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How Fat Loss Works - Episode 1: Energy BalanceEnergy balance and weight management -
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Health conditions Overweight, obesity and weight loss Energy balance and weight. Health professional. Enlarge Text A A. Energy intake and expenditure. Key points Energy is needed by the body to stay alive, grow, keep warm and move around.
Energy is provided by food and drink. It comes from the fat, carbohydrate, protein and alcohol the diet contains. Energy requirements vary from one individual to the next, depending on factors such as age, sex, body composition and physical activity level.
Energy expenditure is the sum of the basal metabolic rate the amount of energy expended while at complete rest , the thermic effect of food TEF, the energy required to digest and absorb food and the energy expended in physical activity. To maintain bodyweight, it is necessary to balance the energy derived from food with that expended in physical activity.
To lose weight, energy expenditure must exceed intake, and to gain weight, energy intake must exceed expenditure. Energy intake and expenditure A regular supply of dietary energy is essential for life and is required to fuel many different body processes. What determines how much energy a person needs?
Basal metabolic rate The basal metabolic rate BMR is the rate at which a person uses energy to maintain the basic functions of the body — breathing, keeping warm, and keeping the heart beating — when at complete rest.
Physical activity level In addition to their BMR, people also use energy for movement of all types. Physical activity Physical activity should be an important component of our daily energy expenditure. How much energy do children and adults need? Intake versus expenditure In order for people to maintain their bodyweight, their energy intake must equal their energy expenditure.
Last reviewed July Revised October Help us improve We'd love to hear your thoughts about this page below. Energy is another word for "calories. What you eat and drink is ENERGY IN. What you burn through physical activity is ENERGY OUT.
You burn a certain number of calories just by breathing air and digesting food. You also burn a certain number of calories ENERGY OUT through your daily routine. For example, children burn calories just being students—walking to their lockers, carrying books, etc.
A chart of estimated calorie requirements for children and adults is available at the link below; this chart can help you maintain a healthy calorie balance. An important part of maintaining energy balance is the amount of ENERGY OUT physical activity that you do.
People who are more physically active burn more calories than those who are not as physically active. Your ENERGY IN and OUT don't have to balance every day. It's having a balance over time that will help you stay at a healthy weight for the long term. Energy balance in children happens when the amount of ENERGY IN and ENERGY OUT supports natural growth without promoting excess weight gain.
This calorie requirement chart presents estimated amounts of calories needed to maintain energy balance and a healthy body weight for various gender and age groups at three different levels of physical activity.
The estimates are rounded to the nearest calories and were determined using an equation from the Institute of Medicine IOM.
Think of it as balancing your "lifestyle budget. Or, you can increase your physical activity level for the few days before or after the party, so that you can burn off the extra energy. The same applies to your kids.
Eating just calories more a day than you burn can lead to an extra 5 pounds over 6 months. Reducing dietary fat without food restriction affects both energy intake and energy expenditure in small ways. Voluntary intake is consistently lower with low-fat vs.
high-fat diets 38 , Because carbohydrate produces more thermic effect than fat, reducing dietary fat and increasing dietary carbohydrate would also be expected to produce a slight increase in the thermic effect of food If lowering dietary fat composition produces slight decreases in energy intake and slight increases in energy expenditure, the result should be that energy balance is reestablished with a slightly lower body weight and body fat content.
During positive energy balance, diet composition can have a big effect on energy balance. We demonstrated that excess energy is efficiently stored in the body regardless of its source, but that excess energy from dietary fat is stored with a greater efficiency than excess energy from carbohydrate.
We demonstrated this with an overfeeding study where subjects were overfed high-fat and high-carbohydrate diets for 14 d each Subjects were studied in a whole room calorimeter that allowed determination of energy expenditure and substrate balances over time.
Carbohydrate overfeeding produced progressive increases in carbohydrate oxidation and in total energy expenditure over the 14 d. The energy storage was due more to declining fat oxidation than to de novo lipogenesis. The excess energy from dietary fat was stored efficiently without noticeable effects on substrate oxidation or energy expenditure.
In summary, our work suggests that gradual increases in dietary fat may have played a role in the weight gain of the population and that reductions in dietary fat would be one way to produce small, but important, reductions in the average weight of the population.
