title: Metabolic adaptation following massive weight loss is related to the degree of energy imbalance and changes in circulating leptin.
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.
authors.affiliation: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA.
authors.forename: Nicolas D
authors.initials: ND
authors.lastname: Knuth
authors.forename: Darcy L
authors.initials: DL
authors.lastname: Johannsen
authors.forename: Robyn A
authors.initials: RA
authors.lastname: Tamboli
authors.forename: Pamela A
authors.initials: PA
authors.lastname: Marks-Shulman
authors.forename: Robert
authors.initials: R
authors.lastname: Huizenga
authors.forename: Kong Y
authors.initials: KY
authors.lastname: Chen
authors.forename: Naji N
authors.initials: NN
authors.lastname: Abumrad
authors.forename: Eric
authors.initials: E
authors.lastname: Ravussin
authors.forename: Kevin D
authors.initials: KD
authors.lastname: Hall
mesh_terms: D000328:Adult; D001481:Basal Metabolism; D001823:Body Composition / Q000502:physiology; D015992:Body Mass Index; D001835:Body Weight; D004734:Energy Metabolism / Q000502:physiology*; D005260:Female; D015390:Gastric Bypass; D006801:Humans; D020738:Leptin / Q000097:blood*; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000378:metabolism* / Q000601:surgery; D015431:Weight Loss / Q000502:physiology*
chemical_list: D020738:Leptin