What Is the Net Energy Loss Needed to Reduce Body Weight by One Pound?
Circulation. Author manuscript; available in PMC 2013 Jul three.
Published in last edited form as:
PMCID: PMC3401553
NIHMSID: NIHMS390766
Energy Balance and Obesity
James O. Loma
University of Colorado Anschutz Medical Campus Denver, Colorado
Holly R. Wyatt
University of Colorado Anschutz Medical Campus Denver, Colorado
John C. Peters
Academy of Colorado Anschutz Medical Campus Denver, Colorado
Abstruse
This paper describes the interplay among energy intake, energy expenditure and torso energy stores and illustrates how an understanding of energy balance tin help develop strategies to reduce obesity. First, reducing obesity will crave modifying both free energy intake and energy expenditure and non simply focusing on either alone. Nutrient brake solitary will non be effective in reducing obesity if human physiology is biased toward achieving energy rest at a loftier free energy flux (i.e. at a high level of energy intake and expenditure). In previous environments a high energy flux was accomplished with a high level of physical activity but in today's sedentary environment information technology is increasingly achieved through weight gain. Matching energy intake to a high level of free energy expenditure will likely be more a more feasible strategy for most people to maintain a healthy weight than restricting food intake to meet a low level of energy expenditure. Second, from an free energy balance signal of view nosotros are probable to be more successful in preventing excessive weight proceeds than in treating obesity. This is because the free energy balance system shows much stronger opposition to weight loss than to weight proceeds. While big behavior changes are needed to produce and maintain reductions in trunk weight, small behavior changes may be sufficient to forestall excessive weight gain. In conclusion, the concept of energy balance combined with an agreement of how the trunk achieves residuum may be a useful framework in helping develop strategies to reduce obesity rates.
Keywords: Obesity, physical activity, energy flux, energy balance
Framing the Upshot
Obesity is often considered to be a result of either excessive food intake or of bereft physical activity. There is a great debate near which behavior deserves the about responsibility, only this arroyo has not yet produced effective or innovative solutions. We believe that obesity can best be viewed in energy balance terms. The beginning law of thermodynamics assures that body weight cannot change if, over a specified time, energy intake and energy expenditure are equal. This way of thinking puts the blame not just on i or the other behavior but on both. If the problem is that also many people are in positive energy balance, so the solution must involve changing a combination of energy intake and energy expenditure to achieve balance. Efforts to develop effective strategies to reduce obesity rates could benefit from an understanding of how free energy rest is achieved past the torso.
Energy Residuum: Definitions
The bones components of energy balance include energy intake, energy expenditure and free energy storage (i). Torso weight can change just when energy intake is non equal to energy expenditure over a given menstruation of time. Humans take in energy in the form of protein, carbohydrate, fat and alcohol (free energy in (EIN)). Humans expend free energy (free energy out (E OUT)) through resting metabolic rate (RMR)—which is the amount of energy necessary to fuel the body at rest; the thermic effect of food (TEF)—which is the energy cost of absorbing and metabolizing nutrient consumed; and the energy expended through physical activity (EEPA). RMR is proportional to body mass, particularly the amount of fat-free mass. TEF is proportional to the total nutrient consumed and on a typical mixed nutrition, comprises viii to 10 per centum of full energy ingested. Physical activeness associated energy expenditure (EEPA) is the most variable component of energy expenditure and consists of the amount of concrete activity performed multiplied by the energy cost of that activity.
When energy intake equals energy expenditure, the body is in energy balance and trunk energy (generally equivalent to body weight) is stable. Nevertheless, the time period over which free energy balance may be controlled or regulated is non well understood. Differences in the time frame over which energy balance occurs between individuals may be important and may likewise explain the big variability in individual responses to weight loss interventions and other perturbations to the free energy balance system. When free energy intake exceeds energy expenditure, a state of positive energy balance occurs and the consequence is an increase in body mass, of which 60 to 80 per centum is usually body fat (2). Conversely, when energy expenditure exceeds free energy intake, a state of negative energy balance ensues and the consequence is a loss of torso mass (again with lx to 80 per centum from trunk fat). Whatever genetic or ecology gene that impacts trunk weight must deed through ane or more component of energy balance.
