Therefore, patience is a key part of the process. The fundamental factor when it comes to weight loss is energy balance. This is referred to as a negative energy balance or a calorie deficit. To figure all of this out, first figure out a healthy calorie deficit.

Read food labels, or track your calories by writing them down or use an app to help you stay on track. Of the three macronutrients, protein is the most satiating.

This can be really helpful when following an energy restricted diet as protein will keep you feeling full and satiated. A high protein intake will also reduce the amount of lean muscle mass lost during your weight loss.

This is important for keeping the weight off long-term, as lean muscle contributes to your resting metabolism and overall energy expenditure. Evidence shows that performing exercise in a glycogen state increases the amount of fat used as fuel during that exercise session. However, carbs can be incredibly beneficial for recovery after a workout, so don't write them off entirely.

Read up on carbs here:. Increasing the amount of training volume will increase your energy expenditure and increase the likelihood of being in a negative energy balance. Increasing your daily step count can also be a good way to increase the number of calories you expend.

Going for a low intensity evening walk can increase your daily calorie expenditure without being too hard to recover from.

Little things also add up. Things like parking the car further away from the shops and choosing the stairs wherever possible all contribute.

Alcohol contains 7 calories per gram and consuming alcoholic drinks regularly is sure fire way to increase your daily calorie intake. Alongside the calories in the drink itself, they're often had with snacks and the calorific foods that help cure a hangover may wipe out your calorie deficit pretty quickly.

Alcohol can also reduce your ability to recover from a training session and a heavy night on the booze may mean your training quality is affected. Making sure you stay hydrated is an important way to keep your energy levels high.

This will help ensure you are able to train hard during your workouts, and get more light movement in too. Drinking plenty of water may also help with hunger cravings as it's possible to confuse hunger with dehydration. Like protein, fibre also has a high effect on satiety. Fibre also helps with digestion and prevents constipation which can have an effect weight loss.

Ensuring you get plenty of high-quality sleep can have a big impact on your weight loss journey. So, avoid any unexpected cravings by getting your 8 hours in. This can be helpful for a couple of reasons. First off, after being in a calorie deficit for a while, your body will adapt and your resting metabolic rate will adjust itself.

This means you might have to reduce your calories even further to get through a plateau, which may not be healthy. However, a diet break of 2 weeks at a time has been shown to reduce this effect. Introducing diet breaks may also make it easier to stick to your diet long-term.

Allowing yourself a decent period of about 2 weeks to enjoy foods that you might not ordinarily have, gives you flexibility. It'll also likely have positive mental effects! These include caffeine and b-vitamins. Read more about natural fat burners here , and have a look at our top weight loss supplements.

Following each of the above tips and staying patient will increase your chances of losing the weight and keeping it off in the long term. Remember, be kind to yourself as well, as a weight loss journey can be tough mentally too.

Our articles should be used for informational and educational purposes only and are not intended to be taken as medical advice. If you're concerned, consult a health professional before taking dietary supplements or introducing any major changes to your diet.

Liam is an experienced personal trainer, helping clients reach their health and fitness goals with practical, evidence informed exercise and nutrition advice. When a person reaches a weight loss plateau, they will no longer lose any weight, despite following a diet and fitness regimen.

Research shows that weight loss plateaus happen after about 6 months of following a low calorie diet. They believe that the weight loss plateau happens due to a person no longer adhering to their diet plan.

Sticking to a restrictive or low calorie diet plan every day can be challenging or, sometimes, unrealistic. Small, unconscious fluctuations in daily calories can cause early weight loss plateaus. More research is necessary to determine why weight loss plateaus occur.

Below, we cover some ways to break through them. Research shows that people tend to underestimate their energy or calorie intake significantly. Once people are fully aware of their eating and drinking patterns and understand where unnecessary calories are coming from, they can make changes.

These participants had:. Keeping a food diary or using a food tracker app can help people see exactly how many calories they are consuming. Some trackers even show whether people are getting enough or too much of one particular macronutrient, such as carbohydrate or fat. Limiting or avoiding the intake of alcohol and sugary treats can help eliminate empty calories that do not provide nutritional value.

Exercise helps people maintain weight and build muscle, which can improve metabolism. How much exercise a person requires depends on many factors, including their weight and age. The Physical Activity Guidelines for Americans recommend that adults do at least — minutes every week of moderate intensity exercise or 75— minutes of vigorous intensity activity.

