL) interventions is attributed in-part to low adherence to dietary/physical activity(PA) recommendations. However, some compensation may occur in PA as a response to energy restriction such as a decrease in non-exercise PA(NEPA) or non-exercise activity thermogenesis(NEAT). The current study aim was 1) to investigate whether adaptive thermogenesis(AT) in NEAT occurs after WL, and 2) to understand the associations of these compensations with WL. Ninety-four former athletes [mean±SD, age: 43.0±9.4y, BMI: 31.1±4.3kg/m², 34.0% female] were recruited and randomly assigned to intervention or control groups (IG, CG). The IG underwent a one-year lifestyle WL-intervention; no treatments were administered to the CG. PA was measured using accelerometery and NEAT was predicted with a model including sample baseline characteristics. AT was calculated as measuredNEAT4mo/12mo(kcal/d)–predictedNEAT4mo/12mo(kcal/d)-measuredNEATbaseline(kcal/d)–predictedNEATbaseline(kcal/d). Dual-energy x-ray absorptiometry was used to assess fat-free mass and fat mass. No differences were found in the IG for NEAT or NEPA after WL. Considering mean values, AT was not found for either group. The SD of individual response (SDIR) for AT was -2(4-months) and 24(12-months) (smallest worthwhile change=87kcal/d), suggesting that the interindividual variability regarding AT in NEAT is not relevant and the variability in this outcome might reflect a large within-subject variability and/or a large degree of random measurement error. No associations were found between AT in NEAT and changes in body composition. Further studies are needed to clarify the mechanisms behind the large variability in AT observed in NEAT and related changes in NEPA to better implement lifestyle-induced WL interventions. Trial registration: ClinicalTrials.gov identifier: NCT03031951..
... This seems to be corroborated by preliminary evidence showing that acute increases in energy flux improve appetite control and reduce the drive to eat (43). Moreover, the maintenance of high total energy expenditure by increasing voluntary or spontaneous physical activity (or targeting inactivity) is one of the few factors that has been shown to favor successful weight-loss maintenance (42,44). Consequently, the decreased energy expenditure induced by weight loss might, to some extent, oppose the effects exerted by appetite-regulating drugs on energy intake. ...
... The decrease in lean mass and energy expenditure observed with weight loss can be somewhat prevented by resistance exercise (42,44). In addition, drugs that favor lean mass preservation could have an important role in the weight maintenance phase ( Figure 5). ...
Article
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New appetite‐regulating antiobesity treatments such as semaglutide and agents under investigation such as tirzepatide show promise in achieving weight loss of 15% or more. Energy expenditure, fat oxidation, and lean mass preservation are important determinants of weight loss and weight‐loss maintenance beyond appetite regulation. This review discusses prior failures in clinical development of weight‐loss drugs targeting energy expenditure and explores novel strategies for targeting energy expenditure: mitochondrial proton leak, uncoupling, dynamics, and biogenesis; futile calcium and substrate cycling; leptin for weight maintenance; increased sympathetic nervous system activity; and browning of white fat. Relevant targets for preserving lean mass are also reviewed: growth hormone, activin type II receptor inhibition, and urocortin 2 and 3. We endorse moderate modulation of energy expenditure and preservation of lean mass in combination with efficient appetite reduction as a means of obtaining a significant, safe, and long‐lasting weight loss. Furthermore, we suggest that the regulatory guidelines should be revisited to focus more on the quality of weight loss and its maintenance rather than the absolute weight loss. Commitment to this research focus both from a scientific and from a regulatory point of view could signal the beginning of the next era in obesity therapies.
... Negative energy balance is required for weight loss and early maintenance phase [1]. Behavioral interventions, including reduction in energy intake (diet) and increase in energy expenditure (exercise/physical activity), result in weight loss of up to 10% of initial body weight within 6 months [2]. ...
... In weight loss programs that exceed 16 weeks of intervention, a flattening occurs in the weight loss curves [17], and if the maintenance period is not continued by a hypocaloric diet, then body weight regain occurs. Moreover, large and persistent increases in physical activity may be required for long-term maintenance of lost weight [1,18]. A review concluded that weight loss tends to reach a plateau, ranging between 5.0 and 8.5 kg (5-9% initial body weight) after 6 months' treatment, gradually increasing to 3.0-5.0 ...
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Studies comparing different types of exercise-based interventions have not shown a consistent effect of training on long-term weight maintenance. The aim of this study was to compare the effects of exercise modalities combined with diet intervention on body composition immediately after intervention and at 3 years’ follow-up in overweight and obese adults. Two-hundred thirty-nine people (107 men) participated in a 6-month diet and exercise-based intervention, split into four randomly assigned groups: strength group (S), endurance group (E), combined strength and endurance group (SE), and control group (C). The body composition measurements took place on the first week before the start of training and after 22 weeks of training. In addition, a third measurement took place 3 years after the intervention period. A significant interaction effect (group × time) (p = 0.017) was observed for the fat mass percentage. It significantly decreased by 5.48 ± 0.65%, 5.30 ± 0.65%, 7.04 ± 0.72%, and 4.86 ± 0.65% at post-intervention for S, E, SE, and C, respectively. Three years after the intervention, the fat mass percentage returned to values similar to the baseline, except for the combined strength and endurance group, where it remained lower than the value at pre-intervention (p < 0.05). However, no significant interaction was discovered for the rest of the studied outcomes, neither at post-intervention nor 3 years later. The combined strength and endurance group was the only group that achieved lower levels of fat mass (%) at both post-intervention and 3 years after intervention, in comparison with the other groups.
... Other groups including the International Association for the Study of Obesity (5), the European College of Sport Science (6), and the American College of Sports Medicine (7) have recommended 60 to 90 min/d (300-450 min/wk) of moderate-intensity PA to maintain WL. Exercise recommendations for weight maintenance are based primarily on results from cross-sectional (8)(9)(10) and nonrandomized studies (11)(12)(13)(14)(15) or retrospective analyses of randomized trials. These studies suggest that relatively high volumes of exercise (>200 min/wk) are required to minimize weight regain (16)(17)(18). ...
... In contrast to our results, results from numerous cross-sectional studies (8,10,32,33), nonrandomized trials (11)(12)(13)15), and retrospective analysis of long-term randomized WL trials (16)(17)(18) suggest that relatively high volumes of exercise (>200 min/wk) are required for long-term WL or to minimize weight regain following WL. For example, several reports from the NWCR indicated that participants engaged in 60 to 90 min/d of moderate-intensity exercise (32,33). ...
Article
Objective This study aimed to evaluate the effectiveness of three levels of exercise on weight regain subsequent to clinically meaningful weight loss (WL). Methods Adults with overweight or obesity (n = 298) initiated a 3‐month behavioral WL intervention, which included reduced energy intake, increased exercise, and weekly behavioral counseling. Participants achieving ≥5% WL (n = 235) began a 12‐month behavioral WL maintenance intervention and were randomized to 150 min/wk (n = 76), 225 min/wk (n = 80), or 300 min/wk (n = 79) of partially supervised moderate‐to‐vigorous–intensity exercise. Results Participants randomized to 150, 225, and 300 minutes of exercise completed 129 ± 30, 153 ± 49 and 179 ± 62 min/wk of exercise (supervised + unsupervised), respectively. Mean WL at 3 months (9.5 ± 3.1 kg) was similar across randomized groups (P = 0.68). Weight change across 12 months was 1.1 ± 6.5 kg, 3.2 ± 5.7 kg, and 2.8 ± 6.9 kg in the 150, 225, and 300 min/wk groups, respectively. Intent‐to‐treat analysis revealed no significant overall trend across the three treatment groups (P = 0.09), effects for group (P = 0.08), or sex (P = 0.21). Conclusions This study found no evidence for an association between the volume of moderate‐to‐vigorous–intensity exercise and weight regain across 12 months following clinically relevant WL. Further, results suggest that exercise volumes lower than those currently recommended for WL maintenance, when completed in conjunction with a behavioral weight‐maintenance intervention, may minimize weight regain over 12 months.
... Bariatric patients must adhere to dietary guidelines, including frequent small meals and limiting certain foods, to reduce nutritional deficiencies and enhance overall health [12][13][14]. Despite these benefits, sustaining behavioral changes can be complex, requiring support from a multidisciplinary team and non-professional networks [15][16][17]. Professional support from surgeons, dietitians, and psychologists has been shown to improve adherence to healthy habits, while non-professional support, such as family and support groups, provides emotional and practical assistance [8,18]. However, most research focuses on the short-term postoperative period, with limited data on patients beyond 2 years post-surgery. ...
Article
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Background Obesity, defined as a body mass index (BMI) of ≥ 30 kg/m², is a global health crisis with severe physical and mental health implications. While bariatric surgery offers the most effective solution for severe obesity, long-term success depends on sustained behavioral changes and support (non-professional and professional). This study explores the role of support in promoting a healthy lifestyle after surgery. Methods This study surveyed 211 individuals, aged 18–65, who had bariatric surgery more than 2 years ago, using random selection. Data were collected via phone interviews, ensuring anonymity. Questionnaires assessed healthy lifestyle (physical activity and nutrition) as well as professional and non-professional support participants received. Analysis methods encompassed χ² tests, Pearson correlations, t-tests, and multiple regressions for predicting a healthy lifestyle. Results Most participants underwent sleeve gastrectomy with varied BMIs (17–47), and only 19.4% had a healthy weight. Two-thirds engaged in physical activities, with generally healthy diets. While 78.7% received post-surgery support, most of this support was provided by surgeons. However, less than half had access to professional psychological support or participated in non-professional support, such as joining support groups. Regression models showed that support significantly predicted nutrition but not physical activity level. However, years from surgery were also an important predictor with the overall model predicting 2% (general nutrition—not appropriate) to 12% (bariatric nutrition) of healthy lifestyle variability. Conclusions Most participants sought surgical consultation early post-surgery, but long-term follow-up and engagement with professional services were low. Support from dietitians or psychologists was linked to improved nutritional outcomes, highlighting the importance of sustained professional guidance.
... (18) Estimation of Insulin Resistance (HOMA-IR) index was done with the standard formula: HOMA-IR Index = (Fasting Insulin, uIU/mL) x (Fasting glucose, mg/dL)/ 405 (19) Lifestyle intervention included a low GI diet plan and 45 minutes of moderate-intensity exercise (60-70% of maximum heart rate) done 3 times per week. Individualized calorie requirement was calculated (20) based on Basal Metabolic Rate (BMR) and Total Daily Energy (21) Expenditure (TDEE) and an appropriate calorie deficit (typically 500-750 kcal/day) was applied to promote a weight loss of 0.5-1 Kg per week. A weight loss of approximately 5-10% of their initial body weight was expected over a 12-week study period. ...