How the Trunk Achieves Energy Balance
Our understanding of the mechanisms past which the body acts to achieve and maintain energy residue is incomplete, simply the available show suggests that a complex physiological command organization is involved. This system includes afferent signals from the periphery about the state of free energy stores and efferent signals that affect energy intake and expenditure (three). Furthermore, we know that the components of energy residual can be influenced by changes in each other as a result of positive or negative energy residual (4-10), which deed to defend body free energy stores, maintain energy residue and preventing shifts in body mass. If energy balance was not controlled by such a arrangement and were subject just to behavioral mechanisms controlling food intake and volitional energy expenditure most people would routinely experience broad swings in body weight over short periods of time. The relative stability of body weight from mean solar day to day is consistent with the view that energy rest is subject to physiological control.
In practical terms, assessment of energy residue is unremarkably accomplished by cess of body weight or trunk limerick (to judge full energy content). Free energy balance itself, is not something that is measured, but rather various surrogates are measured that represent the sum total of energy inputs and outputs and the land of body free energy stores. However, we do not have the ability to measure the minor changes in energy balance that could impact body weight. Given this, great care should be taken in making predictions about changes in body weight from measures of either energy intake or energy expenditure.
Obesity is non a Trouble in only one Component of Free energy Rest
Despite the evidence for a control arrangement, most people in today's environment gain significant escess trunk weight and body fat over their adult years. This does not argue against an free energy residual control organization, but suggests there may be limits to the torso'due south ability to lucifer intake and expenditure under the prevailing conditions in the mod environment. For example, 1 can develop some crude estimates of the extent to which food intake has increased and physical action has decreased over the past decades. Analysis of the NHANES information (eleven) suggests that the boilerplate daily energy intake increased from 1971 to 2000. The average increment was 168 kcal/day for men and 335 kcal/day for women. With no active regulation or adaptation of energy residuum, this increment theoretically could explicate a yearly weight gain of 18 pounds for men and 35 pounds for women.
On the energy expenditure side, Basset et al (12) examined physical activity patterns in an Old Order Amish population who are living an agrarian lifestyle typical of a big fraction of the population in the U.Southward. early on in the twentyth century. Using pedometers, they found that Amish men walked an average of well-nigh 18,000 steps per day and women an average of about 14,000 per 24-hour interval. Basset et al (13) also reported that in 2003, the average American adult walked most 5,000 steps per day. Compared to the Amish lifestyle, this is a difference of thirteen,000 steps/twenty-four hour period for men and nine,000 steps/day for women. Without taking account of physiological adaptation, this pass up in concrete activity over the by century could explicate a yearly weight gain of 68 pounds for men and 47 pounds for women. Similarly Church et al. (14) recently estimated that occupational physical action has declined past an average of near 142 kcal/twenty-four hours since 1960. This solitary could explain a substantial corporeality of weight gain in the population.
Although these estimates are crude, the indicate is that taken together, the changes in reported energy intake and energy expenditure over the past decades would predict more weight gain (by xxx-80 fold) in adults than actually has occurred if there were not some physiological processes attempting to maintain free energy residual. Further, because alterations in one component of free energy balance touch on the others (four-10), it is not realistic or helpful to attribute obesity solely to energy intake or energy expenditure. A slap-up example of the way that components of energy balance interact is demonstrated by Hall et al. (xv) who modeled changes in components of energy balance with nutrient brake. They showed that the traditional guess of a pound of weight loss with each 3500 kcal of negative energy residue was non true considering of reductions in energy expenditure in response to decreases in energy intake, and that the actual weight loss would exist less than expected. The same would hold true for weight proceeds – the expected weight proceeds would be less than predicted from the degree of positive energy residue considering of the interaction among components of energy balance.
Does it Affair How Energy Balance is Accomplished?
Theoretically, an individual can reach energy balance in multiple ways. Free energy balance can be accomplished at dissimilar levels of body weight and body composition and it can be accomplished at dissimilar levels of free energy intake and energy expenditure (as long as the two are equal over a period of fourth dimension). However, the style energy balance is accomplished may exist affected by characteristics of human physiology.