Many people need more than minutes of moderate exercise per week to maintain their body weight. People who engage in more than minutes of moderate physical activity every week and perform muscle strengthening activity of moderate intensity can experience additional benefits.

When a person starts dieting and exercising, their fitness level will improve. Over time, they may reach a certain level of fitness that allows them to progress to higher levels of activity.

Introducing small, progressive changes in activity level can help people break through a weight loss plateau. In one study , researchers followed two groups of people with obesity.

One group received advice on a healthful lifestyle and participated in a stress management program, and the second group only received the advice. The participants in the stress management group experienced a more significant reduction in BMI than those in the control group.

A study that featured in the International Journal of Obesity found that sleeping for the same number of hours — and an adequate number of hours — improved weight loss outcomes.

People who slept for less than 6 hours a night had smaller changes in waist circumference compared with people who slept for 7—9 hours. Researchers have shown that people in the United States eat only about half of the daily fiber recommendation. People who follow low carbohydrate diets are eating even less fiber.

Fruits, vegetables, whole grains, and legumes are all rich in fiber and may be helpful for people who have reached a weight loss plateau. Making small changes, such as replacing a daily glass of juice with a whole fruit, can help a person increase their fiber intake. Many people do not consume enough vegetables on a regular basis.

Vegetables are generally low calorie foods that can help people reduce their overall energy intake. A review of studies found moderate-quality evidence that consuming more vegetables reduced the risk of weight gain and obesity.

Vegetables are high in fiber and water content, which may help people feel full and reduce the urge to overeat or eat foods with fewer nutrients. Diets containing plenty of vegetables may be easier to follow because they encourage the higher consumption of specific foods rather than the restriction of certain types of food.

Hitting a weight loss plateau can be discouraging, but a person can often adapt their diet or fitness routine to continue to lose weight. Recording their daily calorie intake can help people identify dietary issues, while increasing exercise intensity may challenge their body and help them burn more calories.

Getting enough sleep and reducing stress levels can also help a person break through a weight loss plateau. Anyone who feels as though they have hit a weight loss plateau may wish to speak with a dietitian, certified personal trainer, or doctor. Efforts to lose weight may not work for a range of reasons.

A person may be following an ineffective fad diet, or consuming sugary drinks, or…. What are the best exercises for weight loss?

These participants had:. Keeping a food diary or using a food tracker app can help people see exactly how many calories they are consuming. Some trackers even show whether people are getting enough or too much of one particular macronutrient, such as carbohydrate or fat.

Limiting or avoiding the intake of alcohol and sugary treats can help eliminate empty calories that do not provide nutritional value. Exercise helps people maintain weight and build muscle, which can improve metabolism.

How much exercise a person requires depends on many factors, including their weight and age. The Physical Activity Guidelines for Americans recommend that adults do at least — minutes every week of moderate intensity exercise or 75— minutes of vigorous intensity activity.

Many people need more than minutes of moderate exercise per week to maintain their body weight. People who engage in more than minutes of moderate physical activity every week and perform muscle strengthening activity of moderate intensity can experience additional benefits.

When a person starts dieting and exercising, their fitness level will improve. Over time, they may reach a certain level of fitness that allows them to progress to higher levels of activity.

Introducing small, progressive changes in activity level can help people break through a weight loss plateau. In one study , researchers followed two groups of people with obesity. One group received advice on a healthful lifestyle and participated in a stress management program, and the second group only received the advice.

The participants in the stress management group experienced a more significant reduction in BMI than those in the control group. A study that featured in the International Journal of Obesity found that sleeping for the same number of hours — and an adequate number of hours — improved weight loss outcomes.

People who slept for less than 6 hours a night had smaller changes in waist circumference compared with people who slept for 7—9 hours. Researchers have shown that people in the United States eat only about half of the daily fiber recommendation. People who follow low carbohydrate diets are eating even less fiber.

Fruits, vegetables, whole grains, and legumes are all rich in fiber and may be helpful for people who have reached a weight loss plateau. Making small changes, such as replacing a daily glass of juice with a whole fruit, can help a person increase their fiber intake.

Many people do not consume enough vegetables on a regular basis. Vegetables are generally low calorie foods that can help people reduce their overall energy intake. A review of studies found moderate-quality evidence that consuming more vegetables reduced the risk of weight gain and obesity.