Some critics point out that previous public health efforts to lower dietary fat levels in the population have not been effective in lowering the body weight of the population However, such efforts were not effective in actually lowering dietary fat.
Although the percentage of fat in the diet decreased from the late s to early s, this was only because total energy intake increased. The actual amount of fat in grams consumed per day did not decline. Rather than lowering dietary fat, we simply added more carbohydrate on top of a high-fat diet.
Our work also suggests that there is little effect of lowering dietary fat during negative energy balance. Thus, it is not surprising that low-fat diets have not been found to lead to greater weight loss than higher-fat diets.
There is recent interest in how the protein content of the diet impacts body weight 42 , but there is insufficient research at present to understand the impact of these diets on energy balance. Similarly, the impact of high vs. low glycemic diets on energy balance is still unclear and very controversial 43 , There is considerable evidence that the energy density of the diet can impact energy intake, at least over the short term.
Energy density is defined as kilocalories per weight of food. Over the short term, humans eat a constant volume of food at meals 45 , 46 so that total energy intake increases with energy density of the diet.
Some of the effect of high-fat diets on energy intake is likely due to the higher energy density of high-fat diets However, high levels of dietary fat may increase energy intake independently of energy density Portion size is another factor that can influence total energy intake.
Rolls and colleagues 47 have consistently demonstrated that energy intake increases as the portion size of the food offered increases. Other factors, such as increased variety of food, low cost, and accessibility also may increase energy intake The role of added sugars in energy balance and body weight is highly controversial.
Epidemiological data suggest an inverse relationship between carbohydrate content of the diet and weight However, the impact of dietary sugar may depend on whether it replaces other calories or simply adds to them.
We previously found that adding excess carbohydrate to a mixed diet results in the storage of most of the excess carbohydrate. This occurs because carbohydrate oxidation is increased and fat oxidation is decreased, creating a situation of positive fat balance and positive energy balance Much added sugar in the diet of Americans comes from beverages.
There has been speculation that energy intake from beverages may be regulated differently than energy in foods in a way to contribute to positive energy balance If the sugar in beverages adds, rather than replaces, other calories, dietary sugar could be a factor contributing to positive energy balance.
Declining levels of physical activity in the population would likely decrease energy expenditure and, if not matched by a decline in energy intake, produce positive energy balance and weight gain Reductions in physical activity would produce an obvious decline in the energy expended in physical activity, but might also produce small declines in RMR 21 and in the thermic effect of food There is very strong epidemiological data suggesting that moderate to high levels of physical activity protect against weight gain and obesity 54 , We have reviewed these data on several occasions, demonstrating that the impact of physical activity on energy balance is to make it less likely that positive energy balance and weight gain will occur 56 , A controversial issue in this area is how much physical activity should be recommended for prevention of weight gain, weight loss, and prevention of weight regain after weight loss.
Our work suggests that very small increases in physical activity may prevent weight gain 58 , whereas very large increases are necessary to avoid weight regain after weight loss We have also argued that the impact of diet and physical activity together on energy balance must be considered.
Whether the fat content of the diet, for example, produces positive fat and energy balance depends on the level of physical activity. Because regular physical activity increases fat oxidation and total energy expenditure, a physically active person should be able to eat a higher-fat diet without the risk of positive energy balance and weight gain.
Several studies have shown that increased physical activity protects against high-fat diets in producing positive energy balance 60 , Kelly Brownell was one of the first to call attention to the power of the external environment in promoting excessive energy intake and obesity We provided a theoretical foundation for how the environment could affect energy balance in two papers in Science 23 , We pointed out the many ways that both the food and physical activity environment has changed over time in a way to encourage overeating and to discourage physical activity.
The impact of the environment on energy balance seems to be unidirectional and promotes positive rather than negative energy balance. Although we believe that there are biological systems that attempt to maintain energy balance, the ability of such systems to defend body weight in the face of increasing unidirectional environmental pressures is limited.
Hill et al. The fact that obesity rates have gradually increased since the s might suggest that people with a high metabolic susceptibility experienced weight gain first as the environment became more obesigenic i.