A Physiological Drive for High Free energy Expenditure
A person who is very physically active might maintain free energy remainder and a healthy body weight by eating and expending iii,000 kcal/day. That aforementioned person, if adopting a sedentary lifestyle, could maintain energy residue and the same good for you body weight by eating and expending ii,000 kcal/day. Finally, if that sedentary person failed to sufficiently reduce energy intake to match reduced free energy expenditure over time, they would gain weight and could finish up achieving free energy balance at 3,000 kcal/day by becoming obese.
Based on our review of the energy remainder literature and information nigh how our modern lifestyle differs from decades ago, we hypothesize that human being physiology developed under circumstances that conferred a advantage for achieving free energy balance at a relatively high (compared to resting metabolic rate) level of energy expenditure--a loftier energy throughput—or high free energy flux. The thought that energy balance is all-time regulated at high (simply not excessive) levels of physical activity was offset proposed by Jean Mayer and colleagues in the 1950s (16). Mayer observed that energy intake was amend matched to energy expenditure when people were physically active. While these studies in man were cross sectional in nature, other prospective studies published past Mayer and colleagues conducted in rats established the linearity of coupling between nutrient intake and energy expenditure only inside certain limits (17). In rats, matching of energy intake to expenditure was poor at either very low expenditure or very high levels of expenditure. Similarly, in humans, matching of intake and expenditure was less accurate when people were very inactive (plain, food intake does non turn down when energy need declines) or when they were exercised to burnout. This is consistent with the view that the physiology is suited to regulate free energy rest best nether conditions in which physical activity (free energy expenditure) "pulls" appetite. The concept of high energy flux where energy intake is pulled past energy expenditure is illustrated in Figure 1. Mayer further hypothesized that there may exist a minimum threshold of either physical activity or energy throughput higher up which adaptive adjustments in energy intake and expenditure to achieve rest are more sensitive to changes in the other. One authentication feature of this organization bias would exist a constant bulldoze to consume free energy. This would have been necessary in gild to maintain body weight nether ancestral lifestyle weather condition that undoubtedly demanded a relatively high level of physical activity for survival. Given this hypothesized system bias for optimal command under loftier energy throughput conditions, this ways that an individual having a low energy throughput is constantly at risk for weight gain. A depression free energy throughput is a prominent feature of sedentary American life today.
This figure, modified from the work of Jean Mayer and colleagues, illustrates the hypothesis that energy balance may be easier to achieve at high energy throughput (ie. high energy expenditure). Nosotros illustrate the concept to a threshold for physical activity, above which people are in the regulated zone of energy balance and below which they are in the unregulated zone. In the regulated zone free energy intake is "pulled forth" to encounter high energy needs, and energy intake and expenditure are very sensitive to changes in each other. At depression energy throughput, free energy intake and expenditure are only weakly sensitive to changes in each other and maintaining a healthy body weight requires sustained food restriction.
In that location is considerable fence in the literature today about whether physical action has whatever role whatever in the epidemic of obesity that has swept the globe since the 1980's (18). The timing of the secular rise in body weight fits and so well with the expansion of food availability and marketing information technology seems reasonable to assign significant blame to the food environment. Several arguments are made for this point of view. Showtime, measures of leisure fourth dimension physical activity have not changed significantly over fourth dimension (19). Second, measures of total energy expenditure have non declined over the time period during which obesity rates increased (xx). This view, nonetheless, does non consider the necessary, but not sufficient, effect of the decline in physical action that occurred in our society (and in those countries undergoing rapid urbanization and industrialization) during the kickoff half of the twentythursday century. The decline in daily activeness that came from industrialization, mechanized transportation, urbanization and other aspects of technology created the largest decline in activity and created the correct weather condition nether which an increase in nutrient access, availability and decreased cost could accept a major touch on body weight. In effect, the decline in the daily energy expenditure necessary for subsistence prevalent over a century agone was the "permissive" gene that immune the effect of the changing food environment to become apparent. Farther, as concrete action levels declined, body weight increased, which would have increased total energy expenditure due to increases in RMR and the energy cost of movement (ane). Information technology is not surprising that total energy expenditure has not changed, since becoming obese is a fashion to increment energy expenditure in a sedentary population.