Vegetables are high in fiber and water content, which may help people feel full and reduce the urge to overeat or eat foods with fewer nutrients. Diets containing plenty of vegetables may be easier to follow because they encourage the higher consumption of specific foods rather than the restriction of certain types of food.

Hitting a weight loss plateau can be discouraging, but a person can often adapt their diet or fitness routine to continue to lose weight. Recording their daily calorie intake can help people identify dietary issues, while increasing exercise intensity may challenge their body and help them burn more calories.

Getting enough sleep and reducing stress levels can also help a person break through a weight loss plateau. Anyone who feels as though they have hit a weight loss plateau may wish to speak with a dietitian, certified personal trainer, or doctor. Efforts to lose weight may not work for a range of reasons.

A person may be following an ineffective fad diet, or consuming sugary drinks, or…. What are the best exercises for weight loss? Find out the best types of exercise for weight loss, according to research, and get other useful tips.

Researchers say bariatric surgery can help with weight loss, but it can also help improve cognitive functions including memory. Researchers say running can help with weight loss but only in the short term.

This form of exercise does have other health benefits from maintaining…. Researchers people with diabetes who also have obesity or other weight issues can lower their risk of chronic kidney disease with regular moderate to…. My podcast changed me Can 'biological race' explain disparities in health?

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Medical News Today. Health Conditions Health Products Discover Tools Connect. Many athletes tend to post favourable pictures [ 60 , 61 ]. Unintentionally, this may be putting pressure on other athletes to keep their top form as well without acknowledging that changes in body composition between the competitive and the off-season are normal and, in some cases, e.

in bodybuilding necessary. In line with the findings from Vogel et al. Lastly, athletes are often victims of body shaming and cyber bullying [ 63 ]. Taken together, negative comments on appearance can negatively impact body image, body satisfaction, and ultimately also influence dietary behaviour, and support the development of LEA, which in severe cases can be accompanied by an eating disorder [ 65 , 66 ].

On the other side of the spectrum, social media can also be used by athletes themselves to draw attention to grievances within the sporting community. After elite runner Mary Cain shared her story, other female athletes raised their voices and shared their stories. Short-term LEA causes a disturbance of metabolic homeostasis in athletes [ 68 ].

Early human and animal studies found that fuel is spared at the cost of growth and reproduction to maintain cell survival in times of energy deprivation, [ 69 ]. Thus, metabolic mechanisms to conserve energy are evident in male and female athletes in response to prolonged LEA.

To maintain basic vital functions at rest, the human body needs a certain amount of energy known as the basal metabolic rate BMR or the resting energy expenditure REE. Together with the non-resting energy expenditure NREE , REE makes up the total daily energy expenditure TDEE.

In male endurance athletes, LEA was associated with a lower REE when compared to athletes with an adequate energy supply [ 71 ]. Moreover, as energy homeostasis is also controlled by the secretion of leptin from adipose tissue via feedback to the hypothalamus e.

Lower leptin levels depend solely on energy availability, as shown in male rowers [ 72 ] and exercising healthy females [ 16 ], but are also a response to chronic exercise training [ 73 ]. In addition to reducing the BMR, lower leptin levels also suppress the thyroid, the reproductive and growth hormone axes, and the inflammatory response [ 74 , 75 ].

A reduction of TDEE is also mediated by thyroid suppression. In general, chronic exercise training induces a light physiologic rise of thyroid hormones in elite strength athletes and female endurance runners [ 78 , 79 ], which may, to a certain degree, counteract the reduction of T3 and NEAT.

Taken together data suggest, that as energy availability declines, whether intentional through caloric restriction or unintentional through increased exercise energy expenditure, metabolic adaptions will occur Fig.

Although those alterations are normal and negligible if athletes return to an appropriate energy intake, e. While body weight will drop at the beginning of a dieting phase, a plateau in weight loss will inevitably occur after prolonged low energy intake [ 68 ].

Although this is a normal physiological adaption, some athletes may start to further decrease energy intake to continue to lose weight.

This behaviour will lead to a downward spiral of caloric restriction, losing weight, and plateauing followed by another cycle—all of which will ultimately result in LEA and likely in the development of an ED.

Components of total daily energy expenditure and adaptions to low energy availability are shown. a Total daily energy expenditure TDEE consists of the resting energy expenditure REE and the non-resting energy expenditure NREE. NREE can be further subdivided into the thermic effect of food TEF , non-exercise activity thermogenesis NEAT , and exercise activity thermogenesis EAT.

