Obesity is reaching epidemic proportions in developed countries and represents a signifi cant risk factor for cardiovascular disease, diabetes, and cancer ( 1 ). Enrolment in clinical and nonclinical obesity treatment programs is unprecedented. Success in obesity treatment programs is highly variable, related in part to compliance and program characteristics (e.g., type and duration of hypocaloric diets, educational components, and/or exercise-associated energy expenditure). While it is generally well accepted that there is substantial inter-individual variability in the susceptibility to weight gain in response to overfeeding ( 2, 3 ), less well understood is the impact of biological factors on weight loss success. However, studies of monozygotic twins have shown greater inter-pair than intra-pair variation in weight loss ( 4 ), consistent with the idea that there are important genetic determinants of weight loss success. We have studied the molecular and cellular determinants of variable weight loss in highly compliant subjects in an intensively supervised and interactive hypocaloric clinical obesity treatment program at the Ottawa Hospital. We previously reported differences in muscle mitochondrial energy ineffi ciencies between program participants exhibiting high versus low weight loss success ( 5 ). Here, we extend these fi ndings by demonstrating distinct differences in skeletal muscle gene expression profi les and in structural and metabolic characteristics between individuals who Abstract Inter-individual variability in weight gain and loss under energy surfeit and defi cit conditions, respectively, are well recognized but poorly understood phenomena. We documented weight loss variability in an intensively supervised clinical weight loss program and assessed skeletal muscle gene expression and phenotypic characteristics related to variable response to a 900 kcal regimen. Matched pairs of healthy, diet-compliant, obese diet-sensitive (ODS) and dietresistant (ODR) subjects were defi ned as those in the highest and lowest quintiles for weight loss rate. Physical activity energy expenditure was minimal and comparable. Following program completion and weight stabilization, skeletal muscle biopsies were obtained. Gene expression analysis of rectus femoris and vastus lateralis indicated upregulation of genes and gene sets involved in oxidative phosphorylation and glucose and fatty acid metabolism in ODS compared with ODR. In vastus lateralis , there was a higher proportion of oxidative (type I) fi bers in ODS compared with ODR women and lean controls, fi ber hypertrophy in ODS compared with ODR women and lean controls, and lower succinate dehydrogenase in oxidative and oxidative-glycolytic fi bers in all obese compared with lean subjects. Intramuscular lipid content was generally higher in obese versus lean, and specifi cally higher in ODS vs. lean women. Altogether, our fi ndings demonstrate differences in muscle gene expression and fi ber composition related to clinical weight loss success. Abbreviations: B...