Diminished energy requirements in reduced-obese patients

In assessing the reasons for the frequent regaining of weight by reduced-obese patients, we examined retrospectively the seven-day energy intake requirements for weight maintenance of 26 obese patients (12 males, 14 females) at maximum weight (152.5 ± 8.4 kg) and after weight loss (100.2 ± 5.7 kg). These results were compared with those obtained in 26 age- and sex-matched control patients who had never been obese (62.6 ± 2.3 kg). The obese and control subjects required comparable caloric intakes: 1432 ± 32 kcal/m²/d vs 1341 ± 33 kcal/m²/d, respectively. Following weight loss, the reduced-obese subjects required only 1021 ± 32 kcal/m²/d, a 28% decrease (P < 0.001) in requirements relative to their obese state and a 24% decrease relative to the control patients (P < 0.001). The mean individual energy requirement of the reduced-obese subjects (2171 kcal/d) was less than that for the control subjects (2280 kcal/d) despite the fact that they still weighed 60% more than the controls. In order to maintain a reduced weight, some reduced-obese or even partially reduced patients must restrict their food intake to approximately 25% less than that anticipated on the basis of metabolic body size. The reasons why this finding is unlikely to be an artifactual consequence of changes in lean body mass or body water content are discussed. This finding has implications with regard to the pathophysiology and treatment of obesity in humans.