Of those components, NEAT and EAT describe energy expended through physical activity PA. b When energy availability is low, either by restricted dietary energy intake or increased energy exercise expenditure EEE , metabolic adaptions to conserve energy occur. Those encompass a decline in basal metabolic rate BMR , NEAT, and, if caloric intake is restricted, also in TEF.

Generally, EAT will decrease as well but may be elevated in individuals increasing their training volume. Therefore, adaptations in this component are variable.

Figure modified according to MacLean et al. Metabolic changes following LEA are also evident on the blood substrate level. In a similar fashion, insulin levels decrease, while the ketone β-hydroxybutyrate BHB increases in females [ 20 ]. Additionally, in female athletes positive for the female triad, hypoglycaemia and hypercholesterolemia are common [ 19 ].

In opposition to the cardio-protective function of exercise, the altered cholesterol substrate levels may be unfavourable for cardiovascular health in the long term [ 80 ]. The results indicate that decreased glycolytic activity and increased lipolytic activity during LEA in athletes of both sexes occur in order to save mainly one fuel: carbohydrates.

Conceivably, this is due to limited glycogen stores [ 81 ]. Moreover, in female athletes with severe eating disorders, such as anorexia nervosa, the restriction of food and fluid intake can lead to imbalanced electrolytes, anaemia, and hypotension [ 19 , 85 ]. As the impact of LEA slightly differs across sex, we further discuss reproductive and bone adaptations in separate sections.

Female runners with functional hypothalamic amenorrhea FHA express lower oestrogen levels [ 88 ]. Accordingly, rapid bone loss due to low oestrogen is associated with menstrual disorders [ 29 ]. For instance, the bone fracture risk of amenorrhoeic female elite runners was nine times higher than their healthy counterparts [ 89 ].

Furthermore, during LEA, oestradiol and progesterone are reduced in female athletes with RED-S [ 90 ]. In females, oestradiol levels are extremely sensitive to and are attenuated by within-day LEA [ 91 ].

Oestradiol preserves bone mass density BMD by increasing osteoclasts and decreasing osteoblast apoptosis [ 92 ]. Adequate oral administration of oestrogens can prevent a reduction in bone mass after menopause [ 92 ].

Before menopause, a lack of successful oral oestrogen therapy is likely due to the downregulation of insulin-like growth factor-1 IGF-1 [ 93 ].

Therefore, in the young female athletes, improving LEA may have a stronger effect than oestrogen therapy.

In contrast to oral oestrogens, transdermal oestrogen treatment has been effective in increasing bone mass density in amenorrhoeic female athletes [ 94 ]. The influence of LEA on BMD, apart from reproductive hormones, is highlighted by analysis of bone turnover markers [ 95 ].

Ihle and Loucks found changes in three bone turnover markers in response to short-term LEA in exercising females, namely a reduction of the bone formation markers plasma osteocalcin and serum type I procollagen carboxy-terminal propeptide, and an increase in the bone resorption marker urinary N-terminal telopeptide [ 96 ].

In the same study, no significant changes in these newer bone turnover markers were found in males [ 95 ]. Exercise hypogonadal male condition EHMC is the syndrome affecting reproductive function of males, akin to the triad in females.

During EHMC, the hypothalamic-pituitary-gonadal axis is disturbed along with reduced serum testosterone levels TES as a response to LEA [ 98 ]. Although TES values remain in the low end of the normal clinical range [ 89 ], symptoms of hypogonadism—fatigue, sexual dysfunction, and low bone mineral density—are present.

The syndrome was first diagnosed in endurance-trained males; however, it is also seen in power athletes [ 98 ] and energy-restricted bodybuilders [ 99 ]. Of note, protein intake does not mediate TES reduction in exercising males [ ]. However, current information on LEA and endocrine changes in males is based on case reports and studies with small sample sizes [ ]; therefore, further research is needed.

Similar to female athletes, progesterone and oestradiol levels are reduced in response to LEA in male athletes [ 90 ]. Consistently, architecture and turnover markers of bone were significantly reduced in endurance runners [ 89 ].

For male athletes other than runners, evidence on bone turnover markers is less clear. However, there is also some evidence of lower bone health in male athletes with LEA who participate in race horse riding or cycling events [ ].

