Energy balance and fat loss -
The exact success rate in treating obesity is difficult to identify and depends on definitions of success. Although we have a great deal of research about factors that contribute to weight loss, we have surprisingly little research to understand the factors that contribute to weight loss maintenance.
We study weight loss maintenance using our rodent model of dietary obesity and using information from the National Weight Control Registry NWCR.
In , Dr. Rena Wing and I started the NWCR to recruit and study a group of people who had succeeded at long-term weight loss maintenance. Individuals are eligible to enter the NWCR if they have maintained a weight loss of at least 30 pounds for at least 1 yr.
Individuals self-report their weight loss to enter the NWCR and provide information to us, largely, by completing questionnaires about weight loss and weight loss maintenance. Currently, we are following over individuals in the NWCR. These individuals are maintaining an average weight loss of over 70 pounds for an average period of almost 6 yr.
Over the past decade, we have described characteristics of these successful weight loss maintainers 59 , 74 — Although this is not a prospective study of weight loss maintenance, we have identified many common characteristics of these individuals that provide interesting hypotheses about successful weight loss maintenance.
We have found surprisingly few similarities in how NWCR participants report losing their weight. Conversely, many similarities are seen in the behaviors and strategies used to maintain weight loss. The four that stand out are: Eating a moderately low-fat, high-carbohydrate diet.
This is consistent with our previous work suggesting that low-fat diets should be better than high-fat diets in preventing positive energy balance.
Consistent self-monitoring of body weight, food intake, and physical activity. NWCR participants continue to periodically keep diet and physical activity records. This is consistent with other reports that self-monitoring facilitates long-term success in weight management Eating breakfast every day.
This is consistent with a growing body of data showing that eating breakfast facilitates maintenance of a healthy body weight Very high levels of physical activity. Others have reported that high levels of physical activity are important for long-term weight loss maintenance 80 — Weight loss is about negative energy balance, and there are many ways to produce this.
Negative energy balance is a temporary state that cannot be easily maintained for long periods of time. Weight loss maintenance is about achieving energy balance, but at a new lower body weight.
It requires diet and physical activity patterns that can be maintained indefinitely. The challenge is not just achieving energy balance, but achieving it at a lower body weight. This is a challenge because energy requirements decline with weight loss. Holly Wyatt and I developed the concept of the energy gap in an attempt to individualize strategies for weight loss maintenance Fig.
The energy gap is the difference between energy requirements before and after weight loss RMR decreases with decreasing body mass. The thermic effect of food decreases with total energy intake.
The energy cost of physical activity is related to body mass and declines with weight loss. Although there is a debate about whether the drop in energy requirements might actually be larger than expected from the loss of body weight 85 , it is clear that energy expenditure is lower after weight loss than before, and this presents a challenge in achieving energy balance after weight loss.
Most people do not distinguish between weight loss and weight loss maintenance. They try to achieve energy balance after weight loss by maintaining their lower energy intake. A typical energy gap for a weight loss of 40 pounds would be — kcal.
There are two ways to address the energy gap—reduce energy intake or increase physical activity. It is not difficult to maintain this amount of food restriction temporarily, but the challenge is doing it permanently.
Food restriction can be an effective temporary strategy, but it is rarely an effective long-term strategy for many people. It is opposed by our biology that stimulates us to eat 86 and is, perhaps, accompanied by other metabolic changes that we identified in our weight-reduced animal model 15 — Similarly, food restriction is vigorously opposed by an environment that encourages eating.
It is no surprise that few people can consistently fight their biology and their environment to sustain energy restriction. When they fail, they rapidly regain their weight, just like our weight-reduced rats.
The second way of addressing the energy gap is to increase physical activity. There are several advantages to this strategy. Presumably, intake before weight loss was at a level that could be maintained long term.
It is certainly possible that an individual may combine strategies to address the energy gap by reducing energy intake some and increasing energy expenditure some more. We believe that those who rely more on increasing physical activity than food restriction to address the energy gap will be more successful in long-term weight loss maintenance.
In addition to allowing a higher energy intake during weight loss maintenance, there are at least two other ways that high levels of physical activity may facilitate weight loss maintenance. First, high levels of physical activity may compensate for changes in metabolism caused by established obesity.