Blundell (personal communication) refers to the zone to a higher place the theoretical free energy expenditure threshold first proposed by Mayer equally the "regulated zone" and the zone below as the "unregulated zone". Being in the regulated zone would mean having high sensitivity for matching energy intake to free energy expenditure and existence in the unregulated zone would mean existence at much greater risk for positive energy residual and obesity.. Although not definitive, some enquiry supports this view. Blundell et al. (21) demonstrated that at depression levels of physical activity, energy intake does non arrange speedily and accurately to changes in energy expenditure, with the result being an increased propensity to gain weight. Similarly, Stubbs et al. (9) reduced physical activity from 1.8 × RMR to 1.4 × RMR in normal weight men studied in a whole room calorimeter, they found that there was not a compensatory reduction in energy intake. This led to positive energy balance and weight gain.
Flatt (22) recently reviewed a compendium of concepts virtually control of body weight and concluded that at that place is little evidence that a "depression" metabolism plays a meaning role in weight proceeds. Thus, the main contributor to low energy throughput that puts people at risk of weight proceeds is a depression level of physical activity. Increasing energy throughput (i.e increasing free energy expenditure) to promote energy residue can be produced either past increasing physical activeness or past increasing body mass (i.due east., becoming obese)(1). Boosted support for this notion comes from many studies showing that a high level of physical activeness is associated with low weight proceeds over time and comparatively low levels of physical activity are associated with high weight gain over time (23-26). Over the by century, the physical activity level of near of the population has declined substantially. While it is theoretically possible to avoid weight gain in this situation, the fact that few people have accomplished this suggests that information technology is difficult to maintain energy residual at a depression energy throughput.
I could hypothesize that the drop in physical activity related energy expenditure over the past century may have pushed a larger and larger fraction of the population into the "unregulated zone". Much of the dramatic turn down in daily action (and hence, daily free energy expenditure) occurred during the first part of the last century as industrialization and urbanization inverse typical lifestyles and this may have been a pre-requisite for enabling the increase in obesity seen over the terminal thirty years. Unfortunately at that place are no objective measures of physical activity patterns during this period. In the latter role of the 20th century every bit food toll relative to income declined (27) and access, availability (28) and convenience all increased, the physiological system had already been primed for weight gain. Under the prevailing sedentary lifestyle weather condition today, gaining weight serves to increase resting metabolic rate and the energy price of physical activity, thus increasing energy throughput which balances the higher level of energy intake. In this respect, becoming obese is simply an adaptive response to the modern surroundings, but it is also a "merchandise-off" for maintaining a low level of physical action. Indeed, we speculate that becoming obese may be the only fashion to accomplish energy balance when living a sedentary lifestyle in a food abundant environs.
It is important to emphasize that this does non mean that physical activity is the only component of energy residue to focus on in addressing obesity. In fact, the physiological and environmental drivers of food intake are so powerful that we currently take a very poor power to oppose such forces and produce significant, sustained reductions in energy intake. This does not mean we shouldn't keep to push against these forces, simply rather to compliment efforts to change the food environment with strategies to increase energy expenditure. This is a very dissimilar strategy than promoting widespread food restriction as the foundational tactic for combatting obesity.
A healthy torso weight is maintained with a high level of physical activeness and a high energy intake. This would be the well regulated zone where energy intake and free energy expenditure are very sensitive to changes in the other. At low levels of concrete activeness, substantial nutrient restriction would be needed to maintain a healthy torso weight. This would be the unregulated zone where energy intake and expenditure are only weakly sensitive to changes in each other. This seems to be an unsustainable situation for nigh people and the consequence is weight gain and obesity which returns the system to a high free energy throughput.
Food Restriction solitary is not the Answer
Food restriction is a common strategy for treating obesity (29). Food restriction does produce weight loss but it also produces compensatory decreases in other components of free energy balance, ie. decreases in energy expenditure and body energy stores (one,viii,30), and an increase in hunger (31). Because energy requirements fall with weight loss, a common strategy for weight loss maintenance is trying to match a lower level of energy expenditure with a lower energy intake. The lack of success in weight loss maintenance (32) suggests this may not be an optimum strategy. Lowering energy intake is opposed by biology (1,8,30) and the environs (33). Increasing concrete activity serves to increase total free energy expenditure, allowing for a higher energy intake for a given level of torso weight and requiring less food brake. In fact, individuals who are successful in long-term weight loss maintenance report engaging in high amounts of physical activity (34). Simply equally restricting nutrient intake is difficult, information technology is not easy to produce sustained increases in physical activeness, but from an energy rest betoken of view, including concrete activity in the strategy would improve the likelihood of successfully matching energy intake and expenditure at a lower body weight.