In addition, young males with a low BMI sharing the belief that leanness improves performance are more likely to have low BMD [ ].

Overall, the altered endocrine profile caused by LEA, including decreased anabolic hormones e. leptin, oestradiol, TES in both male and female endurance athletes, is harmful to BMD [ 89 ]. The sensitivity of bone turnover makers seems to be sex-specific and higher in female than in males when experiencing short-term LEA.

Of course, there are other factors affecting BMD. Other key metabolic hormones have been discussed to mediate TDEE adaptations by lowering REE such as those decreasing anabolic pathways [ 68 ]. For example, insulin-like growth factor 1 IGF-1 mediating muscular and bone growth [ ] is commonly higher in well-trained, lean subjects [ ].

In line with the lower IGF-1, its carrier insulin-like growth factor-binding protein 3 is also decreased in females when they have LEA [ 20 ].

Overall, the concentration of IGF-1 is linked to BMD in pre- and post-menopausal women [ 92 ]. However, a trend for a reduction was present [ 18 ]. In contrast, growth hormone GH levels mediating IGF-1 are greater in male and female athletes positive for RED-S [ 90 ] and may indicate the development of a GH resistance [ ].

For instance, in male power athletes with low body fat, growth hormone treatment administered in a double-blind controlled trial neither influenced body composition nor muscle strength [ ].

Of note, protein intake does not mediate IGF-1 levels in exercising athletes—independent of their sex [ ]. Overview of selected body-wide effects due to low energy availability LEA. On the left, body-wide effects of LEA: lower insulin, leptin, insulin-like growth factor 1 IGF-1 , and triiodothyronine T3 as well as lower oestradiol and progesterone in female and lower testosterone and oestradiol in male athletes.

In the middle, alterations in substrate: lower glucose, higher free fatty acids FFA , higher glycerol, higher cholesterol, and β-hydroxybutyrate. These alterations, combined with lower glycogen stores and an increased percentage of fat-free mass FFM , potentially increase lipolysis and decrease glycolysis.

An association between LEA, impaired immunity, and infection is likely, as nutrients are also important for the immunometabolism of leukocytes [ ]. However, there is currently no evidence supporting this hypothesis [ ].

Athletes face multiple challenges other than LEA that suppress immune function, ranging from psychological stress to sleep deprivation [ ].

Supporting of the RED-S definition, which includes impairments of immunity, is the association between LEA and upper respiratory tract infection URTI risk in female athletes [ ]. In addition, Sarin et al. described immunosuppression after energy restriction in immune cells such as T cells and B cells [ ].

Furthermore, interleukin-6 IL-6 expression mediating inflammation is reduced by sufficient energy intake before exercise in order to spare muscular glycogen [ ].

Pasiakos et al. found that increased IL-6 levels after endurance exercise are negatively correlated with energy balance and glycogen stores [ ]. This change was also accompanied by increased hepcidin levels regulating iron metabolism. In this context, Badenhorst et al.

assume that an increase in baseline levels of hepcidin arises when either LEA occurs for several days during high energy expenditure or when inflammation as indicated by increased baseline IL-6 levels is present [ ].

Similarly, haematological constraints, such as abnormal bruising, anaemia, low haemoglobin, iron, or ferritin, are 1.

A dysfunctional haematopoiesis may be present in female athletes with LEA, since prolonged energy restriction and intense exercise are associated with lower erythrocyte and platelet counts, while the number of white blood cells increases [ ].

With regard to psychological stress, anxiety and depression have a significant effect on immunity, and an attenuated resistance to infections is well described [ ]. Accordingly, male endurance athletes with symptoms of LEA more often achieve high exercise dependence scores known to correlate with ED [ ].

An increased drive for thinness in female endurance runners with LEA and FHA compared to athletes with normal menses has also been found [ 19 ]. Apparently, increased psychological stress on the athlete, if present, will lead to an attenuated resistance to infections.

Noticeably, a mental predisposition for an increased risk of LEA or for mental consequences of LEA has to be investigated in the future. Chronic stress increases cortisol levels, which may increase the risk of anxiety and depression [ ]. Elevated cortisol levels were also found in females with triad risk factors [ 19 ], as these are closely related to augmented psychological stress during training and fasting.

The cortisol change does not happen unequivocally due to severe energy restriction [ ]. Furthermore, cortisol levels are highly variable throughout the day due to circadian rhythm [ ].

