Associations between the proportion of fat-free mass loss during weight loss, changes in appetite, and subsequent weight change: results from a randomized 2-stage dietary intervention trial

Abstract

Background Dynamic changes in body composition which occur during weight loss may have an influential role on subsequent energy balance behaviors and weight. Objectives The aim of this article is to consider the effect of proportionate changes in body composition during weight loss on subsequent changes in appetite and weight outcomes at 26 wk in individuals engaged in a weight loss maintenance intervention. Methods A subgroup of the Diet, Obesity, and Genes (DiOGenes) study (n = 209) was recruited from 3 European countries. Participants underwent an 8-wk low-calorie diet (LCD) resulting in ≥8% body weight loss, during which changes in body composition (by DXA) and appetite (by visual analog scale appetite perceptions in response to a fixed test meal) were measured. Participants were randomly assigned into 5 weight loss maintenance diets based on protein and glycemic index content and followed up for 26 wk. We investigated associations between proportionate fat-free mass (FFM) loss (%FFML) during weight loss and 1) weight outcomes at 26 wk and 2) changes in appetite perceptions. Results During the LCD, participants lost a mean ± SD of 11.2 ± 3.5 kg, of which 30.4% was FFM. After adjustment, there was a tendency for %FFML to predict weight regain in the whole group (β: 0.041; 95% CI: −0.001, 0.08; P = 0.055), which was significant in men (β: 0.09; 95% CI: 0.02, 0.15; P = 0.009) but not women (β: 0.01; 95% CI: −0.04, 0.07; P = 0.69). Associations between %FFML and change in appetite perceptions during weight loss were inconsistent. The strongest observations were in men for hunger (r = 0.69, P = 0.002) and desire to eat (r = 0.61, P = 0.009), with some tendencies in the whole group and no associations in women. Conclusions Our results suggest that composition of weight loss may have functional importance for energy balance regulation, with greater losses of FFM potentially being associated with increased weight regain and appetite. This trial was registered at clinicaltrials.gov as NCT00390637.

Physiology of weight regain: Lessons from the classic Minnesota Starvation Experiment on human body composition regulation

“…124,125 A nonleptin system (and so far unidentified adipostatic signals) has recently been implicated in the compensatory hypophagia that plays a critical role in the recovery from rapid weight gain induced by overfeeding. 126 On the other hand, the notion of a feedback loop between FFM deficit and compensatory hyperphagia (Figure 9), as suggested by the MSE reanalysis 63 and by recent studies of weight regain after caloric restriction in humans [98][99][100][101][102] and in mice, 127…”

“…Specifically in their reanalysis of the DiOGenes study, they showed that the fraction of weight loss as FFM in men was positively associated with weight regain and with increased appetitive factors such as hunger and desire to eat. 101 Finally, the recent report 102 that following a 12-week aerobic exercise intervention aimed at weight loss in young adults with overweight/obesity, those who lost the greatest amount of FFM showed that the highest increase in reward-driven feeding (which is a strong predictor of energy intake) provides further support for the notion that FFM deficit drives food intake. Consequently, a role for lean tissue depletion driving hyperphagia has direct repercussions for obesity management, as it suggests that various strategies (dietary, behavioral, or pharmacologic) that reduce the loss of lean tissue are also likely to reduce the drive for hunger and thus improve the efficacy of dietary weight loss interventions.…”

“…The importance of FFM loss during therapeutic slimming as a factor in weight regain was also recently underscored by Turicchi et al 100 in a systematic review and metaregression analysis of clinical weight loss and follow‐up studies. Specifically in their reanalysis of the DiOGenes study, they showed that the fraction of weight loss as FFM in men was positively associated with weight regain and with increased appetitive factors such as hunger and desire to eat 101 . Finally, the recent report 102 that following a 12‐week aerobic exercise intervention aimed at weight loss in young adults with overweight/obesity, those who lost the greatest amount of FFM showed that the highest increase in reward‐driven feeding (which is a strong predictor of energy intake) provides further support for the notion that FFM deficit drives food intake.…”

From famine to therapeutic weight loss: Hunger, psychological responses, and energy balance‐related behaviors

“…To assess whether changes in BC occurring during WL were asso- hunger and desire to eat were observed in the male group, suggesting a potentially functional role of dynamic changes in BC in EB regulation. 142 The evidence from the CALERIE studies shows similarly weak evidence of small alterations in appetitive states. 86,91,92,124 These studies provide limited evidence under conservative conditions (10% WL in people with a high body weight and FM) that the relationship between changes in BC and appetitive outcomes so clearly elucidated in the Minnesota study 141,143 are (barely) detectable, but small, at lower levels of WL in people with a higher FM than the Minnesota or CNL subjects.…”

Liraglutide Does Not Adversely Impact Fat‐Free Mass Loss

“…As body weight is reduced, so too is there a reduction of both fat mass (FM) and FFM, which is associated with an increased drive to eat (4). This may contribute to weight regain after periods of intentional or unintentional starvation, with FFM playing a central role (5,6). While the biological link between FFM loss and elevated hunger remains controversial, current best practice suggests preserving muscle mass as patients with obesity lose weight (7).…”