Metabolic Slowing with Massive Weight Loss despite Preservation of Fat-Free Mass
Open accessAbstract
Context: An important goal during weight loss is to maximize fat loss while preserving metabolically active fat-free mass (FFM). Massive weight loss typically results in substantial loss of FFM potentially slowing metabolic rate. Objective: Our objective was to determine whether a weight loss program consisting of diet restriction and vigorous exercise helped to preserve FFM and maintain resting metabolic rate (RMR). Participants and Intervention: We measured body composition by dual-energy x-ray absorptiometry, RMR by indirect calorimetry, and total energy expenditure by doubly labeled water at baseline (n = 16), wk 6 (n = 11), and wk 30 (n = 16). Results: At baseline, participants were severely obese (×± sd; body mass index 49.4 ± 9.4 kg/m2) with 49 ± 5% body fat. At wk 30, more than one third of initial body weight was lost (−38 ± 9%) and consisted of 17 ± 8% from FFM and 83 ± 8% from fat. RMR declined out of proportion to the decrease in body mass, demonstrating a substantial metabolic adaptation (−244 ± 231 and −504 ± 171 kcal/d at wk 6 and 30, respectively, P < 0.01). Energy expenditure attributed to physical activity increased by 10.2 ± 5.1 kcal/kg·d at wk 6 and 6.0 ± 4.1 kcal/kg·d at wk 30 (P < 0.001 vs. zero). Conclusions: Despite relative preservation of FFM, exercise did not prevent dramatic slowing of resting metabolism out of proportion to weight loss. This metabolic adaptation may persist during weight maintenance and predispose to weight regain unless high levels of physical activity or caloric restriction are maintained.
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- Authors
- Johannsen, D. L., Knuth, N. D., Huizenga, R., Rood, J. C., Ravussin, E., & Hall, K. D.
- Affiliations
- National Institutes of Health (US)
- Skeletal Muscle Physiology Laboratory (D.L.J., E.R.), Baton Rouge, Louisiana 70808
- Pennington Biomedical Research Center (US)
- Laboratory of Biological Modeling (N.D.K., K.D.H.), Bethesda, Maryland 20892
- Corresponding author
- Hall, Kevin D.
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2012-07-01
- Volume
- 97
- Issue
- 7
- Pages
- 2489-2496
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- PMC
- PMC3387402
- OpenAlex
- W2144326540
- Cited by
- 254
- References
- 43
- Citations by year
- 2026: 13 · 2025: 14 · 2024: 13 · 2023: 20 · 2022: 21 · 2021: 22 · 2020: 15 · 2019: 15 · 2018: 22 · 2017: 23 · 2016: 16 · 2015: 19 · 2014: 21 · 2013: 18 · 2012: 2
- FWCI
- 8.56
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute of Diabetes and Digestive and Kidney Diseases
- National Institutes of Health
- Topics
- Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Regulation of Appetite and Obesity
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Health Sciences › Medicine › Physiology › Body Composition Measurement Techniques
- Keywords
- massive weight loss, resting metabolic rate, metabolic adaptation, energy expenditure, physical activity, dietary restriction, obesity, weight regain, fat loss
- MeSH terms
- Adipose Tissue, Adult, Basal Metabolism, Body Composition, Body Weight, Combined Modality Therapy, Diet, Reducing, Exercise Therapy, Female, Humans, Male, Metabolic Diseases, Middle Aged, Obesity, Morbid, Weight Gain, Weight Loss, Absorptiometry, Photon, Down-Regulation, Young Adult, Weight Reduction Programs
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