However, as the influence of the environment on energy balance becomes stronger, more and more people are unable to biologically oppose the environmental influences and are experiencing weight gain.
It is tempting to try to identify one or two environmental factors that are most responsible for weight gain in the population.
For example, Bray et al. However, we believe that it is impossible to attribute the influences of the environment on energy balance to one or two—or five factors; rather it has been small changes in numerous environmental factors 23 , 58 , Our current food supply now is one that is high in fat, energy dense, and high in sugar.
Food is inexpensive and available in large portions. Food is heavily advertised, and it has become acceptable to have food everywhere. These are factors that are known to promote energy intake in a way that does not elicit strong biological opposition.
Our physical activity environment has changed largely due to technological advances that make it unnecessary to be physically active in our daily lives.
Most occupations no longer involve physical activity, and we rarely need to be physically active for transportation. The development of television, DVDs, computers, the internet, and video games has filled our leisure time with sedentary rather than physically active pursuits.
The way we build our communities promotes driving and not walking. The major challenge becomes to identify the factors in the environment that can be changed to help reverse the population weight gain. Our challenge is to use our understanding of the regulation of energy balance to develop strategies to address the obesity epidemic.
Figure 3 , which is modified from the work of Dr. Stephan Rossner 66 , can be used to consider two different approaches to reversing the obesity epidemic—treatment and prevention.
The dotted line in Fig. The gradual weight gain of the population and rates of obesity will likely continue, perhaps until everyone is obese. One strategy would be to prevent positive energy balance and stop the gradual weight gain of the population. Another strategy is to treat obesity in those already affected.
This involves producing negative energy balance to produce weight loss followed by achieving energy balance permanently at a lowered body weight. Possible strategies for addressing the obesity epidemic. Bouchard, 63 with permission from CRC Press.
One strategy for reducing obesity rates is to treat obesity and overweight. Many overweight and obese individuals have tried to lose weight, and most have been successful to some degree.
However, few succeed in long-term maintenance of weight loss. Our work suggests that a big reason for the high failure rate in obesity treatment is the failure to see weight loss maintenance as a separate process from weight loss. From an energy balance point of view, weight loss involves a temporary period of negative energy balance, whereas weight loss maintenance involves a permanent period of achieving energy balance at a new level.
For practical purposes, food restriction is the primary driver of weight loss, and any diet that results in eating fewer calories will produce weight loss. Although it is possible to lose weight with physical activity alone 67 , 68 , it is difficult for most people to do enough to achieve a degree of negative energy balance that would result in significant weight loss.
This is also why adding physical activity to food restriction produces only a minimal additional amount of weight loss The difference in weight loss under these conditions is most likely due to the impact of the diet on hunger and satiety. When total calories are fixed in a hypocaloric diet, weight loss does not vary significantly by diet composition 30 — Dansinger et al.
However, attrition was high in all groups. The problem is that weight tends to be regained in most people regardless of the composition of the diet used for weight loss.
For example, the greater initial weight loss of low- vs. high-carbohydrate diets is not maintained at 1 yr 33 — Most people who lose weight, regardless of the diet used to lose the weight, regain it over the next 1—3 yr The exact success rate in treating obesity is difficult to identify and depends on definitions of success.
Although we have a great deal of research about factors that contribute to weight loss, we have surprisingly little research to understand the factors that contribute to weight loss maintenance. We study weight loss maintenance using our rodent model of dietary obesity and using information from the National Weight Control Registry NWCR.
In , Dr. Rena Wing and I started the NWCR to recruit and study a group of people who had succeeded at long-term weight loss maintenance. Individuals are eligible to enter the NWCR if they have maintained a weight loss of at least 30 pounds for at least 1 yr.
Individuals self-report their weight loss to enter the NWCR and provide information to us, largely, by completing questionnaires about weight loss and weight loss maintenance.
Currently, we are following over individuals in the NWCR. These individuals are maintaining an average weight loss of over 70 pounds for an average period of almost 6 yr. Over the past decade, we have described characteristics of these successful weight loss maintainers 59 , 74 — Although this is not a prospective study of weight loss maintenance, we have identified many common characteristics of these individuals that provide interesting hypotheses about successful weight loss maintenance.