If obesity affects humans in the way it affects rats, weight-reduced humans may have a strong metabolic drive to regain weight. We have examined possible metabolic effects of obesity in individuals in the NWCR.
We find that RMR in NWCR participants is not different than lean or obese controls However, RMR was measured while they were performing their usual daily physical activity regimen and might be lower if measured under chronic sedentary conditions. As another example, we find one of the metabolic characteristics of weight-reduced rats that may predispose them to weight regain is a lower than anticipated leptin level 15 — A recent study suggested that giving leptin to weight-reduced humans may be more effective to prevent weight gain than to produce weight loss A second way that physical activity may help with weight loss maintenance is by maintaining a high energy flux.
Weight loss produces a decline in energy requirements, and achieving energy balance by food restriction results in achieving energy balance at a lower flux. By increasing physical activity, energy flux can continue to be maintained at a high level, which may be where biological regulatory systems are most sensitive.
An important question is whether it is any easier for people to maintain an increase in physical activity of — kcal than it is for them to maintain an energy restriction of the same amount. In truth, it is difficult to produce and maintain increases in physical activity in most people. We still have to find better ways to get people to increase physical activity, but the available data suggest that this strategy has a greater potential for success than energy restriction.
Similarly, increasing physical activity is the only strategy found at least partially to prevent weight regain in our weight-reduced animal model Other strategies such as drugs or surgery may partially fill the energy gap. For example, a drug that reduces hunger or increases energy expenditure would help fill the energy gap and require less voluntary food restriction or intentional increase in physical activity.
In summary, the challenge for obesity treatment is not losing weight but keeping it off. There are many ways to produce weight loss, but permanent weight loss maintenance may require a very high level of physical activity. An alternative strategy to obesity treatment is prevention of excessive weight gain.
This strategy does not require producing negative energy balance but rather only requires preventing positive energy balance. This strategy would represent a very long-term approach to addressing the obesity epidemic and is based on the notion that it is easier and more feasible to prevent weight gain than to produce and maintain substantial weight loss.
The first goal with this strategy would be to stop obesity rates from increasing, and gradually, over generations, to reduce levels to those seen before We provided a theoretical basis for this strategy in our second Science paper We estimated the degree of positive energy balance that is producing the gradual weight gain of the population.
Brown et al. If the gradual weight gain of the population is due to a small degree of positive energy balance, it should be possible to stop it with a small changes strategy that involves small decreases in energy intake and small increases in energy expenditure.
Such a strategy makes sense from an energy balance point of view. Making small decreases in energy intake would serve to reduce the positive energy balance, not produce negative energy balance. This should not produce strong biological compensatory decreases in energy intake of the kind that are seen with substantial food restriction.
Similarly, there is no evidence that small increases in physical activity produce compensatory increases in energy intake in relatively sedentary individuals Although we do not have definitive data to show that small behavior changes are more likely to be sustainable than larger ones for most people, this is a reasonable hypothesis.
We have a lot of data to suggest that large behavior changes are not sustainable for most people, as evidenced by the failure in obesity treatment.
Finally, small behavior changes may be less opposed by the environment than larger ones. Since the publication of our paper in , we have been gratified to see the acceptance of the small changes approach.
The Department of Health and Human Services, under Secretary Tommy Thompson, launched a small steps program aimed at making small changes in diet and physical activity The idea of approaching obesity through small lifestyle changes was also part of the Dietary Guidelines for Americans A national nonprofit initiative, America On the Move, was created to promote the small changes approach to prevention of weight gain It seems that the public health community is giving serious consideration to a strategy that involves prevention of weight gain to address obesity.
We recommended the use of inexpensive step counters or pedometers to allow people to set goals and monitor progress for increased walking. We estimated that most adults could increase energy expenditure with an extra steps per day, which is equivalent to walking an additional mile. Because an average walking speed would be — steps per minute, this could be done in 15—20 min, and the increase could be spread throughout the day.
Since then, the use of pedometers to promote physical activity has greatly increased. We have conducted some population surveys to obtain normative data on walking and its relationship to obesity. Table 1 shows these results. The average number of steps taken by adults in the United States daily is for men and for women.