Moreover, results on cortisol levels as evidence of associations between LEA and cortisol levels are inconsistent [ 90 ]. Again, cortisol levels in females may be more sensitive to LEA, since after mere hours of within-day LEA, levels significantly increased [ 91 ].

We need highly standardised research to clarify if changes in cortisol are a primary or secondary consequence of prolonged LEA in the future. As RED-S in athletes was defined recently, there is little research on performance in regard to this specific syndrome.

One study by Ackerman et al. investigated the body-wide influence of LEA in female athletes through several questionnaires [ ]. The authors did not find any evidence of immunologically harmful adaptations due to LEA. However, performance decrements are not exclusive to female athletes.

In male cyclists, prolonged EA, despite higher training loads, resulted in underperformance, while there was no association between body fat and performance for this sport [ ]. Even though there is a dearth of direct research on performance effects of RED-S, optimal energy supply is essential to optimise athletic performance [ ].

We have outlined energy-conserving mechanisms by endocrine hormones and reduced glycogen stores as some of the homeostatic adaptations to LEA in the previous section.

It is hypothesised that a deficient energy homeostasis is the main cause underlying the development of overtraining [ ]. Skeletal muscle, which controls locomotion, is a key regulator of metabolic homeostasis.

Repetitive exercise bouts increase metabolic enzymes and protein content in the long term, whereby variations exist, depending on the placement of the exercise on the continuum between endurance and resistance exercise.

Endurance exercise has a pronounced effect on mitochondrial protein content and resistance exercise has a pronounced effect on myofibrillar protein content to enable performance enhancement [ ].

T3 mediates the elevated mitochondrial content in endurance athletes as it stimulates ATPase activity and increases heat production [ ]. Therefore, low T3 associated with LEA reduces ATPase activity, leading to reduced energy production by mitochondria and has a negative effect on aerobic energy production and vice versa.

This is why increasing NEAT and reducing body weight by T3 supplementation is a promising strategy to enhance performance [ ]. On the other edge of the exercise continuum is the pronounced effect on muscle protein content.

On the one hand, stimulation of muscular protein synthesis is promoted by anabolic hormones, such as insulin, IGF-1, and TES. On the other hand, catabolic glucocorticoids, such as cortisol, increase protein turnover and initiate skeletal muscle protein breakdown [ ].

A negative effect on muscular protein synthesis due to LEA is implied by reduced anabolic hormones and a potential increase of cortisol in more severe or prolonged LEA.

Thus, it is unsurprising that female runners with secondary FHA demonstrated a lower neuromuscular performance reflected by longer manual reaction time and significant lower knee muscular strength and endurance compared to eumenorrheic athletes [ 88 ]. In judo athletes, caloric restriction was associated with poor performance while increasing fatigue and tension and decreasing vigour, as well [ ].

In addition, a decreased performance in other power athletes seems likely due to decreases in glycogen stores [ 81 ].

To summarise, muscular adaptations important to both endurance and resistance athletes are disturbed by LEA alterations.

The influence of LEA on performance may be masked by the tremendous effect of body weight on performance or may even result in slight performance enhancement or stagnation Fig. A clear decrease in muscular performance may not be obvious despite the athlete underperforming.

a Depending on the influence of body weight BW on performance, weight loss may mask underperformance in athletes experiencing low energy availability LEA.

Despite the negative consequences of LEA on performance, athletes may stay at the same level, when the positive influence of lower body weight is equal to the negative effect of LEA on performance. b When the positive influence of BW on performance outweighs the negative influence of LEA on performance, athletes may even get better, although they cannot exploit their full potential.

c However, when negative adaptations due to LEA are greater than the positive influence of weight loss, performance deficits may be clearly associated with LEA.

Next to optimal energy supply, continuous training is key for high-performance athletes to maintain high training volumes in order to reach the limits of physical performance. Of course, the more days athletes report as sick days, the more training hours are reduced [ ]. There is some evidence that training absence due to illness is three times higher in athletes with a risk of LEA.

However, as already mentioned, illness data is scarce. As a reduced EA negatively influenced bone health in physically active individuals [ ], more evidence is found on training absence due to bone injuries of male athletes with low TES and amenorrhoeic females in runners.

Injury risk was 4. With increasing risk for the female triad, the risk for bone stress injuries in a large cohort of females increased significantly [ ].