Article
Background: Polycystic ovary syndrome (PCOS) is a common heterogeneous endocrine condition that affects women of reproductive age, often associated with obesity and insulin resistance. Of particular concern is the association between PCOS and obesity, which exacerbates metabolic dysfunction, insulin resistance, and the risk of developing Type 2 diabetes and cardiovascular disease. Irisin, a novel myokine, has garnered significant interest for its potential role in energy metabolism and glucose homeostasis regulation. Metformin, a biguanide derivative has emerged as a cornerstone in the management of PCOS, especially in obese individuals. Therefore, the present study was conducted to know the effect of Metformin and lifestyle modification on certain key metabolic parameters particularly, serum irisin level in obese women with polycystic ovary syndrome. A prospective interventional study was c Material And Methods: onducted at the Department of Obstetrics & Gynaecology of Dr B.R.A.M. Hospital, Raipur in a span of 1 year, from March 2023 to March 2024. The study was conducted on 52 PCOS women with obesity (BMI >25) coming to the outpatient department. The patients were categorized into two groups. Group A: (26) Subjects receiving metformin therapy along with lifestyle modifications for 12 weeks; and Group B: (26) Subjects not receiving Metformin therapy but only lifestyle modifications for 12 weeks. Irisin levels were assessed using the ELISA kit of Phoenix Pharmaceuticals The statistical analysis was done using MS Excel and SPSS 20. Combining Metformin and lifestyle interven Results: tion significantly increased serum Irisin levels over 12 weeks (p=0.002) in contrast to lifestyle intervention alone (p=0.286). W Conclusion: e observed improvement in irisin values in both groups, but the combined approach with Metformin and lifestyle modification shows pronounced improvement in clinical, metabolic, and hormonal profiles in PCOS women with obesity.
... The gastrointestinal system, which involves multiple organs (including the liver and pancreas), consumes up to 10% of total daily energy expenditure to assimilate nutrients and is heavily innervated by the PNS, especially the vagus nerve [13]. Separated from the thoracic cavity by the diaphragm, the abdominal cavity is heavily muscled on all sides to provide contractile action (through sympathetic nervous system [SNS] signals from the T7-T12 intercostal nerves) for defecation and vomiting, plus sneezing and coughing in concert with the diaphragm [14]. ...
Article
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This entry reviews the health condition known as Roemheld syndrome, or gastrocardiac syndrome in modern medicine. A pathology of gastrointestinal origin, the syndrome relies on a gut–brain–heart triad, interconnected by the vagus nerve. Pressure from the intestines pushes the stomach into the diaphragm and activates the vagus nerve, which affects the heart rate and gives the perception of cardiac issues. This distressing sensation, which usually comes after meals or with other digestive problems, causes anxiety or panic. Although events not arising from anatomic abnormalities are relatively harmless, hypersensitivity to these uncomfortable sensations may precipitate psychiatric problems (anxiety or depression) that cause repeated gastrocardiac events through sympathetic activation and the disruption of peristalsis. Treatment is usually symptomatic and may include diet, lifestyle changes, probiotics, or prescriptions that increase gut motility, but this specific set of reproducible symptoms may also be caused by hiatal hernia or side effects from medication/surgery and treated with respect to those mechanical causes. This review highlights details from the most current knowledge of the condition and offers suggestions for clinical management based on the literature.
... It is generally accepted that unhealthy behaviours are important proximal causes of overweight and obesity. Overweight and obesity is a consequence of a prolonged energy surplus (i.e., greater energy intake than energy expenditure) [31,54]. Thus, increasing energy expenditure and/or decreasing energy intake will create energy deficit in the body that can lower body weight over time. ...
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Background More than two-thirds of Australians are overweight. Existing research based on non-experimental data has primarily established associations, rather than causal inferences, between physical activity (PA) and Body Mass Index (BMI). PA and BMI likely affect each other, a reciprocal interplay most studies overlook. We investigate the causal relationship between PA and BMI using a quasi-experimental approach to overcome reverse causality Methods A Maximum Likelihood Treatment Effect model, a quasi-experimental method, was employed. Data was from an observational longitudinal dataset of 130,397 observations with 19,677 unique individuals aged 15-64 (52% are females) from the Household, Income, and Labour Dynamics in Australia survey 2006-2019. We first tested for the reverse relationships (whereby overweight limits PA) before estimating the effect of PA on BMI. Results The first stage modelling results showed that overweight and obese adults are less likely to engage in PA, as are those resource constrained (time or socioeconomically). In the second modelling stage, there was a clear and significant effect of PA on BMI. Being physically active more than three times a week led to a 2.55-point reduction in BMI (p<0.001). For women, this effect was more pronounced, with a 2.92-point reduction (p<0.001). Conclusions This study leverages existing longitudinal data to provide causal estimates of PA on BMI - finding that PA reduces BMI, particularly for women. As many individuals face resource constraints campaigns to promote behavioural change need to be nuanced, and shift some of the responsibility for physically activity from individuals to policy and organizational reforms.
... Moreover, the chatbot comes with BMI, BMR calculation program to help users record daily calories intake. [8]. ...
... Due to the complex causes associated with overweight and obesity, the quest to find the optimal, sustainable weight loss approach has been exhaustive. Studies have repeatedly demonstrated that a variety of dietary approaches work equally well both for weight loss and adherence if a consistent calorie deficit is achieved (Adegboye & Linne, 2013;Franz et al., 2007;Hall & Guo, 2017;Ostendorf et al., 2019;Tzur et al., 2018;Wadden et al., 2015). Unfortunately, while short-term weight loss can appear promising, the majority of dieters regain their lost weight within a year, often eventually resulting in a higher weight than at baseline (Dulloo et al., 2012;Maclean et al., 2018). ...
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Purpose The prevalence of overweight and obesity is continuously increasing globally and long-term weight loss intervention outcomes remain disappointing. To determine which behavioural intervention approaches improve the probability of achieving long-term weight loss, this two-year follow-up study aimed to identify distinct factors and strategies for successful long-term weight loss maintenance. Methods A cohort of 20 participants with overweight and obesity from a primary-care led weight management programme with diverse backgrounds was interviewed at baseline, after 1 and 2 years, and asked to do quantitative self-description. This study focused on the 2-year follow-up interviews from this study series. Results We found that agile, continuous self-monitoring with personalized, sustainable lifestyle habits correlated with positive outcomes. Participants reported health benefits, maintained weight loss, and found motivation in supportive peer networks. Challenges like anxiety, disappointment, and disruptions derailed progress. Long-term success relied on a strong support system of healthcare professionals, friends, and family. Conclusions The findings of this study series highlight the intricate nature of long-term weight loss maintenance. This study corroborates the persistence of overarching themes while highlighting the individual variability in their relative importance. Findings emphasize the importance of long-term support to effectively address the diverse needs of patients trying to achieve long-term weight loss maintenance.
... With higher levels of total daily energy expenditure, the energy intake required to match energy expenditure and maintain the new, lower "settling point" may be more feasible for weight-reduced individuals. For example, in a cross-sectional sample of weight-loss maintainers, it was found that energy expended from physical activity was significantly higher compared with nonweight-reduced individuals of a similar BMI [105]. Furthermore, strategies to dissipate negative preconceptions about physical activity and to meet people where they are at are needed. ...
Article
Obesity is a chronic disease that affects more than 650 million adults worldwide. Obesity not only is a significant health concern on its own, but predisposes to cardiometabolic comorbidities, including coronary heart disease, dyslipidemia, hypertension, type 2 diabetes, and some cancers. Lifestyle interventions effectively promote weight loss of 5% to 10%, and pharmacological and surgical interventions even more, with some novel approved drugs inducing up to an average of 25% weight loss. Yet, maintaining weight loss over the long-term remains extremely challenging, and subsequent weight gain is typical. The mechanisms underlying weight regain remain to be fully elucidated. The purpose of this Pennington Biomedical Scientific Symposium was to review and highlight the complex interplay between the physiological, behavioral, and environmental systems controlling energy intake and expenditure. Each of these contributions were further discussed in the context of weight-loss maintenance, and systems-level viewpoints were highlighted to interpret gaps in current approaches. The invited speakers built upon the science of obesity and weight loss to collectively propose future research directions that will aid in revealing the complicated mechanisms involved in the weight-reduced state.
... The sample size was determined according to the primary outcome of the main study. For this study, using the most conservative assumptions, a difference in energy estimates of 350 ± 450 kcal/day (effect size 0.78) between TDEI reported with SNAQ and TDEE estimated with DLW was considered relevant in assessing the validity of SNAQ (37,38). Therefore, it was estimated that 27 study participants would have been necessary to have 80% power to detect this difference at a 5% significance level. ...
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Accurate dietary assessment is crucial for nutrition and health research. Traditional methods, such as food records, food frequency questionnaires, and 24-hour dietary recalls (24HR), have limitations, such as the need for trained interviewers, time-consuming procedures, and inaccuracies in estimations. Novel technologies, such as image-based dietary assessment apps, have been developed to overcome these limitations. SNAQ is a novel image-based food-recognition app which, based on computer vision, assesses food type and volume, and provides nutritional information about dietary intake. This cross-sectional observational study aimed to investigate the validity of SNAQ as a dietary assessment tool for measuring energy and macronutrient intake in adult women with normal body weight (n = 30), compared to doubly labeled water (DLW), a reference method for total daily energy expenditure (TDEE). Energy intake was also estimated using a one-day 24HR for direct comparison. Bland–Altman plots, paired difference tests, and Pearson’s correlation coefficient were used to assess agreement and relationships between the methods. SNAQ showed a slightly higher agreement (bias = −329.6 kcal/day) with DLW for total daily energy intake (TDEI) compared to 24HR (bias = −543.0 kcal/day). While both SNAQ and 24HR tended to underestimate TDEI, only 24HR significantly differed from DLW in this regard (p < 0.001). There was no significant relationship between estimated TDEI and TDEE using SNAQ (R² = 27%, p = 0.50) or 24HR (R² = 34%, p = 0.20) and there were no significant differences in energy and macronutrient intake estimates between SNAQ and 24HR (Δ = 213.4 kcal/day). In conclusion, these results indicate that SNAQ provides a closer representation of energy intake in adult women with normal body weight than 24HR when compared to DLW, but no relationship was found between the energy estimates of DLW and of the two dietary assessment tools. Further research is needed to determine the clinical relevance and support the implementation of SNAQ in research and clinical settings. Clinical trial registration: This study is registered on ClinicalTrials.gov with the unique identifier NCT04600596 (https://clinicaltrials.gov/ct2/show/NCT04600596).
