Abstract

With energy intake restriction and exercise remaining the key diet and lifestyle approaches to weight loss, this is not without potential negative implications for body composition, metabolic health, and quality and quantity of life. Ideally, weight loss should be derived almost exclusively from the fat mass compartment as this is the main driver of metabolic disease, however, several studies have shown that there is an accompanying loss of tissue from the fat-free compartment, especially skeletal muscle. Population groups including post-menopausal women, the elderly, those with metabolic disease and athletes may be particularly at risk of skeletal muscle loss when following a weight management programme. Research studies that have addressed this issue across a range of population groups are reviewed with a focus upon the contribution of resistance and endurance forms of exercise and a higher intake dietary protein above the current guideline of 0.8 g/kg body weight/day. While findings can be contradictory, overall, the consensus appears that fat-free and skeletal muscle masses can be preserved, albeit to varying degrees by including both forms of exercise (but especially resistance forms) in the weight management intervention. Equally, higher intakes of protein can protect loss of these body compartments, acting either separately or synergistically with exercise. Elderly individuals in particular may benefit most from this approach. Thus, the evidence supports the recommendations for intakes of protein above the current guidelines of 0.8 g/kg body weight/d for the healthy elderly population to also be incorporated into the dietary prescription for weight management in this age group.

Highlights

  • IntroductionRestriction of energy intake to below energy requirements coupled with increased levels of physical activity (both aerobic and resistance/strength forms) remain the key nonsurgical and non-pharmacological therapeutic weight loss strategy

  • Restriction of energy intake to below energy requirements coupled with increased levels of physical activity remain the key nonsurgical and non-pharmacological therapeutic weight loss strategy

  • Whilst the desired weight loss should arise from an almost exclusive loss of fat mass (FM, since this tissue is a key driver of metabolic risk), it is inevitable than some unintentional loss of mass will occur from the lean or fat-free mass (FFM) compartment including skeletal muscle mass (SMM)

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Summary

Introduction

Restriction of energy intake to below energy requirements coupled with increased levels of physical activity (both aerobic and resistance/strength forms) remain the key nonsurgical and non-pharmacological therapeutic weight loss strategy. Their study showed that while FM showed a strong positive association with CVD risk, for aSMM, this risk differed between the sexes and that measurements of FM and aSMM were not superior to BMI in predicting CVD incidence or all-cause mortality at the population level Taken together, these observations demonstrate that any loss of SM could impair quality (and quantity) of life, and maintaining an optimum SMM is important for long-term health, physical function, and longevity. As a consequence of the ageing process, chronic inactivity or the result of repeated attempts at weight loss, a condition known as sarcopenic obesity can arise [19] In this situation, even though a healthy BMI may be apparent, this masks an imbalance between (excess) body fat and (decreased) SM. This has a number of consequences including a reduction in resting metabolic rate, a reduced capacity for physical activity, and increased risk for metabolic disease

Regulation of SMM Maintenance and Turnover
Fat-Free Mass and Skeletal Muscle Mass Loss Following Therapeutic Dietary
Metabolic Disease
Older Individuals and Post-Menopausal Women
10. Protein-Rich Foods and Preservation of FFM
11. Timing of Protein Feeding and Muscle Mass Maintenance
12. Weight Loss in Sports People
Findings
13. Conclusions
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