Background No current treatment for obesity reliably sustainsweight loss, perhaps because compensatory metabolic processesresist the maintenance of the altered body weight. We examinedthe effects of experimental perturbations of body weight onenergy expenditure to determine whether they lead to metabolicchanges and whether obese subjects and those who have neverbeen obese respond similarly.
Methods We repeatedly measured 24-hour total energy expenditure,resting and nonresting energy expenditure, and the thermic effectof feeding in 18 obese subjects and 23 subjects who had neverbeen obese. The subjects were studied at their usual body weightand after losing 10 to 20 percent of their body weight by underfeedingor gaining 10 percent by overfeeding.
Results Maintenance of a body weight at a level 10 percent ormore below the initial weight was associated with a mean (±SD)reduction in total energy expenditure of 6±3 kcal perkilogram of fat-free mass per day in the subjects who had neverbeen obese (P<0.001) and 8±5 kcal per kilogram perday in the obese subjects (P<0.001). Resting energy expenditureand nonresting energy expenditure each decreased 3 to 4 kcalper kilogram of fat-free mass per day in both groups of subjects.Maintenance of body weight at a level 10 percent above the usualweight was associated with an increase in total energy expenditureof 9±7 kcal per kilogram of fat-free mass per day inthe subjects who had never been obese (P<0.001) and 8±4kcal per kilogram per day in the obese subjects (P<0.001).The thermic effect of feeding and nonresting energy expenditureincreased by approximately 1 to 2 and 8 to 9 kcal per kilogramof fat-free mass per day, respectively, after weight gain. Thesechanges in energy expenditure were not related to the degreeof adiposity or the sex of the subjects.
Conclusions Maintenance of a reduced or elevated body weightis associated with compensatory changes in energy expenditure,which oppose the maintenance of a body weight that is differentfrom the usual weight. These compensatory changes may accountfor the poor long-term efficacy of treatments for obesity.
Source Information
From the Laboratory of Human Behavior and Metabolism, Rockefeller University, 1230 York Ave., New York, NY 10021, where reprint requests should be addressed to Dr. Leibel.
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A correction has been published: N Engl J Med 1995;333(6):399.