However, while LEA in female athletes has a negative effect on BMD, there is a concurrent performance-enhancing outcome of endocrine alterations concerning oestrogen. The associated low oestrogen increases the stiffness of connective tissue such as ligaments and tendons [ ].

A higher stiffness of the connective tissue is associated with performance parameters such as jump height [ ]. Therefore, the risk of ligament injuries and the power performance of women with low oestrogen potentially increases [ ].

As we pointed out in the Adaptations to Short-Term and Long-Term LEA section, for male athletes other than runners, evidence on BMD is less clear. Overall, the risk of training absence may increase when exercising with LEA and thus leads to underperformance—noticeable or not.

Taken together, the evidence shows that LEA causes body-wide effects paving the way for the recognition of RED-S as a multifactorial condition in athletes. Causes for LEA range from harmless reasons, such as lack of motivation to prepare meals, up to deliberate chronic undereating with severe Eds.

The consequences on health and performance outlined by the female triad and the hypogonadal male condition are self-evident, though better-controlled, highly standardised trials are needed.

Given the information above, this article should highly encourage coaches to support a healthy environment during daily practice. Staff involved in the supervision of athletes should be sensitised for signs of LEA and openly talk to athletes.

With regard to performance, professionals should keep in mind that performance reductions due to LEA might not necessarily come with LEA. In weight-sensitive sports, athletes may even enhance performance being at LEA due to lower body weight and a higher tissue stiffness.

Beyond that, the sociocultural pressure and influence of media on athletes should not be overlooked. Yet again, more studies investigating their impact on athletes in this day and age are necessary.

As evidence shows the high prevalence of feeling pressure from coaches or teammates, particularly coaches should acknowledge their impact on athletes and act responsibly. Sundgot-Borgen J, Torstveit MK.

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Negative consequences of low energy availability in natural male bodybuilding: a review. De Souza MJ, Koltun KJ, Strock NC, Williams NI. Rethinking the concept of an energy availability threshold and its role in the female athlete triad.

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Micalis Institute, MGP MetagenoPolis, INRA, AgroParisTech, Université Paris-Saclay, Jouy-en-Josas, France. Genetic and Molecular Epidemiology Unit, Lund University Diabetes Centre, CRC, University hospital Malmö, Malmö, Sweden.

Faculty of Agricultural and Food Science, American University of Beirut, Beirut, Lebanon. Department of Nutrition and the Nutrition Research Institute, The University of North Carolina, Chapel Hill, USA. Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany.

Faculty of Medicine, Southampton General Hospital, University of Southampton, Southampton, UK. Nutrition Policy and Scientific Advice NPU , Department of Nutrition for Health and Development NHD , World Health Organization WHO , Geneva, Switzerland.

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You can also search for this author in PubMed Google Scholar. Correspondence to Isabelle Romieu. Open Access This article is distributed under the terms of the Creative Commons Attribution 4. Reprints and permissions. Romieu, I. et al. Energy balance and obesity: what are the main drivers?. Cancer Causes Control 28 , — Download citation.

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Sorry, a shareable link is not currently available for this article. Provided by the Springer Nature SharedIt content-sharing initiative. Energy balance and obesity: what are the main drivers? Download PDF. Abstract Purpose The aim of this paper is to review the evidence of the association between energy balance and obesity.

Methods In December , the International Agency for Research on Cancer IARC , Lyon, France convened a Working Group of international experts to review the evidence regarding energy balance and obesity, with a focus on Low and Middle Income Countries LMIC.

Results The global epidemic of obesity and the double burden, in LMICs, of malnutrition coexistence of undernutrition and overnutrition are both related to poor quality diet and unbalanced energy intake.

Conclusion Energy intake that exceeds energy expenditure is the main driver of weight gain. Obesity and Weight Control: Is There Light at the End of the Tunnel?

Article 15 May Mediterranean Diet and Obesity-related Disorders: What is the Evidence? Article Open access 30 September The role of the Mediterranean diet on weight loss and obesity-related diseases Article 23 August Use our pre-submission checklist Avoid common mistakes on your manuscript.

Introduction Obesity is defined as a state of excess adiposity that presents a risk to health such as increased risk of chronic diseases including cancer [ 1 — 3 ] and is the consequence of sustained positive energy balance over time.

The International Agency for Research on Cancer IARC of the World Health Organization WHO convened a Working Group Meeting in December to review evidence regarding energy balance and obesity, with a focus on Low and Middle Income Countries LMIC , and to tackle the following scientific questions: 1.

