Abstract
Background/ObjectiveDiet-induced weight loss (WL) leads to a compensatory increase in appetite and changes in the plasma concentration of appetite-regulating hormones are likely to play a role. Whether these changes are transient or sustained remains unclear. This study aimed to assess if changes in subjective and objective appetite markers observed with WL are sustained after 1 year (1Y).Subjects/MethodsIn total 100 (45 males) individuals with obesity (BMI: 37 ± 4 kg/m2, age: 43 ± 10 years) underwent 8 weeks (wks) of a very-low energy diet (VLED), followed by 4 wks refeeding, and a 1Y maintenance program. Fasting/postprandial subjective ratings of hunger, fullness, desire to eat, and prospective food consumption (PFC) were assessed, and plasma concentration of active ghrelin (AG), total peptide YY (PYY), active glucagon-like peptide 1, cholecystokinin (CCK), and insulin measured, at baseline, week 13 (Wk13) and 1Y.ResultsAt Wk13, 16% WL (−18 ± 1 kg, P < 0.001) was associated with a significant increase in fasting and postprandial hunger ratings (P < 0.01 and P < 0.05, respectively), and postprandial fullness (P < 0.01) combined with a reduction in PFC (P < 0.001). These were accompanied by a significant rise in basal and postprandial AG concentrations (P < 0.001, for both), a reduction in postprandial CCK (P < 0.01) and in basal and postprandial insulin (P < 0.001). At 1Y follow-up, with sustained WL (15%; −16 ± 1 kg, P < 0.001), fasting hunger and postprandial fullness ratings remained increased (P < 0.05 for both), and postprandial PFC reduced (P < 0.001). Basal and postprandial AG remained elevated and insulin reduced (P < 0.001, for all), while postprandial CCK was increased (P < 0.01) and PYY decreased (P < 0.001).ConclusionWith a 15% sustained WL at 1Y, the drive to eat in the fasting state is increased, but this may be balanced out by raised postprandial feelings of fullness. To assist with WL maintenance, new strategies are required to manage increased hunger and drive to eat.
Highlights
IntroductionWorldwide >40% of all adults have attempted to control their body weight by weight loss strategies [1]
Electronic supplementary material The online version of this article contains supplementary material, which is available to authorized users.Worldwide >40% of all adults have attempted to control their body weight by weight loss strategies [1]
95 participants completed the 8-week very-low energy diet (VLED) (2 did not tolerate the VLED, 1 was excluded due to consumption of extra foods, 1 withdrew for personal reasons and 1 was lost to follow-up), 94 completed Wk 13 measurements (1 withdrew due to family illness) and 71 (41 females) completed the full 1 year (1Y) (8 withdrew due to own or family related illness, 3 due to work constraints making it difficult to return for measurements, 2 were excluded due to non-compliance as they had started a new VLED, and 10 were lost to follow-up)
Summary
Worldwide >40% of all adults have attempted to control their body weight by weight loss strategies [1]. Weight loss (WL) maintenance is the most challenging part within obesity management as relapse is common and only 10–20% succeed in maintaining their lower body weight long-term [2, 3]. The landmark papers by Leibel et al [10] and Dulloo et al [11] showed that WL is followed by a reduction in total energy expenditure (TEE) larger than predicted and, despite that, an increase in hunger and hyperphagia. Reviews by Cornier et al [8], Rosenbaum et al [9] and Doucet et al [12], among others, have described the compensatory mechanisms activated with WL, on both sides of the energy balance equation, which may contribute to weight re-gain
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