We have found surprisingly few similarities in how NWCR participants report losing their weight. Conversely, many similarities are seen in the behaviors and strategies used to maintain weight loss. The four that stand out are: Eating a moderately low-fat, high-carbohydrate diet.
This is consistent with our previous work suggesting that low-fat diets should be better than high-fat diets in preventing positive energy balance. Consistent self-monitoring of body weight, food intake, and physical activity. NWCR participants continue to periodically keep diet and physical activity records.
This is consistent with other reports that self-monitoring facilitates long-term success in weight management Eating breakfast every day. This is consistent with a growing body of data showing that eating breakfast facilitates maintenance of a healthy body weight Very high levels of physical activity.
Others have reported that high levels of physical activity are important for long-term weight loss maintenance 80 — Weight loss is about negative energy balance, and there are many ways to produce this.
Negative energy balance is a temporary state that cannot be easily maintained for long periods of time. Weight loss maintenance is about achieving energy balance, but at a new lower body weight. It requires diet and physical activity patterns that can be maintained indefinitely.
The challenge is not just achieving energy balance, but achieving it at a lower body weight. This is a challenge because energy requirements decline with weight loss. Holly Wyatt and I developed the concept of the energy gap in an attempt to individualize strategies for weight loss maintenance Fig.
The energy gap is the difference between energy requirements before and after weight loss RMR decreases with decreasing body mass.
The thermic effect of food decreases with total energy intake. The energy cost of physical activity is related to body mass and declines with weight loss. Although there is a debate about whether the drop in energy requirements might actually be larger than expected from the loss of body weight 85 , it is clear that energy expenditure is lower after weight loss than before, and this presents a challenge in achieving energy balance after weight loss.
Most people do not distinguish between weight loss and weight loss maintenance. They try to achieve energy balance after weight loss by maintaining their lower energy intake. A typical energy gap for a weight loss of 40 pounds would be — kcal.
There are two ways to address the energy gap—reduce energy intake or increase physical activity. It is not difficult to maintain this amount of food restriction temporarily, but the challenge is doing it permanently.
Food restriction can be an effective temporary strategy, but it is rarely an effective long-term strategy for many people. It is opposed by our biology that stimulates us to eat 86 and is, perhaps, accompanied by other metabolic changes that we identified in our weight-reduced animal model 15 — Similarly, food restriction is vigorously opposed by an environment that encourages eating.
It is no surprise that few people can consistently fight their biology and their environment to sustain energy restriction. When they fail, they rapidly regain their weight, just like our weight-reduced rats.
The second way of addressing the energy gap is to increase physical activity. There are several advantages to this strategy. Presumably, intake before weight loss was at a level that could be maintained long term.
It is certainly possible that an individual may combine strategies to address the energy gap by reducing energy intake some and increasing energy expenditure some more. We believe that those who rely more on increasing physical activity than food restriction to address the energy gap will be more successful in long-term weight loss maintenance.
In addition to allowing a higher energy intake during weight loss maintenance, there are at least two other ways that high levels of physical activity may facilitate weight loss maintenance.
First, high levels of physical activity may compensate for changes in metabolism caused by established obesity. If obesity affects humans in the way it affects rats, weight-reduced humans may have a strong metabolic drive to regain weight.
We have examined possible metabolic effects of obesity in individuals in the NWCR. We find that RMR in NWCR participants is not different than lean or obese controls However, RMR was measured while they were performing their usual daily physical activity regimen and might be lower if measured under chronic sedentary conditions.
As another example, we find one of the metabolic characteristics of weight-reduced rats that may predispose them to weight regain is a lower than anticipated leptin level 15 — A recent study suggested that giving leptin to weight-reduced humans may be more effective to prevent weight gain than to produce weight loss A second way that physical activity may help with weight loss maintenance is by maintaining a high energy flux.
Weight loss produces a decline in energy requirements, and achieving energy balance by food restriction results in achieving energy balance at a lower flux.
By increasing physical activity, energy flux can continue to be maintained at a high level, which may be where biological regulatory systems are most sensitive.