Free energy Balance Implications for Addressing Obesity: Treatment vs Prevention
Ii thirds of adults and ~20% of children and adolescents are overweight or obese and could benefit from weight loss (35). Further, much of the population seems to be continuing to gain weight or in the case of children, gain weight at an excessive charge per unit (36,37). Thus there is need for both prevention and treatment of obesity. From an energy remainder point of view it should be easier to prevent obesity than to reverse it once information technology is nowadays. This is because the biological compensatory mechanisms defending body weight announced to respond much more strongly to negative energy balance than to prevention of positive energy balance (8,30). In consequence, the system is biased toward preserving existing body weight but does not appear to strongly defend against torso weight that has not yet been acquired. Thus, an free energy rest framework would predict that information technology would exist easier to forestall weight gain than to produce sustained reductions in trunk weight in those already obese.
Because metabolism declines with loss of trunk mass (vii,8) (one component of energy remainder affects another), energy requirements are greatly reduced following intentional weight loss. The reductions can be from 170-250 kcal/day for a 10% weight loss and 325-480 for a 20% weight loss (38,39). Thus substantial weight loss and subsequent maintenance requires substantial and permanent behavior change. The lack of success in long-term weight loss maintenance (32) suggests almost people are not able to sustain the degree of beliefs change they need to keep weight off.
Compensatory reductions in RMR and increases in hunger occur with caloric restriction and weight loss (1,31). However, simply preventing positive energy balance should non produce meaning compensation through increased energy intake or reduction in RMR. A reasonable starting point in addressing obesity is to develop behavior goals for primary prevention of weight gain. In free energy balance terms, this would require less alter than producing and maintaining weight loss since the degree of positive energy remainder producing this gradual weight proceeds seems to be relatively minor.
Hill et al. reported (36), using longitudinal and cross exclusive data sets, that the average weight gain of the population over the past two decades (when obesity increased well-nigh rapidly) has been about 1 to two pounds per year. Using a very conservative analysis of the distribution of weight gain over fourth dimension, they estimated that the average weight proceeds was due to nigh 15 kcal/day of positive energy balance. At the 90thursday percentile of weight gain, this was 50 kcal/solar day. Past assuming that excess free energy is stored with a 50% efficiency, they predicted that weight gain in 90 percent of the adult population could exist prevented by reducing positive energy balance past 100 kcal/day. We termed this the "enegy gap". Wang et al. (37) estimated that excessive weight gain could be prevented in children and adolescents past reducing positive energy balance by about 150 kcal/day.
A population weight gain prevention strategy demand simply advocate small changes in concrete activity and energy intake to be successful. Such a programme could concentrate on increasing lifestyle physical activity and on helping focus people on reducing energy density and portion size of some foods consumed. Ane plan based on this concept is the America on the Move (AOM) programme (40; www.americaonthemove.org), a national weight gain prevention program that advocates walking 2,000 more than steps each 24-hour interval and eating 100 kcal less each twenty-four hours. Testify indicates this plan is constructive in increasing total physical action, reducing energy intake, and reducing excessive weight proceeds (41-44). In particular, the AOM minor changes approach was used to reduce weight proceeds in overweight and obese children when delivered equally part of a family-based intervention (42,43). As compared to the command grouping, the group receiving the pocket-sized changes intervention reduced relative body mass index over time. The modest changes intervention involved increasing walking every bit measured by pedometers and making pocket-sized changes in food intake such as eating breakfast or substituting foods/beverages with not-caloric sweeteners for those containing sugar. Other researchers have demonstrated the effectiveness of a minor modify approach for promoting weight loss when compared to a standard didactically based nutrition and physical action program (45-48). The main features of the small change model that distinguish information technology from other models of behavior modify are: 1) the starting indicate is a alter from an individual's baseline, two) the private is involved in setting their own goal vs. beingness given a goal by the program, and iii) the changes required are small and manageable so that the individual does non feel restricted or overburdened (48).