... The cause of overweight and obesity can appear to be a simple imbalance in energy utilization and consumption, yet the underlying drivers are multifaceted and diverse, ranging from biological, psychological and social to economical and infrastructural, amongst many (Emmer et al., 2019). Interventions combining dietary modifications as well as increased physical activity levels and behavioural support tend to yield the most promising results (Cai et al., 2020;Foresight, 2020;Milner & Beck, 2012;Van der Zalm et al., 2020) regardless of dietary preference and composition (Adegboye & Linne, 2013;Ostendorf et al., 2019). However, while various short term weight loss attempts can yield promising results, the majority of successful dieters regain their lost weight after 1 year (Franz et al., 2007). ...
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Introduction The global prevalence of overweight and obesity is continuously increasing. Long-term weight loss results remain disappointing. This study aims to identify factors and strategies for successful long-term weight loss in a primary care-led weight-loss intervention from the perspective of participants. Materials and methods This qualitative interview study is the first follow-up study in a 2-year study series of participants with overweight or obesity. Methods utilized are semi-structured interviews (n = 20) with quantitative self-description. The data were transcribed from audio-taped interviews and analysed thematically. Results This study found that clear, continuously evolving self-monitoring strategies facilitated by strong routines and a long-term focus enhanced successful outcomes. Challenges faced included stress, disappointment and loss of routine along with external criticism and discouragement. Benefits experienced due to weight loss included improved health, self-esteem, communal support and encouragement, which continued to fuel motivation. Receiving continuous support and encouragement from healthcare practitioners was instrumental for long-term success. Conclusion This study highlighted the complex, multifaceted experiences patients encounter in the pursuit of trying to achieve long-term weight loss. Personalized treatment protocols taking into account the diverse requirements and circumstances of individuals have the potential to improve treatment outcomes. Continuous, professional support may enhance long-term outcomes.
... Furthermore, a higher self-reported level of physical activity during a follow-up period after a weight loss intervention has been found to be associated with less weight regain 24,128,129 . Individuals who successfully maintained their weight loss reported high levels of physical activity 130 , and had a higher physical activity-related energy expenditure and total daily energy expenditure, measured with doubly labelled water, than weight-matched controls 131 . Subsequent decreases in physical activity over time in these individuals were associated with weight regain 132 . ...
Article
Weight regain after successful weight loss resulting from lifestyle interventions is a major challenge in the management of overweight and obesity. Knowledge of the causal mechanisms for weight regain can help researchers and clinicians to find effective strategies to tackle weight regain and reduce obesity-associated metabolic and cardiovascular complications. This Review summarizes the current understanding of a number of potential physiological mechanisms underlying weight regain after weight loss, including: the role of adipose tissue immune cells; hormonal and neuronal factors affecting hunger, satiety and reward; resting energy expenditure and adaptive thermogenesis; and lipid metabolism (lipolysis and lipid oxidation). We describe and discuss obesity-associated changes in these mechanisms, their persistence during weight loss and weight regain and their association with weight regain. Interventions to prevent or limit weight regain based on these factors, such as diet, exercise, pharmacotherapy and biomedical strategies, and current knowledge on the effectiveness of these interventions are also reviewed.
... They argued that this might explain why their vertical intercept (time rate of energy expenditure at zero speed) was greater than resting metabolic rate. This is especially relevant for DEE estimation, since resting metabolic rate is one of the two largest contributors (30-60%) to DEE, the other being the energetic cost of physical activity (25-87%) [26][27][28][29]. It is thus worth investigating how a calibration model should treat activity and inactivity: separately, or together in a single equation. ...
Article
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Background All behaviour requires energy, and measuring energy expenditure in standard units (joules) is key to linking behaviour to ecological processes. Animal-borne accelerometers are commonly used to infer proxies of energy expenditure, termed ‘dynamic body acceleration’ (DBA). However, converting acceleration (m/s^2) to standard units (watts) involves costly in-lab respirometry measurements, and there is a lack of viable substitutes for empirical calibration relationships when these are unavailable. Methods We used past allometric work quantifying energy expenditure during resting and locomotion as a function of body mass to calibrate DBA. We used the resulting ‘power calibration equation’ to estimate daily energy expenditure (DEE) using two models: (i) locomotion data-based linear calibration applied to the waking period, and Kleiber’s law applied to the sleeping period (ACTIWAKE), and (ii) locomotion and resting data-based linear calibration applied to the 24-h period (ACTIREST24). Since both models require locomotion speed information, we developed an algorithm to estimate speed from accelerometer, gyroscope, and behavioural annotation data. We applied these methods to estimate DEE in free-ranging meerkats (Suricata suricatta), and compared model estimates with published DEE measurements made using doubly labelled water (DLW) on the same meerkat population. Results ACTIWAKE’s DEE estimates did not differ significantly from DLW (t(19) = -1.25; P = 0.22), while ACTIREST24’s estimates did (t(19) = -2.38; P = 0.028). Both models underestimated DEE compared to DLW: ACTIWAKE by 14% and ACTIREST by 26%. The inter-individual spread in model estimates of DEE (s.d. 1-2% of mean) was lower than that in DLW (s.d. 33% of mean). Conclusions We found that linear locomotion-based calibration applied to the waking period, and a ‘flat’ resting metabolic rate applied to the sleeping period can provide realistic Joule estimates of DEE in terrestrial mammals. The underestimation and lower spread in model estimates compared to DLW likely arise because the accelerometer only captures movement-related energy expenditure, whereas DLW is an integrated measure. Our study offers new tools to incorporate body mass (through allometry), and changes in behavioural time budgets and intra-behaviour changes in intensity (through DBA) in acceleration-based field assessments of daily energy expenditure.
... Unfortunately, gym-goers were found to have a low level of nutrition knowledge, especially when compared with athletes (Calella et al., 2021). Following the PN concept, it is insufficient to adhere to any generic dietary plan since an optimal macronutrient distribution compliant with the total daily energy expenditure is vital to achieving fitness goals (Garcia, 2019;Genton, 2011;Ostendorf et al., 2019). ...
Conference Paper
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The Virtual Dietitian (VD) application is a nutrition knowledge-based system that generates personalized meal plans in accordance with the one-size-does-not-fit-all concept of precision nutrition. A subset of the population that was not involved in its four-part developmental study was gym and fitness enthusiasts despite them being important target users. As part of our quality improvement (QI) plan, we initiated a two-phase user testing to inform modifications to VD. We recruited a total of 30 users with prior experience in nutrition applications. In phase 1, they used the current version of VD for a week and answered a mixed-form questionnaire afterward. We used the same questionnaire from our previous study, which is composed of System Usability Scale (SUS) items and open-ended questions. After months of system modification, the same set of users evaluated again the new VD version after another week of use. A paired-sample t-test showed a statistically significant difference in SUS scores before (SUS = 79) and after (SUS = 82) modifying VD based on the suggestions of the participants (p = 0.005). Some new features include water tracker and reminder modules, Google Fit integration, and other nutrition support services (e.g., teleconsultation with registered dietitians). Although further refinements to VD are still needed, we were able to incorporate a QI initiative typically employed by healthcare organizations into software development for a better and improved personalized nutrition application.
... [18] The activity energy expenditure of the participants in this study was lower than that in a previous study (534 vs 621 kcal/d) targeting the general population. [26] The difference in these results is difficult to directly compare because energy expenditure according to activity intensity level was not analyzed in the previous study; however, the previous study's participants probably completed more activity. Conversely, high-intensity activities were performed for approximately 1 minute in the present study. ...
Article
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The aim of this study was to analyze the daily physical activity and the relationship between the physical activity levels and psychological variables of Koreans with HIV. Twenty-two people with HIV participated in this study. The participants completed questionnaires, and we assessed the daily physical activity for 2 weeks. The daily physical activity level of most of the participants was low-intensity; high-intensity activities were only performed for approximately 1 minute. The participants had unhealthy dietary habits, such as eating 2 meals a day, eating irregularly, and skipping breakfast. Psychological well-being and environmental satisfaction were higher in the high-intensity group than in the medium- and low-intensity groups (P < .05). The overall stress level among the groups was statistically significantly different (P < .05), and the stress level was lower in the high-intensity group than in the low- and medium-intensity groups. Restraint eating was higher in the low-intensity group than in the medium- and high-intensity groups (P < .05). However, among the groups, the external eating variable was highest in the high-intensity group (P < .05). Daily physical activity during positively affects the physical and mental well-being of people living with HIV.
... The importance of aerobic exercise has been demonstrated in numerous studies in the improvements produced at the cardiovascular level (Niebauer & Cooke, 1996;Miele & Headley, 2017;Nystoriak & Bhatnagar, 2018) and its importance in the EE (Strasser & Schobersberger, 2011;Drenowatz et al. al., 2015;Gastin et al., 2018;Ostendorf et al., 2019;Berge et al., 2021). That is why sports sciences are in constant evolution looking for methods and scientific research to improve sports performance and rehabilitation (Sozen, 2010). ...
Article
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The objective of this article was to compare different cardiovascular training machines and their effects on the body, as well as to determine their suitability for people with low intensity or high intensity training needs. A total of 8 physically active and healthy male subjects (mean ± standard deviation; age: 28.45 ± 1.75 years; height: 1.84 ± 0.07 m; body weight 76.42 ± 8.62 kg; body mass index: 25.5 ± 2.6) were evaluated through of an incremental exercise test at different intensities on two different machines: Elliptical Domyos 680 (BED) and Deconstruct Elliptical 331-EF (DEC). To compare both machines against the two mentioned training needs, two different protocols were carried out: Low Intensity Protocol (LIP) and High Intensity Protocol (HIP). In addition, a thermographic analysis was carried out in order to determine the temperature differences reached in the musculature. No significant differences were found in HR and EE (p < .05) between the two machines. However, a greater and more progressive activation of the muscles of the upper extremities was observed in the DEC machine. In the HIP, HR and EE were measured, obtaining significant differences (p < .05) higher in the DEC machine. Therefore, in our comparison, the Deconstruct Elliptical machine produced more appropriate results for both low and high intensity training compared to the Elliptical machine. These results and the novel nature of the Deconstruct Elliptical raise the need for further studies to better understand this machine.