An important question is whether it is any easier for people to maintain an increase in physical activity of — kcal than it is for them to maintain an energy restriction of the same amount.
In truth, it is difficult to produce and maintain increases in physical activity in most people. We still have to find better ways to get people to increase physical activity, but the available data suggest that this strategy has a greater potential for success than energy restriction.
Similarly, increasing physical activity is the only strategy found at least partially to prevent weight regain in our weight-reduced animal model Other strategies such as drugs or surgery may partially fill the energy gap.
For example, a drug that reduces hunger or increases energy expenditure would help fill the energy gap and require less voluntary food restriction or intentional increase in physical activity. In summary, the challenge for obesity treatment is not losing weight but keeping it off.
There are many ways to produce weight loss, but permanent weight loss maintenance may require a very high level of physical activity.
An alternative strategy to obesity treatment is prevention of excessive weight gain. This strategy does not require producing negative energy balance but rather only requires preventing positive energy balance.
This strategy would represent a very long-term approach to addressing the obesity epidemic and is based on the notion that it is easier and more feasible to prevent weight gain than to produce and maintain substantial weight loss.
The first goal with this strategy would be to stop obesity rates from increasing, and gradually, over generations, to reduce levels to those seen before We provided a theoretical basis for this strategy in our second Science paper We estimated the degree of positive energy balance that is producing the gradual weight gain of the population.
Brown et al. If the gradual weight gain of the population is due to a small degree of positive energy balance, it should be possible to stop it with a small changes strategy that involves small decreases in energy intake and small increases in energy expenditure.
Such a strategy makes sense from an energy balance point of view. Making small decreases in energy intake would serve to reduce the positive energy balance, not produce negative energy balance. This should not produce strong biological compensatory decreases in energy intake of the kind that are seen with substantial food restriction.
Similarly, there is no evidence that small increases in physical activity produce compensatory increases in energy intake in relatively sedentary individuals Although we do not have definitive data to show that small behavior changes are more likely to be sustainable than larger ones for most people, this is a reasonable hypothesis.
We have a lot of data to suggest that large behavior changes are not sustainable for most people, as evidenced by the failure in obesity treatment. Finally, small behavior changes may be less opposed by the environment than larger ones. Since the publication of our paper in , we have been gratified to see the acceptance of the small changes approach.
The Department of Health and Human Services, under Secretary Tommy Thompson, launched a small steps program aimed at making small changes in diet and physical activity The idea of approaching obesity through small lifestyle changes was also part of the Dietary Guidelines for Americans A national nonprofit initiative, America On the Move, was created to promote the small changes approach to prevention of weight gain It seems that the public health community is giving serious consideration to a strategy that involves prevention of weight gain to address obesity.
We recommended the use of inexpensive step counters or pedometers to allow people to set goals and monitor progress for increased walking. We estimated that most adults could increase energy expenditure with an extra steps per day, which is equivalent to walking an additional mile. Because an average walking speed would be — steps per minute, this could be done in 15—20 min, and the increase could be spread throughout the day.
Since then, the use of pedometers to promote physical activity has greatly increased. We have conducted some population surveys to obtain normative data on walking and its relationship to obesity. Table 1 shows these results. The average number of steps taken by adults in the United States daily is for men and for women.
Adults in Colorado 94 take more steps than the national average and have lower obesity rates , whereas adults in Tennessee take fewer steps per day and have higher obesity rates. Our recent work has focused on demonstrating the feasibility of the small changes approach in preventing excessive weight gain.
We have demonstrated that providing a goal of walking an extra steps per day is achievable and results in a significant increase in total walking Finally, we have conducted two intervention studies in families to demonstrate that the small changes approach can reduce excessive weight gain in overweight children and their parents 97 , Regardless of whether one advocates obesity treatment or prevention of weight gain as a strategy to reverse the obesity epidemic, it will be necessary to address environmental changes.
A big question is how much environmental change is needed? It is important to realize that at some level we intentionally created the environment that is making us fat and we are not unhappy with it. The hope is that the small changes approach will work with modifying the environment. Rather than just focus on changing one or two environmental factors, it may be more useful to make small changes in a lot of factors.