Adults in Colorado 94 take more steps than the national average and have lower obesity rates , whereas adults in Tennessee take fewer steps per day and have higher obesity rates. Our recent work has focused on demonstrating the feasibility of the small changes approach in preventing excessive weight gain.
We have demonstrated that providing a goal of walking an extra steps per day is achievable and results in a significant increase in total walking Finally, we have conducted two intervention studies in families to demonstrate that the small changes approach can reduce excessive weight gain in overweight children and their parents 97 , Regardless of whether one advocates obesity treatment or prevention of weight gain as a strategy to reverse the obesity epidemic, it will be necessary to address environmental changes.
A big question is how much environmental change is needed? It is important to realize that at some level we intentionally created the environment that is making us fat and we are not unhappy with it.
The hope is that the small changes approach will work with modifying the environment. Rather than just focus on changing one or two environmental factors, it may be more useful to make small changes in a lot of factors. There are some hopeful signs of change.
Many food companies are working to develop and designate healthier items. The school food environment is improving with the agreement crafted by the Alliance for a Healthier Generation 99 with the soft drink manufacturers to remove soft drinks from schools.
Communities are looking at how they can facilitate walking over driving. We certainly have a long way to go in addressing the environment, but such efforts are beginning.
An advantage of the small changes approach to environmental change is that it provides an opportunity for all sectors of society to change gradually. It is certainly possible that systemic changes in the food supply such as promoting healthier foods and making them more affordable and in the systems that promote physical activity i.
can be made. It is also unclear how quickly such changes could be made or whether they would be effective. The environment did not get this way overnight, and small changes may be more acceptable than big ones in changing it. Although there is some sense of urgency in addressing the environment, small changes in a lot of environmental factors could make an immediate difference in at least stopping any further increase of obesity rates.
Experts debate the role of the environment vs. the role of personal responsibility in addressing obesity. It is certainly possible in our current environment for people to choose to eat a healthy diet and to engage in regular physical activity. However, in an environment where high-energy dense foods are readily available and vigorously marketed, and where physical activity is not necessary for most people to get through their daily lives, it is hard to maintain a healthy lifestyle.
For these reasons, we cannot approach obesity solely as an issue of personal responsibility. If we can change the environment to one that less strongly promotes obesity, it is likely that more people will be able to achieve and maintain healthy lifestyles.
On the other hand, we are not likely to be able to change the environment to one where most people can maintain a healthy body weight with little conscious effort. This means that we have to address obesity both as an environmental issue and as an issue of personal responsibility.
Maintaining a fair balance in doing this will be difficult. The issue of personal responsibility is even more sensitive in children, who may lack the knowledge and skills to make appropriate lifestyle choices and may not necessarily have the opportunity to engage in a healthy lifestyle.
For this group, it is critically important to create an environment that promotes healthier lifestyle choices. However, it is also important for us to help our children develop skills for making lifestyle choices that will help them maintain a healthier weight as adults.
The future does not look optimistic in terms of addressing obesity unless we can come together as a society to address behavior and environmental change. The high rates of childhood obesity that exist today suggest that obesity rates in the United States have not peaked and will continue to increase gradually if we do nothing.
Most overweight children become overweight or obese adults. The worst case scenario is that the entire population becomes obese, and the best case scenario is that we get serious about intervening to reverse the obesity epidemic.
However, we have to do this together as a society; if we remain as individuals struggling with the problem, environmental change will not likely occur. Is there real hope that we can make progress in reversing obesity before we all become obese? The more we learn about our complex system of regulating energy balance, the more we learn that it is operating as it has always operated.
Similarly, I am convinced that better behavior modification techniques alone will not solve the problem. The major influence toward positive energy balance is coming from the environment. It is operating through behavior and does not elicit strong biological opposition.
Put simply, we have a mismatch between our biology and our environment. We cannot attribute the obesity epidemic to abnormal biology or to a sudden rash of bad behavior.
We have to get serious about focusing attention on the environment. We are not likely to change the environment to one that existed before , where it was easier to maintain a healthy lifestyle. To get back to the obesity rates that existed then, individuals are going to have to make a greater conscious effort to manage their weight than they did then.
