Cited by 254Regulation of Appetite and ObesityObesity, Physical Activity, DietBody Composition Measurement Techniques

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Metabolic Slowing with Massive Weight Loss despite Preservation of Fat-Free Mass

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Johannsen, Darcy L., Knuth, Nicolas D., Huizenga, Robert, Rood, Jennifer C., Ravussin, Eric, Hall, Kevin D.·2012·The Journal of Clinical Endocrinology & Metabolism

DOI 10.1210/jc.2012-1444PMC PMC3387402

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Abstract

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.
ORCID: Johannsen, Darcy L.
Knuth, Nicolas D.
Rood, Jennifer C.
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
DOI: 10.1210/jc.2012-1444
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 (medical) › 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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Metabolic Slowing with Massive Weight Loss despite Preservation of Fat-Free Mass

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