There are some hopeful signs of change. Many food companies are working to develop and designate healthier items. The school food environment is improving with the agreement crafted by the Alliance for a Healthier Generation 99 with the soft drink manufacturers to remove soft drinks from schools.
Communities are looking at how they can facilitate walking over driving. We certainly have a long way to go in addressing the environment, but such efforts are beginning. An advantage of the small changes approach to environmental change is that it provides an opportunity for all sectors of society to change gradually.
It is certainly possible that systemic changes in the food supply such as promoting healthier foods and making them more affordable and in the systems that promote physical activity i.
can be made. It is also unclear how quickly such changes could be made or whether they would be effective. The environment did not get this way overnight, and small changes may be more acceptable than big ones in changing it.
Although there is some sense of urgency in addressing the environment, small changes in a lot of environmental factors could make an immediate difference in at least stopping any further increase of obesity rates. Experts debate the role of the environment vs.
the role of personal responsibility in addressing obesity. It is certainly possible in our current environment for people to choose to eat a healthy diet and to engage in regular physical activity.
However, in an environment where high-energy dense foods are readily available and vigorously marketed, and where physical activity is not necessary for most people to get through their daily lives, it is hard to maintain a healthy lifestyle.
For these reasons, we cannot approach obesity solely as an issue of personal responsibility. If we can change the environment to one that less strongly promotes obesity, it is likely that more people will be able to achieve and maintain healthy lifestyles.
On the other hand, we are not likely to be able to change the environment to one where most people can maintain a healthy body weight with little conscious effort. This means that we have to address obesity both as an environmental issue and as an issue of personal responsibility.
Maintaining a fair balance in doing this will be difficult. The issue of personal responsibility is even more sensitive in children, who may lack the knowledge and skills to make appropriate lifestyle choices and may not necessarily have the opportunity to engage in a healthy lifestyle.
For this group, it is critically important to create an environment that promotes healthier lifestyle choices. However, it is also important for us to help our children develop skills for making lifestyle choices that will help them maintain a healthier weight as adults.
The future does not look optimistic in terms of addressing obesity unless we can come together as a society to address behavior and environmental change. The high rates of childhood obesity that exist today suggest that obesity rates in the United States have not peaked and will continue to increase gradually if we do nothing.
Most overweight children become overweight or obese adults. The worst case scenario is that the entire population becomes obese, and the best case scenario is that we get serious about intervening to reverse the obesity epidemic.
However, we have to do this together as a society; if we remain as individuals struggling with the problem, environmental change will not likely occur. Is there real hope that we can make progress in reversing obesity before we all become obese?
The aim of this paper weightt to review Energy balance and weight management evidence balabce the association between energy balance and obesity. In Energy balance and weight managementthe Weight management strategies Agency for Research on Cancer IARCLyon, EEnergy convened a Working Group of international experts to Energy balance and weight management manaegment evidence regarding energy balance and obesity, with a focus on Low and Middle Income Countries LMIC. The global epidemic of obesity and the double burden, in LMICs, of malnutrition coexistence of undernutrition and overnutrition are both related to poor quality diet and unbalanced energy intake. Dietary patterns consistent with a traditional Mediterranean diet and other measures of diet quality can contribute to long-term weight control. Limiting consumption of sugar-sweetened beverages has a particularly important role in weight control. Genetic factors alone cannot explain the global epidemic of obesity. However, genetic, epigenetic factors and the microbiota could influence individual responses to diet and physical activity. James O. The Weight loss psychology of this paper is to wnd the obesity epidemic, managemetn Energy boosting dietary supplements a term used to describe the sudden and rapid increase Ennergy obesity baoance that began managfment Energy balance and weight management s and continues unabated Bitter orange supplements for metabolism. Sincethe Managemfnt population, regardless weeight starting weight, is gradually gaining weight. This has led to escalating obesity rates and to obesity being considered one of the most serious public health challenges facing the world. At one level, the obesity epidemic is a classic gene-environment interaction where the human genotype is susceptible to environmental influences that affect energy intake and energy expenditure. It is also a problem of energy balance. Understanding the etiology of obesity requires the study of how behavioral and environmental factors have interacted to produce positive energy balance and weight gain.
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