This does not mean that biological and behavioral research is not important—it is critically important. We still have much to learn about the biological regulation of energy balance and must improve our ability to help people make behavior changes.
However, without devoting at least similar attention toward the environment, we will not succeed in reversing the obesity epidemic. Obesity cannot be addressed solely in the clinic or in the school or in the workplace. It must be addressed everywhere.
We are really talking about social change to make our communities into places where it is easy to make good food choices and to be physically active. This change can only come from within communities and can only happen if every sector of the community engages in the effort.
The good news is that if every member of each sector of the community commits to making small changes, the result can be a big change.
It will not be easy, but we have dealt with other hard social issues such as tobacco smoking, recycling, and seat belt use. It can be done, but it needs to be done quickly. I believe that our best chance of reversing the obesity epidemic is in creating a social change movement focused on small changes—in behavior and in the environment.
The small changes approach allows everyone to play a role in addressing obesity. Our immediate challenge is to first stop the continued increase in the weight of the population, and over time, return obesity rates to pres levels.
I thank the many people who have worked in my laboratory over the past 25 yr. In particular, I thank Drs. John C. Peters, Holly R.
Wyatt, and Paul MacLean for their friendship and collaboration and for reviewing this paper. I gratefully acknowledge support from the National Institute of Diabetes and Digestive and Kidney Diseases over the past 25 yr. National Health and Nutrition Examination Survey , current version.
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A loss of bacterial gene richness is linked to more severe metabolic syndrome, and less sensitivity to weight loss following caloric restriction diet [ 83 ].
Dietary habits also seem to be associated with microbiota richness [ 84 ]. The proposed mechanisms by which gut microbiota dysbiosis and loss of richness can promote obesity and insulin resistance are diverse, often derived from mouse models, and still deserve more studies and validation in humans.
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.
Experiences during early life e. In particular, maternal gestational weight gain GWG [ 92 ], maternal overweight prior to pregnancy, smoking during pregnancy, high or low infant birth weight, rapid weight gain during the first year of life [ 93 — 95 ], early obesity rebound [ 96 ], breastfeeding patterns [ 97 ] and early introduction of complementary food [ 98 ] have all been linked to later excess adiposity.
Many of these are inter-related and work is ongoing to disentangle concurrent factors. In addition, high levels of stress during childhood and adolescence may change eating habits and augment consumption of highly palatable but nutrient-poor foods [ 99 ].
Numerous policy options to prevent obesity have been explored, and evidence is sufficient to conclude that many are cost effective. Given the multifactorial nature of obesity, as in other complex public health problems, a combination of interventions is more likely to generate better results than focusing only on a single measure [ ].
Gortmaker et al. They modeled the reach, costs and savings for the US population Some of these interventions excise tax on sugar-sweetened beverages, elimination of tax deduction for advertising unhealthy food to children and nutrition standards for food and beverages sold in schools outside of meals not only prevent many cases of childhood obesity, but also potentially cost less to implement than they would save for society.
The global childhood obesity epidemic demands a population-based multisector, multi-disciplinary, and culturally relevant approach. Children need protection from exploitative marketing and special efforts to support healthy eating, PA behaviors, and optimal body weight [ — ].
Adequate evidence has been accumulated that interventions, especially school-based programs, can be effective in preventing childhood obesity [ ]. Preventing obesity will require sustained efforts across all levels of government and civil society. Although there are individual differences in susceptibility, obesity is by large a societal problem resulting from health related behaviors that are largely driven by environmental upstream factors.
Many options for policies to prevent obesity are available and many of these are effective and cost-effective. Integrated management of the epidemic of obesity requires top-down government policies and bottom-up community approaches and involvement of many sectors of society.
Integrating evidence-based prevention and management of obesity is essential. There is convincing evidence for a role of obesity as a causal factor for many types of cancer including colorectum, endometrium, kidney, oesophagus, postmenopausal breast, gallbladder, pancreas, gastric cardia, liver, ovary, thyroid, meningioma, multiple myeloma, and advanced prostate cancers [ 19 ].