... Even then, the value of engaging in a physically active lifestyle was understood. From there on, a vast body of evidence has been accumulated documenting the benefits of physical activity in mitigating a wide variety of healthrelated concerns (Katzmarzyk et al., 2003;Lavie et al., 2019;McTiernan et al., 2019;Ostendorf et al., 2019;Park et al., 2021). Additionally, the value of learning skills and strategies for how to engage in and maintain active and healthy lifestyle choices during the college years has been established (Adams & Brynteson, 1992, 1995Ferrara, 2009;Hager et al., 2012;Pearman et al., 1997;Sallis et al., 1999;Slava et al., 1984;Sparling & Snow, 2002;Sparling, 2003;Woekel et al., 2013). ...
Article
Purpose: Physical education requirements (PERs) have been suggested as a potential solution for increasing physical activity (PA) among undergraduate students, specifically for the inactive who face the greatest barriers to PA. In 2010, among a nationally-representative, random sample of tertiary institutions in the U.S. only 39% had PERs as part of their general education curriculum. But, being a decade old, this data may be outdated. The aim of this study was to examine the current status of PERs in U.S. tertiary institutions and to explore what institutional characteristics are associated with having a PER. Methods: Academic catalogs of a nationally representative, random sample of 331 institutions were searched for PER information. Results: The majority of U.S. tertiary institutions did not mandate physical education (PE) courses (56.2%), whereas 31.7% fully and 12% partially required their undergraduate students to complete a PE course to graduate. The characteristics most associated with an institution having a PER included being private, having a small enrollment size, having an academic degree program related to the field, having both activity and conceptual components, being <3 credit hours, offering an elective program in physical activity education, and being located in the south. Conclusion: Future work is needed to identify important elements of PER courses, reasons why PERs are sustained by some institutions versus others, and to establish practical guidelines regarding best practices for quality PER courses. More direct action within the discipline of kinesiology is needed to underscore the importance and need of PERs at the tertiary level.
... It is also important to highlight that although triathletes, a weight-sensitive sport, increased EI, their EA was the lowest among sports, reinforcing our previous findings about the metabolic adaption in the REE observed in triathletes (Silva et al., 2017a). It should also be emphasized that nonexercise activity thermogenesis (i.e., the energy expenditure of unstructured physical activity [Ostendorf et al., 2019]) may have decreased in triathletes, as nonexercise activity thermogenesis has been observed to decrease in the presence of exercise routines (King et al., 2007) and EI restrictions (Martin et al., 2011;Redman et al., 2009), possibly contributing to energy conservation, supporting a constrained TEE model as proposed by Pontzer et al. (2016). Nevertheless, evidence is too scarce to draw any definitive conclusions about the regulation of the energy balance components. ...
Article
During the athletic season, changes in body composition occur due to fluctuations in energy expenditure and energy intake. Literature regarding changes of energy availability (EA) is still scarce. The aim was to estimate EA of athletes from nonweight and weight-sensitive sports during the athletic season (i.e., preparatory and competitive phase). Eighty-eight athletes (19.1 ± 4.2 years, 21.8 ± 2.0 kg/m2, 27% females, self-reported eumenorrheic) from five sports (basketball [n = 29]; handball [n = 7]; volleyball [n = 9]; swimming [n = 18]; and triathlon [n = 25]) were included in this observational study. Energy intake and exercise energy expenditure were measured through doubly labeled water (over 7 days and considering neutral energy balance) and metabolic equivalents of tasks, respectively. Fat-free mass (FFM) was assessed through a four-compartment model. EA was calculated as EA = (energy intake − exercise energy expenditure)/FFM. Linear mixed models, adjusted for sex, were performed to assess EA for the impact of time by sport interaction. Among all sports, EA increased over the season: basketball, estimated mean (SE): 7.2 (1.5) kcal/kg FFM, p < .001; handball, 14.8 (2.9) kcal/kg FFM, p < .001; volleyball, 7.9 (2.8) kcal/kg FFM, p = .006; swimming, 8.7 (2.0) kcal/kg FFM, p < .001; and triathlon, 9.6 (2.0) kcal/kg FFM, p < .001. Eleven athletes (12.5%) had clinical low EA at the preparatory phase and none during the competitive phase. During both assessments, triathletes’ EA was below optimal, being lower than basketballers (p < .001), volleyballers (p < .05), and swimmers (p < .001). Although EA increased in all sports, triathlon’s EA was below optimal during both assessments. Risk of low EA might be seasonal and resolved throughout the season, with higher risk during the preparatory phase. However, in weight-sensitive sports, namely triathlon, low EA is still present.
... Research has consistently shown that both weight loss success and adherence can be achieved with varying dietary approaches [6,7]. Behavioural interventions entailing dietary and physical activity protocols have shown to be particularly promising [8][9][10][11]. Yet, while short term weight loss attempts using a multitude of methods have shown to be successful at times, weight regain is experienced by the majority of successful dieters [12]. Additionally, patients frequently regain more weight than they initially lost [13]. ...
Article
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Introduction The long-term effects of interventions aiming to achieve substantial, sustainable weight loss maintenance have been disappointing. Most people regain their lost weight over time but some seem to be able to maintain their weight loss. We are following the experiences of patients over time prospectively. This study forms the baseline to provide insights into patient experiences prior to entering a primary care-led weight management intervention and their expectations going forward. Materials and methods We recruited 21 adult male and female patients of varying ethnicity with a BMI between 27.7kg/m2 and 48.4kg/m2 from a cohort of patients entering a primary care-led weight management intervention. Patients were offered video and audio interview options during the COVID-19 lockdown. In total, twenty chose the audio option, while one chose the video option. The interview format was semi-structured with room for individual exploration. Discussion We found that participants experienced feeling unable to control their weight and encountered a multitude of internal and external barriers to weight management. Some had supportive environments, while others experienced discouraging external influences. Though personal characteristics varied, motivations, goals and expected benefits were similar across this cohort. Most participants had previously experienced transient successful weight-loss attempts with varying approaches. COVID-19 was experienced as an opportunity or barrier for change. Conclusion This study illustrates the importance of gaining comprehensive insights into the diverse experiences patients encounter when trying to achieve weight loss. Personalized support taking into account individual experiences and circumstances may enhance long-term treatment outcomes. Future research into the complexities of weight management based on individual accounts can aid in the creation of improved treatment protocols.
... Better understanding the compensatory responses to energy deficits achieved by diet vs exercise should optimize weight management interventions for adolescents with obesity. While total daily REI is reduced here during both energy deficits (Def-EI and Def-mixed), including physical exercise should be encouraged for its beneficial effect on weight loss and weight maintenance [28], as well as on overall health in people with obesity [27]. Moreover, in addition to inducing a deficit by increasing EE, physical activity favors a high energy turnover in absence of dietary restriction, which has been shown to improve the homeostasis of energy balance by optimizing the physiological control of appetite (endocrine signals) and subjective appetite sensations [18]. ...
Article
Background Acute dietary-induced energy deficits have been shown to favor compensatory appetitive responses. The aim of this study was to compare energy intake (EI), appetite sensations and the hedonic responses to equivalent energy deficits induced by dietary restriction alone and combined with exercise in adolescents with obesity. Methods In a within-subjects design, seventeen adolescents with obesity (12-16 years, Tanner stage 3-5, 6 males) randomly completed three 14-hour conditions: i) control (CON); ii) deficit induced by diet only (Def-EI) and; iii) deficit induced by combined diet and physical exercise (Def-mixed). Breakfast and lunch were calibrated to generate a 500 kcal deficit in Def-EI and 250 kcal deficit in Def-mixed. A 250 kcal deficit was created through a cycling exercise set at 65% VO2peak in Def-mixed. Ad libitum EI, macronutrients and relative EI (REI) were assessed at dinner, subjective appetite sensations taken at regular intervals, and food reward measured before dinner. Results EI at dinner was significantly lower in Def-EI compared to CON (p=0.014; Effect size (ES): -0.59 [-1.07; -0.12]), with no difference between Def-mixed and both CON and Def-EI. Total REI was lower in both deficit conditions compared with CON (Def-mixed: p<0.001; ES: -3.80 [-4.27; -3.32], Def-EI: p<0.001; ES: -4.90 [-5.37; -4.42] respectively), indicating incomplete compensation for the energy deficits. Absolute protein ingestion at dinner was lower in Def-EI than Def-mixed (p=0.037; ES: -0.50 [-0.98; -0.03]) and absolute lipid ingestion was lower in Def-EI than in CON (p=0.033; ES: -0.51 [-0.99; -0.04]). A higher proportion of protein and a lower proportion of carbohydrates was observed in Def-mixed than in Def-EI (p=0.078; ES: -0.42 [-0.90; 0.04] and p=0.067; ES: 0.44 [-0.03; 0.92] respectively). Total area under the curve for appetite sensations were similar between conditions. Explicit liking for sweet relative to savoury food was lower in Def-mixed compared to CON (p=0.027; ES: -0.53 [-1.01; -0.06]) with no difference in food reward between Def-EI and CON. Conclusion Neither of the two acute isoenergetic deficits led to subsequent appetitive compensation, with the dietary deficit even inducing a lower ad libitum EI at the subsequent dinner. Further studies are needed to better understand the appetitive response to dietary and exercise energy balance manipulations in this population.
... Individuals successfully maintaining weight have reported greater levels of MVPA than those who are unsuccessful [42]. Objective measures of energy expenditure have recently confirmed these findings by indicating that, compared to normal weight and overweight/obese controls, individuals that have successfully maintained long-term weight loss have markedly higher levels of physical-activity-related energy expenditure [43]. Research on sedentary behavior has demonstrated that successful weight loss maintainers have lower levels of sedentary time in comparison to controls [21,22]. ...
