Revisiting Resting Metabolic Rate: What is the Relation to Weight Fluctuations?

Abstract

Despite the great progress in obesity-tackling strategies, a negative energy equilibrium between energy expenditure and energy intake remains the cornerstone in obesity management. The present review article aims to shed light on the complicated interrelations of resting metabolic rate to weight fluctuations. Energy expenditure depends on body composition and is highly affected by weight changes, exerting a significant role in subsequent weight regain and underlining the metabolic resistance that people with obesity face when dealing with weight maintenance. The main tissue involved in energy expenditure is fat-free mass, as opposed to fat mass, which exerts a substantially lower impact. Although people with obesity display higher energy expenditures than their lean counterparts, these decrease substantially in the setting of weight loss. Metabolic adaptation is the difference between measured and predicted RMR after weight loss, either via lifestyle modification or after obesity surgery. Plausible explanations for this include differences in body composition, with loss of fat-free mass playing a significant role. This becomes especially apparent in the setting of rapid and massive weight loss, as in the case of bariatric surgery. A better understanding of energy expenditure pathophysiology may aid in further enhancing weight loss and promoting weight maintenance in people with obesity.