Recent progress on elucidating the mechanisms underlying the obesity-cancer connection suggests that obesity exerts pleomorphic effects on pathways related to tumor development and progression and, thus, there are potential opportunities for primary to tertiary prevention of obesity-related cancers.
We now know that obesity can impact well-established hallmarks of cancer such as genomic instability, angiogenesis, tumor invasion and metastasis and immune surveillance [ 20 ]. However, obesity-associated perturbations in systemic metabolism and inflammation, and the interactions of these perturbations with cancer cell energetics, are emerging as the primary drivers of obesity-associated cancer development and progression.
In both obesity and metabolic syndrome, alterations occur in circulating levels of insulin and insulin-like growth factors, sex hormones, adipokines, inflammatory factors, several chemokines, lipid mediators and vascular associated factors [ 21 — 23 ].
Most research on obesity and cancer has focused on Caucasians in HICs. While many of the identified risk factors in HICs will have the same physiologic effects in LMICs, the determinants may be different, in addition to other environmental and genetic differences across populations. Novel risk factors or traditional diets may be identified in newly studied populations and regions.
Diet is shaped by many factors such as traditions, knowledge about diet, food availability, food prices, cultural acceptance, and health conditions. Likewise, a variety of factors will influence daily physical activity and sedentary behaviors, including dwellings, urbanization, opportunities for safe transportation by bicycle riding and walking, recreational facilities, employment constraints and health conditions.
Surveillance of current diet and health conditions and assessment of trends over time is of major importance in LMICS. Further resources and research capacity are of highest priority. In addition to surveillance efforts, prospective studies able to document lifestyle and change of lifestyle over time are an important area of research.
Several cohort studies conducted in HICs have shown an impact of healthy dietary patterns on obesity [ ] and similar studies could be conducted in LMICs to identify dietary patterns related to weight gain and obesity in a variety of settings to evaluate the major lifestyle, behavioral and policy influences in an effort to plan public health interventions appropriately.
A major challenge is to capture life course exposures and identify windows of susceptibility. Cohort studies covering the whole life course, focusing on critical windows of exposure and the time course of exposure to disease birth cohorts, adolescent cohorts, and young adult cohorts , should be considered.
Of particular interest are multi-centered cohorts and inter-generational cohorts that would create resources to enable research on the interplay between genetics, lifestyle and the environment.
For example in the Avon longitudinal study of parents and children ALSPAC , increasing intake of energy-dense nutrient-poor foods during childhood mostly free sugar was associated with obesity development.
Diets with higher energy density were associated with increased fat mass [ ]. Most relevant to LMICs is the observation that children who were stunted in infancy and are subsequently exposed to more calories, at puberty, are more likely to have higher fat mass at the same BMI compared with children who were not stunted [ 93 , 94 , ].
Poor maternal prenatal dietary intakes of energy, protein and micronutrients have been associated with increased risk of adult obesity in offspring while a high protein diet during the first 2 years of life was also associated with increased obesity later in life [ ]; conversely, exclusive breastfeeding was associated with lower risk of obesity later in childhood, although this may not persist into adulthood [ ].
Similar results from a cohort study conducted in Mexico show that children exclusively or predominantly breastfed for 3 months or more had lower adiposity at 4 years [ ]. Further work on birth cohorts or other prospective studies in LMICs is likely to provide insights into the developmental causes of obesity and NCDs.
Input from local research communities, health ministries and policy makers and appropriate funding or resource assignment are critical for the success of new efforts in LMICs. There is clearly a need for capacity building and resources devoted to nutritional research in LMICs.
The first step would be a comprehensive assessment of resources already in place, and the identification of gaps and priorities for moving forward. Repeated surveillance surveys are essential in LMICs for evaluation of current and future status of the population and addressing undesirable trends with prevention and control programs.
It is recognized that few prospective studies are currently underway in LMICs and resources will be needed to pursue this important area of research.
Input from local research communities, health ministries and policy makers are critical for the success of new efforts in LMICs. 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.
The benefits of a healthy diet on adiposity are likely mediated by effects of dietary quality on energy intake, which is the main driver of weight gain.