Information technology is sometimes suggested in the pop media that the small changes strategy volition be effective for substantial weight loss versus its intention as a means to eliminate primary weight gain. For instance, it has been suggested that cut 100 kcal/day from energy intake could result in losing 10 pounds per yr and 50 pounds over five years. This argument fails to recognize the interrelatedness of components of energy residual. In fact, cut 100 kcal/day would produce some weight loss merely far less than 10 pounds per yr (15), because as the body loses mass its energy requirements fall and the 100 kcal cut from the diet becomes a smaller and smaller free energy deficit each day. This is why the small changes approach is designed as a means to forestall weight gain rather than promote weight loss and a daily endeavour to increase activity and decrease intake past 100 kcal does not lose its ability to reduce positive energy residual over time.
Information technology is especially of import that we apply weight proceeds prevention strategies to children. Many children are likewise gaining weight at excessive rates (37) due to the same factors that promote increased energy intake and decreased concrete action in adults. The same tactics that influence energy intake and expenditure in adults have an touch on on children. The RMR and TEF may exist greater for growing children per kg body mass than in adults, simply low levels of physical activity still promote positive energy balance. This impact may be even greater considering historically high levels of physical activity were common for children and youth in activities of daily life. The establishment of healthy weight in early on life is particularly important for long-term health. The responsibility of parents, caregivers and teachers to facilitate healthy eating and regular physical action is greater in today'southward lodge. Young children should be active more than they are sedentary (49) during their waking hours which may be a significant challenge in our contemporary sedentary social club. Pediatricians regularly provide guidance virtually nutritional needs of children, still physical activity guidance is much less specific. Recent guidelines (50) suggest that appropriate concrete activity levels for young children are greater than for adolescents or adults.
How to Produce Behavior Changes in the Population
Fifty-fifty if nosotros hold on population strategies and on the type and corporeality of beliefs change needed to accost obesity, we still demand quantitative goals for behavior alter and we still have the enormous challenge of producing this behavior change in the population. At that place is increasing recognition that the physical surroundings impacts beliefs (33), and in that location are increasing efforts to empathize and modify the physical environment to help people achieve healthier lifestyles (51). However, it seems unlikely that we can change the surround sufficiently and then that nigh people would maintain a healthy lifestyle without witting effort. If we are request individuals to take some personal responsibility in making these behavior changes, we should make sure they accept the cognitive skills needed to move toward healthier lifestyles. We believe there is a great need to evaluate the potential impact of teaching our children about energy balance (i.east. how energy in nutrient interacts with free energy expenditure to determine body weight) and about how food and physical activeness choices bear upon free energy balance.
Summary and Recommendations
Looking at reducing obesity through the lens of the free energy remainder framework provides the opportunity to recommend specific strategies to reduce obesity. Kickoff, by increasing physical action in the population nosotros tin can get more people in the regulated zone of energy rest and maximize the intrinsic biological mechanisms for managing energy remainder. Accomplishing this would allow us to focus on promoting smarter eating and reduce the need for dramatic food restriction. Second, we are likely going to be more effective in preventing weight proceeds than in producing and maintaining weight loss. This is considering components of free energy balance recoup to oppose weight loss in response to negative energy balance. Finally, in our electric current environment, maintaining a healthy torso weight for most people requires using cognitive skills to assist match energy intake with energy expenditure and to overcome biological tendencies to overeat and underexercise. Didactics those skills to people and specially to children could empower them with better tools to be agile participants in managing their own torso weight. Simultaneously nosotros should intensity efforts to modify the physical environment to make healthier choices both more available and accessible while increasing their perceived value past consumers.
Acknowledgments
Funding Sources
The work described in this manuscript was supported in part by NIH grants DK42549 and DK48520.
Footnotes
Conflict of Interest/Disclosures
None of the authors have whatsoever conflicts to disclose.
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Contributor Information
James O. Hill, University of Colorado Anschutz Medical Campus Denver, Colorado.
Holly R. Wyatt, University of Colorado Anschutz Medical Campus Denver, Colorado.
John C. Peters, Academy of Colorado Anschutz Medical Campus Denver, Colorado.
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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3401553/
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