Metabolic adaptation following massive weight loss is related to the degree of energy imbalance and changes in circulating leptin

Nicolas D Knuth, Darcy L Johannsen, Robyn A Tamboli, Pamela A Marks-Shulman, Robert Huizenga, Kong Y Chen, Naji N Abumrad, Eric Ravussin, Kevin D Hall, Nicolas D Knuth, Darcy L Johannsen, Robyn A Tamboli, Pamela A Marks-Shulman, Robert Huizenga, Kong Y Chen, Naji N Abumrad, Eric Ravussin, Kevin D Hall

Abstract

Objective: To measure changes in resting metabolic rate (RMR) and body composition in obese subjects following massive weight loss achieved via bariatric surgery or calorie restriction plus vigorous exercise.

Methods: Body composition and RMR were measured in 13 pairs of obese subjects retrospectively matched for sex, body mass index, weight, and age who underwent either Roux-en-Y gastric bypass surgery (RYGB) or participated in "The Biggest Loser" weight loss competition (BLC).

Results: Both groups had similar final weight loss (RYGB: 40.2 ± 12.7 kg, BLC: 48.8 ± 14.9 kg; P = 0.14); however, RYGB lost a larger proportion of their weight as fat-free mass (FFM) (RYGB: 30 ± 12%, BLC: 16 ± 8% [P < 0.01]). In both groups, RMR decreased significantly more than expected based on measured body composition changes. The magnitude of this metabolic adaptation was correlated with the degree of energy imbalance (r = 0.55, P = 0.004) and the decrease in circulating leptin (r = 0.47, P = 0.02).

Conclusions: Calorie restriction along with vigorous exercise in BLC participants resulted in preservation of FFM and greater metabolic adaption compared to RYGB subjects despite comparable weight loss. Metabolic adaptation was related to the degree of energy imbalance and the changes in circulating leptin.

Conflict of interest statement

Conflicts of Interest Statement

No authors have conflicts of interest.

© 2014 The Obesity Society.

Figures

Figure 1
Figure 1
Percentage of total weight loss from fat mass (FM) and fat-free mass (FFM) in 13 pair-matched BLC and RYGB participants (mean ± SD). * P < 0.01 BLC percentage of total weight loss from fat mass significantly different from RYGB. † P < 0.01 BLC percentage of total weight loss from fat-free mass significantly different from RYGB.
Figure 2
Figure 2
Metabolic adaptation (measured minus predicted RMR) in BLC (●) at baseline and 7 months; and in RYGB (□) at baseline (n=13), 6 months (n=9), and 12 months (n=13) (mean ± SD). * P < 0.01 metabolic adaptation significantly different from zero. † P < 0.05 compared with BLC 7 month.
Figure 3
Figure 3
Correlation between metabolic adaptation and (A) average energy imbalance (r = 0.55, p =0.004) and (B) percent decrease in circulating leptin (r = 0.47, p =0.02) in BLC at 7 months (●) and RYGB at 6 months (■) and 12 months (□). Linear correlations were calculated for all data combined.

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