What are the factors that modulate these associations? Table 1 List of topics presented during the working group meeting Full size table. Full size image. Determinants of energy balance: what the evidence tells us With recognition that overweight and obesity are major risk factors for cancer, cardiovascular disease, diabetes, and many other health conditions, the difference between energy intake and expenditure, frequently referred to as energy balance, has become of great interest because of its direct relation to long-term gain or loss of adipose tissue and alterations in metabolic pathways.

Measurements of adiposity Several measures for overweight and obesity have been used in epidemiological studies [ 3 ]; however, it is important to be aware that such measures are imperfect markers of the internal physiological processes that are the actual determinants of cancer development.

Energy intake and energy expenditure Energy balance is the result of equilibrium between energy intake and energy expenditure. Understanding nutritional determinants of obesity Many factors relating to foods and beverages have been shown to influence amounts consumed or energy balance over the short to medium term, such as energy density and portion size [ 36 , 37 ], although the effect of energy density over the longer term is unclear.

Foods and dietary patterns One factor that has been suggested as being obesogenic is a high energy density of foods i. Understanding weight loss In weight loss trials, low carbohydrate interventions led to significantly greater weight loss than did low-fat interventions when the intensity of intervention was similar [ 60 ].

Factors that modulate the association between dietary intake and obesity Physical activity Long-term observational studies fairly consistently show an association between physical activity and weight maintenance, and a position paper from the American College of Sports Medicine ACSM stated that — min per week of moderate intensity physical activity is effective to prevent weight gain [ 62 ].

Genetic and epigenetic factors The patterns and distributions of obesity within and between ethnically diverse populations living in similar and contrasting environments suggest that some ethnic groups are more susceptible than others to obesity [ 70 ].

Microbiota In a healthy symbiotic state, the colonic microbiota interacts with our food, in particular dietary fiber, allowing energy harvest from indigestible dietary compounds. Determinants of childhood obesity Many factors have contributed to the increase in the prevalence of obesity in children including unhealthy dietary patterns with high consumption of fast foods and highly processed food [ 85 ], of sugar sweetened beverages [ 86 ], lack of PA, an increase in sedentary behaviors e.

Prevention of obesity Numerous policy options to prevent obesity have been explored, and evidence is sufficient to conclude that many are cost effective.

The obesity-cancer link: what are the underlying mechanisms? Conclusions and recommendations The global epidemic of obesity and the double burden of malnutrition are both related to poor quality diet; therefore, improvement in diet quality can address both phenomena.

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This calorie deficit promotes weight loss until you reach a new energy balance equilibrium. To maintain your weight loss, you must restrict your energy intake to the same number of calories you were consuming when you hit a plateau. This is why most people regain the weight they lost when they stop dieting.

Learn more about your estimated calorie requirements here. Weight loss will decrease your total daily energy expenditure, comprised of your basal metabolic rate, the thermic effect of food, and calories burned during physical activity. Any changes will disrupt the equilibrium of the energy balance equation.

Fortunately, you can change your weight loss plan to overcome the plateau and avoid regaining the weight you lost. To break through a plateau, you must eat fewer calories and burn more calories through physical activity.

To lose weight, you must create a calorie deficit by using more calories than you consume. For example, a daily energy deficit of calories would result in a weekly weight loss of approximately one pound. Lean muscle mass increases your metabolism, so you want to minimize muscle loss while maximizing fat loss.

So, to maintain a calorie deficit, you must increase your exercise frequency, intensity, and length of time. The training effect may also cause a plateau. Your muscles become more efficient and burn fewer calories when repeatedly performing the same type of exercise.

Cross-training combats this effect by stimulating muscle growth as a response to varying physical demands from different types of exercise. Engaging in a regular exercise program is one of the best predictors of long-term weight loss because it shows your commitment to a healthy lifestyle.

To maintain weight loss, you must make permanent lifestyle changes that are both realistic and sustainable. Successful weight loss depends on maintaining equilibrium of the energy balance equation.

Learn more secrets to long-term weight loss in this article. This site uses cookies. By continuing to browse the site, you are agreeing to our use of cookies. We may request cookies to be set on your device. We use cookies to let us know when you visit our websites, how you interact with us, to enrich your user experience, and to customize your relationship with our website.

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