Article
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Despite adults’ desire to reduce body mass (weight) for numerous health benefits, few are able to successfully lose at least 5% of their starting weight. There is evidence on the independent associations of physical activity, sedentary behaviors, and sleep with weight loss; however, this study provided insight on the combined effects of these behaviors on long-term body weight loss success. Hence, the purpose of this cross-sectional study was to evaluate the joint relations of sleep, physical activity, and sedentary behaviors with successful long-term weight loss. Data are from the 2005–2006 wave of the National Health and Examination Survey (NHANES). Physical activity and sedentary behavior were measured with an accelerometer, whereas sleep time was self-reported. Physical activity and sleep were dichotomized into meeting guidelines (active/not active, ideal sleep/short sleep), and sedentary time was categorized into prolonged sedentary time (4th quartile) compared to low sedentary time (1st–3rd quartiles). The dichotomized behaviors were combined to form 12 unique behavioral combinations. Two-step multivariable regression models were used to determine the associations between the behavioral combinations with (1) long-term weight loss success (≥5% body mass reduction for ≥12-months) and (2) the amount of body mass reduction among those who were successful. After adjustment for relevant factors, there were no significant associations between any of the independent body weight loss behaviors (physical activity, sedentary time, and sleep) and successful long-term weight loss. However, after combining the behaviors, those who were active (≥150 min MVPA weekly), regardless of their sedentary time, were significantly (p < 0.05) more likely to have long-term weight loss success compared to the inactive and sedentary referent group. These results should be confirmed in longitudinal analyses, including investigation of characteristics of waking (type, domain, and context) and sleep (quality metrics) behaviors for their association with long-term weight loss success.
... 1,2 Evidence demonstrates that the degree of success of weight loss and weight loss maintenance in people living with obesity is related to the amount of physical activity performed measured by minutes spent or energy expended. 3,4 Short-term controlled trials with supervised regular exercise can show clear (but modest) effects on average loss of body weight and adipose tissue. 5 However, weight loss (or fat loss) cannot be guaranteed, and the average fat loss in these trials usually masks a wide individual range of values with some participants losing, for example, three times the average, others maintaining weight, and a certain proportion even gaining weight. ...
Article
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This systematic review examined the impact of exercise training interventions on energy intake (EI) and appetite control in adults with overweight/obesity (≥18 years including older adults). Articles were searched up to October 2019. Changes in EI, fasting appetite sensations, and eating behavior traits were examined with random effects meta‐analysis, and other outcomes were synthesized qualitatively. Forty‐eight articles were included (median [range] BMI = 30.6 [27.0–38.4] kg/m2). Study quality was rated as poor, fair, and good in 39, seven, and two studies, respectively. Daily EI was assessed objectively (N = 4), by self‐report (N = 22), with a combination of the two (N = 4) or calculated from doubly labeled water (N = 1). In studies rated fair/good, no significant changes in pre‐post daily EI were found and a small but negligible (SMD < 0.20) postintervention difference when compared with no‐exercise control groups was observed (five study arms; MD = 102 [1, 203] kcal). There were negligible‐to‐small pre‐post increases in fasting hunger and dietary restraint, decrease in disinhibition, and some positive changes in satiety and food reward/preferences. Within the limitations imposed by the quality of the included studies, exercise training (median duration of 12 weeks) leads to a small increase in fasting hunger and a small change in average EI only in studies rated fair/good. Exercise training may also reduce the susceptibility to overconsumption (PROSPERO: CRD42019157823).
... As a most common type of physical activity in daily life, walking is the principal component of non-exercise activity thermogenesis [83]. Since higher levels of physical activity are consistently associated with weight loss maintenance [84], increasing usual walking speed may be an active and useful strategy for weight management. ...
Article
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Background: Childhood obesity is reported to be associated with the risk of many diseases in adulthood. However, observational studies cannot fully account for confounding factors. We aimed to systematically assess the causal associations between childhood body mass index (BMI) and various adult traits/diseases using two-sample Mendelian randomization (MR). Methods: After data filtering, 263 adult traits genetically correlated with childhood BMI (P < 0.05) were subjected to MR analyses. Inverse-variance weighted, MR-Egger, weighted median, and weighted mode methods were used to estimate the causal effects. Multivariable MR analysis was performed to test whether the effects of childhood BMI on adult traits are independent from adult BMI. Results: We identified potential causal effects of childhood obesity on 60 adult traits (27 disease-related traits, 27 lifestyle factors, and 6 other traits). Higher childhood BMI was associated with a reduced overall health rating (β = - 0.10, 95% CI - 0.13 to - 0.07, P = 6.26 × 10-11). Specifically, higher childhood BMI was associated with increased odds of coronary artery disease (OR = 1.09, 95% CI 1.06 to 1.11, P = 4.28 × 10-11), essential hypertension (OR = 1.12, 95% CI 1.08 to 1.16, P = 1.27 × 10-11), type 2 diabetes (OR = 1.36, 95% CI 1.30 to 1.43, P = 1.57 × 10-34), and arthrosis (OR = 1.09, 95% CI 1.06 to 1.12, P = 8.80 × 10-9). However, after accounting for adult BMI, the detrimental effects of childhood BMI on disease-related traits were no longer present (P > 0.05). For dietary habits, different from conventional understanding, we found that higher childhood BMI was associated with low calorie density food intake. However, this association might be specific to the UK Biobank population. Conclusions: In summary, we provided a phenome-wide view of the effects of childhood BMI on adult traits. Multivariable MR analysis suggested that the associations between childhood BMI and increased risks of diseases in adulthood are likely attributed to individuals remaining obese in later life. Therefore, ensuring that childhood obesity does not persist into later life might be useful for reducing the detrimental effects of childhood obesity on adult diseases.
... Our 24hEE measurements were obtained in sedentary conditions and low levels of spontaneous physical activity (e.g., low energy turnover), which may not reflect those in free-living conditions where we did not directly measure physical activity levels. Therefore, we cannot rule out that physical activity may constitute an independent predictor of weight regain as previously shown [53,54], considering that higher levels of physical activity (e.g., high energy turnover) are beneficial for weight maintenance through better appetite control [55]. The variability in weight regain between individuals with low and high eucaloric 24hEE was substantial, thus we speculate that other physiological mechanisms in addition to greater energy sensing might explain the differences in weight regain between both metabolic groups, e.g., we hypothesize that differences in the free-living physical activity level might add up to these differences. ...
Article
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Successful long-term weight loss maintenance after caloric restriction (CR) is rarely achieved. Besides known metabolic, behavioural, and cognitive factors, 24-hour energy expenditure (24hEE) relative to body size (i.e., metabolic efficiency) might influence subsequent weight loss maintenance. Eleven participants with obesity (BMI = 39.0 ± 8.7 kg/m², body fat = 36.1 ± 6.4%) had 24hEE measured in a whole-room indirect calorimeter during eucaloric conditions and weight stability prior to starting a 6-week inpatient CR study (50% of daily energy needs). Twenty-four-hour energy expenditure was adjusted via regression analysis for fat free mass (FFM) and fat mass (FM) by DXA. Body composition was reassessed at the end of CR and after 1-year follow-up. Free-living weight was assessed by monthly weight measurements during 12 months. After 6-week CR, participants lost 8.5 ± 2.7% weight (FFM: –6.3 ± 3.6 kg, FM: –3.4 ± 1.2 kg) but regained 5.1 ± 8.0% 1 year following CR, which was mostly due to FFM regain (+5.7 ± 5.5 kg) and unchanged FM. A relatively higher 24hEE by 100 kcal/day prior to CR was associated with an average greater rate of weight regain by +0.3 kg/month during follow-up and a greater final weight regain by +5.1 kg after 1 year of follow-up. These results suggest that reduced metabolic efficiency in 24hEE during eucaloric, sedentary conditions may predict greater weight regain after CR-induced weight loss.
... Ostendorf et al. examined what leads some people to be consistent exercisers and demonstrated that weight loss maintainers weren't using continuous calorie restriction to maintain their weight. 70 Instead, the weight loss maintainers had a much higher energy burn from exercise despite eating approximately the same number of calories per day as the control participants with overweight/obesity. It takes a significant time commitment to achieve the level of activity observed in these weight-loss maintainers. ...
... From a pathophysiological standpoint, most currently available agents aim for a state of reduced energy influx, achieved either by impaired macronutrient absorption or by reduced appetite. Although there are still open questions regarding the importance of observed changes in energy expenditure in obesity pathogenesis, it is likely an important component of weight loss maintenance [132][133][134]. ...
Article
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Purpose of review: There is currently a steep rise in the global prevalence of obesity. Pharmaceutical therapy is a valuable component of conservative obesity therapy. Herein, medications currently in the phase of preclinical or clinical testing are reviewed, along with an overview of the mechanisms that regulate energy intake and expenditure. In addition, the current and potential future directions of obesity drug therapy are discussed. Recent findings: Although the current arsenal of obesity pharmacotherapy is limited, a considerable number of agents that exert their actions through a variety of pharmacodynamic targets and mechanisms are in the pipeline. This expansion shapes a potential near future of obesity conservative management, characterized by tailored combined therapeutic regimens, targeting not only weight loss but also improved overall health outcomes. The progress regarding the elucidation of the mechanisms which regulate the bodily energy equilibrium has led to medications which mimic hormonal adaptations that follow bariatric surgery, in the quest for a "Medical bypass." These, combined with agents which could increase energy expenditure, point to a brilliant future in the conservative treatment of obesity.
... This increase, however, was smaller, rising by a mean of 1200 MET-mins/week 73,74 , than that of our study in which a mean increase of 3200 MET-mins/week was recorded (Table 5). In our study, the AT group had a higher metabolic expenditure than the ST group and the CG, results that are in line with research by Bakker et al. (2017), Scharhag-Rosenberger (2017), Ramírez-Vélez (2017) and Ostendorf (2019) in which it was detected that in AT programs, metabolic expenditure is higher than when ST or mixed training is implemented, especially in moderate physical activity [75][76][77][78][79][80] . Nonetheless, significant improvements were found in moderate, vigorous and total physical activity. ...
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... On the contrary, losing a large amount of weight and maintaining lost weight with lifestyle change alone is uncommon because it requires an indefinite reduction in caloric intake and a high level of daily physical activity (up to 60 minutes of moderateintensity exercise). [19][20][21][22] This magnitude of behavioral effort is unsustainable for most patients in the obesity-promoting environment of modern society. ...
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Despite professional society guidelines recommending that obesity be treated as a chronic disease by emphasizing the use of lifestyle modification in conjunction with pharmacotherapy, anti-obesity medications are uncommonly prescribed in most clinical practices. The recent FDA approval of semaglutide 2.4 mg weekly to treat obesity – as well as other forthcoming advancements in diabetes and anti-obesity medications – highlights the potential of pharmacotherapy to significantly augment weight loss efforts. In this Expert Endocrine Consult, we review the evolving role of anti-obesity pharmacotherapy in clinical practice and suggest a framework for the use of these medications.