Energy balance is best assessed by changes in weight or in fat mass. Measures of energy intake and expenditure are not precise enough to capture small differences that are of individual and public health importance.
Dietary patterns characterized by higher intakes of fruits and vegetables, legumes, whole grains, nuts and seeds and unsaturated fat, and lower intakes of refined starch, red meat, trans and saturated fat, and sugar-sweetened foods and beverages, consistent with a traditional Mediterranean diet and other measures of dietary quality, can contribute to long-term weight control.
Genetic factors cannot explain the global epidemic of obesity. It is possible that factors such as genetic, epigenetic and the microbiota can influence individual responses to diet and physical activity. Very few gene—diet interactions or diet-microbiota have been established in relation to obesity and effects on cancer risk.
Short-term studies have not provided clear benefit of physical activity for weight control, but meta-analysis of longer term trials indicates a modest benefit on body weight loss and maintenance.
The combination of aerobic and resistance training seems to be optimal. Long-term epidemiologic studies also support modest benefits of physical activity on body weight. This includes benefits of walking and bicycle riding, which can be incorporated into daily life and be sustainable for the whole population.
Physical activity also has important benefit on health outcomes independent of its effect on body weight. In addition, long-term epidemiologic studies show that sedentary behavior in particular TV viewing is related to increased risk of obesity, suggesting that limiting sedentary time has potential for prevention of weight gain.
The major drivers of the obesity epidemic are the food environment, marketing of unhealthy foods and beverages, urbanization, and probably reduction in physical activity.
Existing evidence on the relations of diet, physical activity and socio-economic and cultural factors to body weight is largely from HICs. There is an important lack of data on diet, physical activity and adiposity in most parts of the world and this information should to be collected in a standardized manner when possible.
In most environments, 24h recalls will be the more suitable method for dietary surveillance. Attention should be given to data in subgroups because mean values may obscure important disparities.
In utero and early childhood, environment has important implications for lifetime adiposity. This offers important windows of opportunity for intervention. Observational data on determinants of body weight and intervention trials across the life course to improve body weight are also required.
To accomplish these goals, there is a need for resources to build capacity and conduct translational research. Gaining control of the obesity epidemic will require the engagement of many sectors including education, healthcare, the media, worksites, agriculture, the food industry, urban planning, transportation, parks and recreation, and governments from local to national.
This provides the opportunity for all individuals to participate in this effort, whether at home or in establishing high-level policy. We now have evidence that intensive multi-sector efforts can arrest and partially reverse the rise of obesity in particular among children.
In conclusion, we are gaining understanding on the determinants of energy balance and obesity and some of these findings are being translated into public health policy changes. However, further research and more action from policy makers are needed. Samuel J. Fernanda Morales-Berstein, Carine Biessy, … on behalf of the EPIC Network.
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balanxe out. Performance-enhancing supplements your energy balance wnd involves tracking what types of Energy balance and fat loss you put into your Energu, the Performance-enhancing nutrition at which you burn those calories, baance type of activity you do outside the gym, Enerby a whole lot Energy balance and fat loss. Blaance a little know-how behind these subjects can make your bulking or cutting phase a smooth one. None of these supplements are meant to treat or cure any disease. If you feel you may be deficient in a particular nutrient or nutrients, please seek out a medical professional. Calories are a unit of measurement used to calculate the energy content of food and beverages — or how much fuel they provide your body. Your body uses these calories for everything from temperature regulation to lifting heavy iron at the gym. The aim of bbalance paper Energy balance and fat loss to balxnce the Energy balance and fat loss of the association between energy balance and obesity. Sports nutrition for recovery and injury rehabilitation December Energy balance and fat loss, the International Fxt for Research on Cancer BalxnceLyon, France convened balancs Working Group of international experts Enrrgy review the evidence lows energy balance and obesity, with a focus on Low and Middle Income Countries LMIC. 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. Dietary patterns consistent with a traditional Mediterranean diet and other measures of diet quality can contribute to long-term weight control. Limiting consumption of sugar-sweetened beverages has a particularly important role in weight control. Genetic factors alone cannot explain the global epidemic of obesity. However, genetic, epigenetic factors and the microbiota could influence individual responses to diet and physical activity.
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