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The role of physical activity (PA) in the regulation of body weight is still a major topic of debate. This may be because studies have essentially focused on the effects of moderate/vigorous PA (MVPA) on body weight while overlooking the other components of PA, namely, light-intensity PA (LPA, daily life activities) and sedentary behaviors (SB, too much sitting). In this review, we will (i) describe the history of changes in PA behaviors that occurred with modernization; (ii) review data from cross-sectional and longitudinal studies that examined the associations between PA, SB, and measures of obesity; (iii) review interventional studies that investigated the effects of changes in PA and SB on body weight and adiposity; and (iv) discuss experimental studies that addressed potential biological mechanisms underlying the effects of PA and SB on weight regulation. Overall recent findings support the importance of considering all components of PA to better understand the regulation of energy balance and suggest an important role for LPA and SB in addition to MVPA on body weight regulation. Longitudinal large-scale rigorous studies are needed to advance our knowledge of the role of PA/SB in combating the obesity epidemic.
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An association between ADHD and obesity has been established throughout the past 20 years via animal model experiments and both correlational and longitudinal studies in humans. However, much remains to be determined regarding causality, developmental course, and effective treatments targeting both conditions. This chapter provides an overview and update on the current state of the science on the relationship between obesity and ADHD; expands the scope of the connection between obesity and ADHD to include behavioral components important to weight regulation - i.e., physical activity, eating behaviors, and sleep; and presents applications of these findings to treatment approaches and future directions.
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Purpose: To examine the shape of the relationship between physical activity (PA) and total energy expenditure (TEE) and to explore the role of energy balance status (negative, stable, positive) in influencing this association. Methods: Cross-sectional. Participants were 584 older adults (50-74 yrs.) participating in the Interactive Diet and Activity Tracking in AARP study. TEE was assessed by doubly labeled water and PA by accelerometer. The relationship between PA and TEE was assessed visually and using non-linear methods (restricted cubic splines). Percent weight change (>3%) over a six-month period was used as a proxy measurement of energy balance status. Results: TEE generally increased with increasing deciles of PA averaging 2354 (SD = 351) kcal/d in the bottom decile to 2693 (SD = 480) kcal/d in the top decile. Cubic spline models showed an approximate linear association between PA and TEE (linear relation p < 0.0001, curvature p = 0.920). Results were similar in subgroup analyses for individuals classified as stable or positive energy balance. For those in negative energy balance, TEE was generally flat with increasing deciles of PA averaging 2428 (SD = 285) kcal/d in the bottom decile to 2372 (SD = 560) kcal/d in the top decile. Conclusion: Energy balance status appears to play an important role in the relationship between PA and TEE. When in a positive energy balance, the relationship between TEE and PA was consistent with an additive model, however, when energy balance was negative, TEE appears to be consistent with a constrained model. These findings support PA for weight gain prevention by increasing TEE; however, the effect of PA on TEE during periods of weight loss may be limited. An adequately powered, prospective study is warranted to confirm these exploratory findings.
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Individuals successful at weight loss maintenance engage in high amounts of physical activity (PA). Understanding how and when weight loss maintainers accumulate PA within a day and across the week may inform PA promotion strategies and recommendations for weight management. We compared patterns of PA in a cohort of weight loss maintainers (WLM, n = 28, maintaining ≥13.6 kg weight loss for ≥1 year, BMI 23.6 ± 2.3 kg/m²), controls without obesity (NC, n = 30, BMI similar to current BMI of WLM, BMI 22.8 ± 1.9 kg/m²), and controls with overweight/obesity (OC, n = 26, BMI similar to pre-weight loss BMI of WLM, 33.6 ± 5.1 kg/m²). PA was assessed during 7 consecutive days using the activPALTM activity monitor. The following variables were quantified; sleep duration, sedentary time (SED), light-intensity PA (LPA), moderate-to-vigorous intensity PA (MVPA), and steps. Data were examined to determine differences in patterns of PA across the week and across the day using mixed effect models. Across the week, WLM engaged in ≥60 min of MVPA on 73% of days, significantly more than OC (36%, p < 0.001) and similar to NC (59%, p = 0.10). Across the day, WLM accumulated more MVPA in the morning (i.e., within 3 h of waking) compared to both NC and OC (p < 0.01). WLM engaged in significantly more MVPA accumulated in bouts ≥10 min compared to NC and OC (p < 0.05). Specifically, WLM engaged in more MVPA accumulated in bouts of ≥60 min compared to NC and OC (p < 0.05). WLM engage in high amounts of MVPA (≥60 min/d) on more days of the week, accumulate more MVPA in sustained bouts, and accumulate more MVPA in the morning compared to controls. Future research should investigate if these distinct patterns of PA help to promote weight loss maintenance.
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Clinical guidelines have long been one of the working tools of the modern doctor, helping him quickly navigate the most effective proven methods of treatment and prevention of various diseases, and also to adapt these methods to the specific tasks of their patients and to achieve maximum personalization of treatment. Clinical practice guidelines are drawn up by professional non-profit associations and are approved by the Scientific Council of the Ministry of Health of the Russian Federation, while often one recommendation is prepared by two or even three associations. The peculiarity of the recommendations offered to your attention is that not only endocrinologists, but also therapists, cardiologists, gynecologists, gastroenterologists, and experts of many other specialties are involved in the prevention and treatment of obesity. The Multidisciplinary Working Group presents this a project in a multidisciplinary journal to bring together the efforts of several professional associations that associated with the need to pay attention not only to obesity itself but also to comorbid conditions. We are looking forward to constructive criticism and a comprehensive discussion of the problem on the pages of our journal. © 2021 Russian Association of Endocrinologists. All rights reserved.
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Earlier diagnosis and more effective treatments mean that the estimated number of cancer survivors in the United Kingdom is expected to reach 4 million by 2030. However, there is an increasing realisation that excess body fatness (EBF) is likely to influence the quality of cancer survivorship and disease-free survival. For decades, the discussion of weight management in patients with cancer has been dominated by concerns about unintentional weight loss, low body weight and interventions to increase weight, often re-enforced by the existence of the obesity paradox, which indicates that high body weight is associated with survival benefits for some types of cancer. However, observational evidence provides strong grounds for testing the hypothesis that interventions for promoting intentional loss of body fat and maintaining skeletal muscle in overweight and obese cancer survivors would bring important health benefits in terms of survival outcomes and long-term impact on treatment-related side effects. In this paper, we outline the need for studies to improve our understanding of the health benefits of weight-loss interventions, such as hypocaloric healthy-eating plans combined with physical activity. In particular, complex intervention trials that are pragmatically designed are urgently needed to develop effective, clinically practical, evidence-based strategies for reducing EBF and optimising body composition in people living with and beyond common cancers.
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The dramatic increase in overweight and obesity rates poses a public health threat a mandate for nurse practitioners to address this challenge in clinical practice. Exercise plays an essential role in prevention, initial weight loss, and maintenance of weight loss and recommendations for physical activity differ for each category. Intensity of exercise, duration, and effectiveness of various types of physical activity are reviewed. Possible reasons why exercise-focused weight loss goals are not attained are also explored. Nurse practitioners are assuming an increasingly important role in combating the obesity epidemic and can make a positive impact by implementing effective, evidence-based, exercise-focused strategies for prevention, initial weight loss, and maintenance of weight loss.
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Metabolic adaptations occur with weight loss that result in increased hunger with discordant simultaneous reductions in energy requirements—producing the so-called energy gap in which more energy is desired than is required. The increased hunger is associated with elevation of the orexigenic hormone ghrelin and decrements in anorexigenic hormones. The lower total daily energy expenditure with diet-induced weight loss results from (1) a disproportionately greater decrease in circulating leptin and resting metabolic rate (RMR) than would be predicted based on the decline in body mass, (2) decreased thermic effect of food (TEF), and (3) increased energy efficiency at work intensities characteristic of activities of daily living. These metabolic adaptations can readily promote weight regain. While more experimental research is needed to identify effective strategies to narrow the energy gap and attenuate weight regain, some factors contributing to long-term weight loss maintenance have been identified. Less hunger and greater satiation have been associated with higher intakes of protein and dietary fiber, and lower glycemic load diets. High levels of physical activity are characteristic of most successful weight maintainers. A high energy flux state characterized by high daily energy expenditure and matching energy intake may attenuate the declines in RMR and TEF, and may also result in more accurate regulation of energy intake to match daily energy expenditure.
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The National Weight Control Registry (NWCR) is, to the best of our knowledge, the largest study of individuals successful at long-term maintenance of weight loss. Despite extensive histories of overweight, the 629 women and 155 men in the registry lost an average of 30 kg and maintained a required minimum weight loss of 13.6 kg for 5 y. A little over one-half of the sample lost weight through formal programs; the remainder lost weight on their own. Both groups reported having used both diet and exercise to lose weight and nearly 77% of the sample reported that a triggering event had preceded their successful weight loss. Mean (+/-SD) current consumption reported by registry members was 5778 +/- 2200 kJ/d, with 24 +/- 9% of energy from fat, Members also appear to be highly active: they reported expending approximately 11830 kJ/wk through physical activity. Surprisingly, 42% of the sample reported that maintaining their weight loss was less difficult than losing weight. Nearly all registry members indicated that weight loss led to improvements in their level of energy, physical mobility, general mood, self-confidence, and physical health. In summary, the NWCR identified a large sample of individuals who were highly successful at maintaining weight loss. Future prospective studies will determine variables that predict continued maintenance of weight loss.
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Energy intake (EI) and physical activity energy expenditure (PAEE) are key modifiable determinants of energy balance, traditionally assessed by self-report despite its repeated demonstration of considerable inaccuracies. We argue here that it is time to move from the common view that self-reports of EI and PAEE are imperfect, but nevertheless deserving of use, to a view commensurate with the evidence that self-reports of EI and PAEE are so poor that they are wholly unacceptable for scientific research on EI and PAEE. While new strategies for objectively determining energy balance are in their infancy, it is unacceptable to use decidedly inaccurate instruments, which may misguide health care policies, future research, and clinical judgment. The scientific and medical communities should discontinue reliance on self-reported EI and PAEE. Researchers and sponsors should develop objective measures of energy balance.International Journal of Obesity accepted article preview online, 13 November 2014. doi:10.1038/ijo.2014.199.
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Background: Diet-induced weight loss is accompanied by adaptive thermogenesis, ie, a disproportional or greater than expected reduction of resting metabolic rate (RMR). Objective: The aim of this study was to investigate whether adaptive thermogenesis is sustained during weight maintenance after weight loss. Design: Subjects were 22 men and 69 women [mean ± SD age: 40 ± 9 y; body mass index (BMI; in kg/m(2)): 31.9 ± 3.0]. They followed a very-low-energy diet for 8 wk, followed by a 44-wk period of weight maintenance. Body composition was assessed with a 3-compartment model based on body weight, total body water (deuterium dilution), and body volume. RMR was measured (RMRm) with a ventilated hood. In addition, RMR was predicted (RMRp) on the basis of the measured body composition: RMRp (MJ/d) = 0.024 × fat mass (kg) + 0.102 × fat-free mass (kg) + 0.85. Measurements took place before the diet and 8, 20, and 52 wk after the start of the diet. Results: The ratio of RMRm to RMRp decreased from 1.004 ± 0.077 before the diet to 0.963 ± 0.073 after the diet (P < 0.001), and the decrease was sustained after 20 wk (0.983 ± 0.063; P < 0.01) and 52 wk (0.984 ± 0.068; P < 0.01). RMRm/RMRp was correlated with the weight loss after 8 wk (P < 0.01), 20 wk (P < 0.05), and 52 wk (P < 0.05). Conclusion: Weight loss results in adaptive thermogenesis, and there is no indication for a change in adaptive thermogenesis up to 1 y, when weight loss is maintained. This trial was registered at clinicaltrials.gov as NCT01015508.
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After weight loss, total energy expenditure -- in particular, energy expenditure at low levels of physical activity -- is lower than predicted by actual changes in body weight and composition. An important clinical issue is whether this reduction, which predisposes to weight regain, persists over time. We aimed to determine whether this disproportionate reduction in energy expenditure persists in persons who have maintained a body-weight reduction of > or =10% for >1 y. Seven trios of sex- and weight-matched subjects were studied in an in-patient setting while receiving a weight-maintaining liquid formula diet of identical composition. Each trio consisted of a subject at usual weight (Wt(initial)), a subject maintaining a weight reduction of > or =10% after recent (5-8 wk) completion of weight loss (Wt(loss-recent)), and a subject who had maintained a documented reduction in body weight of >10% for >1 y (Wt(loss-sustained)). Twenty-four-hour total energy expenditure (TEE) was assessed by precise titration of fed calories of a liquid formula diet necessary to maintain body weight. Resting energy expenditure (REE) and the thermic effect of feeding (TEF) were measured by indirect calorimetry. Nonresting energy expenditure (NREE) was calculated as NREE = TEE - (REE +TEF). TEE, NREE, and (to a lesser extent) REE were significantly lower in the Wt(loss-sustained) and Wt(loss-recent) groups than in the Wt(initial) group. Differences from the Wt(initial) group in energy expenditure were qualitatively and quantitatively similar after recent and sustained weight loss. Declines in energy expenditure favoring the regain of lost weight persist well beyond the period of dynamic weight loss.
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Debate remains regarding the amount of physical activity that will facilitate weight loss maintenance. Between December 1, 1999, and January 31, 2003, 201 overweight and obese women (body mass index [calculated as weight in kilograms divided by height in meters squared], 27 to 40; age range, 21-45 years) with no contraindications to weight loss or physical activity were recruited from a hospital-based weight loss research center. Participants were assigned to 1 of 4 behavioral weight loss intervention groups. They were randomly assigned to groups based on physical activity energy expenditure (1000 vs 2000 kcal/wk) and intensity (moderate vs vigorous). Participants also were told to reduce intake to 1200 to 1500 kcal/d. A combination of in-person conversations and telephone calls were conducted during the 24-month study period. Weight loss did not differ among the randomized groups at 6 months' (8%-10% of initial body weight) or 24 months' (5% of initial body weight) follow-up. Post-hoc analysis showed that individuals sustaining a loss of 10% or more of initial body weight at 24 months reported performing more physical activity (1835 kcal/wk or 275 min/wk) compared with those sustaining a weight loss of less than 10% of initial body weight (P < .001). The addition of 275 mins/wk of physical activity, in combination with a reduction in energy intake, is important in allowing overweight women to sustain a weight loss of more than 10%. Interventions to facilitate this level of physical activity are needed.
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No current treatment for obesity reliably sustains weight loss, perhaps because compensatory metabolic processes resist the maintenance of the altered body weight. We examined the effects of experimental perturbations of body weight on energy expenditure to determine whether they lead to metabolic changes and whether obese subjects and those who have never been obese respond similarly. We repeatedly measured 24-hour total energy expenditure, resting and nonresting energy expenditure, and the thermic effect of feeding in 18 obese subjects and 23 subjects who had never been obese. The subjects were studied at their usual body weight and after losing 10 to 20 percent of their body weight by underfeeding or gaining 10 percent by overfeeding. Maintenance of a body weight at a level 10 percent or more below the initial weight was associated with a mean (+/- SD) reduction in total energy expenditure of 6 +/- 3 kcal per kilogram of fat-free mass per day in the subjects who had never been obese (P < 0.001) and 8 +/- 5 kcal per kilogram per day in the obese subjects (P < 0.001). Resting energy expenditure and nonresting energy expenditure each decreased 3 to 4 kcal per kilogram of fat-free mass per day in both groups of subjects. Maintenance of body weight at a level 10 percent above the usual weight was associated with an increase in total energy expenditure of 9 +/- 7 kcal per kilogram of fat-free mass per day in the subjects who had never been obese (P < 0.001) and 8 +/- 4 kcal per kilogram per day in the obese subjects (P < 0.001). The thermic effect of feeding and nonresting energy expenditure increased by approximately 1 to 2 and 8 to 9 kcal per kilogram of fat-free mass per day, respectively, after weight gain. These changes in energy expenditure were not related to the degree of adiposity or the sex of the subjects. Maintenance of a reduced or elevated body weight is associated with compensatory changes in energy expenditure, which oppose the maintenance of a body weight that is different from the usual weight. These compensatory changes may account for the poor long-term efficacy of treatments for obesity.
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To investigate whether walking or resistance training improves weight maintenance after weight loss when added to dietary counselling. Two months' weight reduction with very-low-energy-diet (VLED) followed by randomization into three groups (control, walking, resistance training) for 6 months' weight maintenance (WM) program and 23 months' unsupervised follow-up. During VLED and WM all groups received similar dietary counselling. The main inclusion criteria were BMI >30 kg/m(2), waist>100 cm and physical inactivity (exercise < or = once a week). Ninety healthy, obese (mean BMI 32.9 kg/m(2) and waist 112.5 cm), 35-50 y-old men started the study and 68 were measured at the end of the study. Weight and body composition assessed by underwater weighing. Exercise diaries and dietary records to assess energy balance. During VLED the mean body weight decreased from 106.0 (s.d. 9.9) kg to 91.7 (9.4) kg. Weight was regained mostly during follow-up and in the end of the study the mean weight in groups was 99.9-102.0 kg. Exercise training did not improve short or long-term weight maintenance when compared to the control group. However, resistance training attenuated the regain of body fat mass during WM (P=0.0l), but not during follow-up. In the combined groups the estimated total energy expenditure (EE) of reported physical activity was associated with less weight regain during WM. EE of 10.1 MJ/week was associated with maintaining weight after weight loss. EE of physical activity tended to decrease after WM in exercise groups due to poor long-term adherence to prescribed exercise. Energy intake seemed to increase during follow-up. Exercise training of moderate dose did not seem to improve long-term weight maintenance because of poor adherence to prescribed exercise.
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This paper is a systematic review of research data on associations between physical activity and weight gain, with or without prior weight reduction. The selected studies were restricted to Caucasian (white) adults. Most studies with data on physical activity collected at follow-up, found an inverse association between physical activity and long-term weight gain. This finding was present in studies both with and without prior weight reduction. Prospective studies with physical activity measured at baseline, and randomized weight reduction interventions, gave inconsistent results regarding the effects of increased physical activity on weight change. The weighted mean weight regain in randomized studies with or without exercise training was 0.28 and 0.33 kg/month, respectively. Based on observational studies, it seemed that an actual increase in energy expenditure of physical activity of approximately 6300-8400 kJ/week (1500-2000 kcal/week) is associated with improved weight maintenance. This is more than was prescribed in most randomized trials, and certainly more than the participants actually achieved. Adherence to a prescribed exercise programme remains a big challenge. Before new methods to improve exercise adherence are found, the role of prescribed physical activity in prevention of weight gain remains modest.
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Maintenance of reduced or elevated body weight results in respective decreases or increases in energy expended in physical activity, defined as 24-h energy expenditure excluding resting energy expenditure and the thermic effect of feeding, beyond those attributable to weight change. We examined skeletal muscle work efficiency by graded cycle ergometry and, in some subjects, rates of gastrocnemius muscle ATP flux during exercise by magnetic resonance spectroscopy (MRS), in 30 subjects (15 males, 15 females) at initial weight and 10% below initial weight and in 8 subjects (7 males, 1 female) at initial weight and 10% above initial weight to determine whether changes in skeletal muscle work efficiency at altered body weight were correlated with changes in the energy expended in physical activity. At reduced weight, muscle work efficiency was increased in both cycle ergometry [mean (SD) change = +26.5 (26.7)%, P < 0.001] and MRS [ATP flux change = -15.2 (23.2)%, P = 0.044] studies. Weight gain resulted in decreased muscle work efficiency by ergometry [mean (SD) change = -17.8 (20.5)%, P = 0.043]. Changes in muscle efficiency at altered body weight accounted for 35% of the change in daily energy expended in physical activity.
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Recommending increased physical activity facilitates long-term weight loss, but the optimal level of physical activity to recommend is unknown. The objective of the study was to evaluate the efficacy for long-term weight loss of recommendations for much higher physical activity than those normally used in behavioral treatments. Overweight men and women (n = 202) were randomly assigned to either a standard behavior therapy (SBT) for obesity, incorporating an energy expenditure (EE) goal of 1000 kcal/wk, or to a high physical activity (HPA) treatment, in which the goal was an EE of 2500 kcal/wk. To help HPA treatment group participants achieve this high exercise goal, their treatment included encouragement to recruit 1-3 exercise partners into the study, personal counseling from an exercise coach, and small monetary incentives. The HPA treatment group reported achieving higher mean (+/- SD) physical activity levels than did the SBT group at 6 mo (EE of 2399 +/- 1571 kcal/wk compared with 1837 +/- 1431 kcal/wk), 12 mo (EE of 2249 +/- 1751 kcal/wk compared with 1565 +/- 1309 kcal/wk), and 18 mo (EE of 2317 +/- 1854 kcal/wk compared with 1629 +/- 1483 kcal/wk) (all P < 0.01). Mean (+/- SEM) cumulative weight losses at 6, 12, and 18 mo in the HPA treatment group were 9.0 +/- 7.1, 8.5 +/- 7.9, and 6.7 +/- 8.1 kg, respectively. In the SBT group, the corresponding weight losses were 8.1 +/- 7.4, 6.1 +/- 8.8, and 4.1 +/- 7.3 kg, respectively. Between-group differences in weight loss were significant at 12 and 18 mo. These results suggest that recommendations of higher levels of physical activity (EE of 2500 kcal/wk) promote long-term weight loss better than do conventional recommendations.
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Objective: The aim of this study was to explore how physical activity (PA) and energy intake (EI) changes were related to weight loss and regain following "The Biggest Loser" competition. Methods: At baseline, week 6 and week 30 of the competition, and 6 years after the competition, body composition was measured via dual-energy x-ray absorptiometry, resting energy expenditure was measured by using indirect calorimetry, and EI and PA were measured by using doubly labeled water. Results: Six years after the competition, median weight loss in 14 of "The Biggest Loser" participants was 13%, with those maintaining a greater weight loss (mean ± SE) of 24.9% ± 3.8% having increased PA by 160% ± 23%, compared with a PA increase of 34% ± 25% (P = 0.0033) in the weight regainers who were 1.1% ± 4.0% heavier than the precompetition baseline. EI changes were similar between weight loss maintainers and regainers (-8.7% ± 5.6% vs. -7.4% ± 2.7%, respectively; P = 0.83). Weight regain was inversely associated with absolute changes in PA (r = -0.82; P = 0.0003) but not with changes in EI (r = -0.15; P = 0.61). EI and PA changes explained 93% of the individual weight loss variability at 6 years. Conclusions: Consistent with previous reports, large and persistent increases in PA may be required for long-term maintenance of lost weight.
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Background/objectives: The limited success in addressing the current obesity epidemic reflects the insufficient understanding of the regulation of energy balance. The present study examines the longitudinal association of body weight with physical activity (PA), total daily energy expenditure (TDEE) and total daily energy intake (TDEI). Subjects/methods: A total of 195 adults (52% male) between 21 and 35 years of age with no intention for weight loss were followed over a 2-year period. Body weight, fat mass and fat-free mass were measured every 3 months. Participants were stratified into three groups based on change in body weight using a 5% cutpoint. TDEE and time spent in different PA intensities were determined via a multisensor device at each measurement time. TDEI was calculated based on change in body composition and TDEE. Results: At 2-year follow-up, 57% of the participants maintained weight, 14% lost weight and 29% gained weight. Average weight change was −6.9±3.4 and 7.1±3.6 kg in the weight-loss and weight-gain groups, respectively. Average TDEE and TDEI did not change significantly in any weight change group (P>0.16). Moderate-to-vigorous PA, however, increased significantly in the weight-loss group (35±49 min/day; P<0.01) and decreased in the weight-gain group (−35±46 min/day; P<0.01). Conclusions: Results of this observational study indicate an inverse association between body weight and PA to maintain a stable TDEE and allow for a stable TDEI over time. Sufficient PA levels, therefore, are an important contributor to weight loss maintenance.
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Objective: To measure long-term changes in resting metabolic rate (RMR) and body composition in participants of "The Biggest Loser" competition. Methods: Body composition was measured by dual energy X-ray absorptiometry, and RMR was determined by indirect calorimetry at baseline, at the end of the 30-week competition and 6 years later. Metabolic adaptation was defined as the residual RMR after adjusting for changes in body composition and age. Results: Of the 16 "Biggest Loser" competitors originally investigated, 14 participated in this follow-up study. Weight loss at the end of the competition was (mean ± SD) 58.3 ± 24.9 kg (P < 0.0001), and RMR decreased by 610 ± 483 kcal/day (P = 0.0004). After 6 years, 41.0 ± 31.3 kg of the lost weight was regained (P = 0.0002), while RMR was 704 ± 427 kcal/day below baseline (P < 0.0001) and metabolic adaptation was -499 ± 207 kcal/day (P < 0.0001). Weight regain was not significantly correlated with metabolic adaptation at the competition's end (r = -0.1, P = 0.75), but those subjects maintaining greater weight loss at 6 years also experienced greater concurrent metabolic slowing (r = 0.59, P = 0.025). Conclusions: Metabolic adaptation persists over time and is likely a proportional, but incomplete, response to contemporaneous efforts to reduce body weight.
Article
Objective To examine the amount of objectively measured MVPA and LPA that is associated with long-term weight loss and the maintenance of clinically significant weight loss.Methods Adults (N = 260; BMI: 25 to <40 kg/m2; age: 18–55 years) participated in an 18-month behavioral weight loss intervention and were prescribed a low-calorie diet and increased physical activity. Change in weight and objectively measured physical activity were assessed. MVPA > 10 (MET-min/week) was computed from bouts >10 min and >3.0 METs and MVPA < 10 was computed from bouts <10 min in duration and >3.0 METs. LPA was computed from bouts between 1.5 to <3.0 METs.ResultsWhen grouped on percent weight loss at 18 months, there was a significant group × time interaction effect (P < 0.0001) for both MVPA > 10 and LPA, with both measures being significantly greater at 18 months in those with >10% weight loss. Similar results were observed for MVPA > 10 and LPA with participants grouped on achieving >10% weight loss at 6 months and sustaining this at 18 months.ConclusionsMVPA > 10 of 200-300 min per week, coupled with increased amounts of LPA, are associated with improved long-term weight loss. Interventions should promote engagement in these amounts and types of physical activity.
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The National Weight Control Registry (NWCR) was established to examine characteristics of successful weight loss maintainers. This study compares the diet and behavioral characteristics and weight regain trajectories of NWCR members with differing physical activity (PA) levels at baseline. Participants (n=3591) were divided into 4 levels of self-reported PA at registry entry (<1000, 1000 to <2250, 2250 to <3500, and ≥3500 kcals/week). We compared self-reported energy intake (EI), macronutrient composition, eating behaviors (dietary restraint, hunger, and disinhibition), weight loss maintenance strategies, and 3 year weight regain between these 4 activity groups. Those with the highest PA at registry entry had lost the most weight, and reported lower fat intake, more dietary restraint, and greater reliance on several specific dietary strategies to maintain weight loss. Those in the lowest PA category maintained weight loss despite low levels of PA and without greater reliance on dietary strategies. There were no differences in odds of weight regain at year 3 between PA groups. These findings suggest that there is not a "one size fits all strategy" for successful weight loss maintenance and that weight loss maintenance may require the use of more strategies by some individuals than others.
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The challenge of weight-loss maintenance is well known, but few studies have followed successful weight losers over an extended period or evaluated the effect of behavior change on weight trajectories. To study the weight-loss trajectories of successful weight losers in the National Weight Control Registry (NWCR) over a 10-year period, and to evaluate the effect of behavior change on weight-loss trajectories. A 10-year observational study of self-reported weight loss and behavior change in 2886 participants (78% female; mean age 48 years) in the NWCR who at entry had lost at least 30 lbs (13.6 kg) and kept it off for at least one year. Data were collected in 1993-2010; analysis was conducted in 2012. Weight loss (kilograms; percent weight loss from maximum weight). Mean weight loss was 31.3 kg (95% CI=30.8, 31.9) at baseline, 23.8 kg (95% CI=23.2, 24.4) at 5 years and 23.1±0.4 kg (95% CI=22.3, 23.9) at 10 years. More than 87% of participants were estimated to be still maintaining at least a 10% weight loss at Years 5 and 10. Larger initial weight losses and longer duration of maintenance were associated with better long-term outcomes. Decreases in leisure-time physical activity, dietary restraint, and frequency of self-weighing and increases in percentage of energy intake from fat and disinhibition were associated with greater weight regain. The majority of weight lost by NWCR members is maintained over 10 years. Long-term weight-loss maintenance is possible and requires sustained behavior change.
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The National Weight Control Registry (NWCR) was established in 1993 to examine characteristics of successful weight-loss maintainers. This group consistently self-reports high levels of physical activity. The aims of this study were to obtain objective assessments of physical activity in NWCR subjects and compare this to physical activity in both normal-weight and overweight controls. Individuals from the NWCR (n = 26) were compared to a never obese normal-weight control group matched to the NWCR group's current BMI (n = 30), and an overweight control group matched to the NWCR group's self-reported pre-weight-loss BMI (n = 34). Objective assessment of physical activity was obtained for a 1-week period using a triaxial accelerometer. Bouts of moderate-to-vigorous physical activity (MVPA) ≥10 min in duration, as well as nonbout MVPA (bouts of MVPA 1-9 min in duration) were summed and characterized. NWCR subjects spent significantly (P = 0.004) more time per day in sustained bouts of MVPA than overweight controls (41.5 ± 35.1 min/day vs. 19.2 ± 18.6 min/day) and marginally (P = 0.080) more than normal controls (25.8 ± 23.4). There were no significant differences between the three groups in the amount of nonbout MVPA. These results provide further evidence that physical activity is important for long-term maintenance of weight loss and suggest that sustained volitional activity (i.e., ≥10 min in duration) may play an important role. Interventions targeting increases in structured exercise may be needed to improve long-term weight-loss maintenance.
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The global obesity pandemic has arisen from small imbalances in energy intake and expenditure that have accumulated over time. For primary obesity prevention, the energy gap in the United States is less than 100 kcal/day for 90% of the population, meaning that relatively small changes in energy intake and expenditure adding up to 100 kcal/day could arrest excess weight gain in most people. Preventing further weight gain in the population could substantially reduce the prevalence of obesity within one generation. The energy gap is even smaller in other countries that have done similar analyses.
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Maintenance of weight loss continues to be a critical concern in behavioral treatment programs. Problems with the acquisition and/or application of behavioral skills are a likely contributor to relapse. However, biological models, especially the hypothesis of a body weight setpoint, are being offered increasingly as alternative explanations for maintenance failure. Within the context of these sometimes opposing viewpoints the present study describes long-term weight outcomes for 114 men and 38 women assessed annually for 4 or 5 years following completion of a 15 week behavioral weight loss program. Although significant mean weight loss was evident at long-term follow-up, a negatively accelerating pattern of weight regain was the predominant outcome. Less than 3 percent of the subjects were at or below their posttreatment weight on all follow-up visits. Consistent sex differences were found, with women having better weight loss maintenance than men. Implications and potential future directions are discussed.