The role of appetite-related hormones, adaptive thermogenesis, perceived hunger and stress in long-term weight-loss maintenance: a mixed-methods study

• Published in: European journal of clinical nutrition Vol. 74; no. 4; pp. 622 - 632
• Main Authors: Thom, George, Dombrowski, Stephan U., Brosnahan, Naomi, Algindan, Yasmin Y., Rosario Lopez-Gonzalez, M., Roditi, Giles, Lean, Michael E. J., Malkova, Dalia
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.04.2020; Nature Publishing Group
• Subjects: 59/57; 631/443/319/1488/393; 631/45/776/198; 692/163/2743/393; 692/700/2814; 692/700/2817; Adipose tissue; Appetite; Body weight; Body weight loss; Calorimetry; Care and treatment; Clinical Nutrition; Eating; Eating behavior; Epidemiology; Fasting; Ghrelin; Glucagon; Glucagon-like peptide 1; Hormones; Hunger; Internal Medicine; Leptin; Magnetic resonance imaging; Maintenance; Medicine; Medicine & Public Health; Metabolic Diseases; Metabolic rate; Metabolism; Mixed methods research; Obesity; Peptides; Psychological aspects; Psychological factors; Public Health; Reduction; Thermogenesis; Weight control; Weight loss measurement; United Kingdom
• ISSN: 0954-3007; 1476-5640; 1476-5640
• DOI: 10.1038/s41430-020-0568-9

Background/objectives Weight-loss maintenance is challenging, and few succeed in the long term. This study aimed to explain how appetite-related hormones, adaptive thermogenesis, perceived hunger and stress influence weight-loss maintenance. Subjects/methods Fifteen adult women (age, 46.3 ± 9.5 years; BMI, 39.4 ± 4.3 kg/m 2 ) participated in a 24-month intervention, which included 3–5 months total diet replacement (825–853 kcal/d). Body weight and composition (Magnetic Resonance Imaging), resting metabolic rate (indirect calorimetry), and fasting plasma concentration of leptin, ghrelin, glucagon-like peptide-1 (GLP-1), peptide YY (PYY), and growth differentiation factor 15 (GDF-15) were measured at baseline and after weight loss, around 6 months. Perceptions relating to weight-loss maintenance were explored using qualitative interviews. Results Mean (SD) changes in body weight (−13.8 ± 6.3 kg) and total adipose tissue (−11.5 ± 4.9 kg) were significant ( P  < 0.001). Weight loss was associated with a significant reduction in resting metabolic rate (−291 ± 226 kcal/day, P  < 0.001) and adaptive thermogenesis (−150 ± 162 kcal/day, P  = 0.003), reduction in leptin ( P  < 0.001) and GLP-1 ( P  = 0.015), an increase in ghrelin ( P  < 0.001), and no changes in PYY and GDF-15. Weight regain between 6 and 24 months (6.1 ± 6.3 kg, P  < 0.05) was negatively correlated with GLP-1 at baseline ( r  = −0.7, P  = 0.003) and after weight loss ( r  = −0.7, P  = 0.005). Participants did not report increased hunger after weight loss, and stress-related/emotional eating was perceived as the main reason for regain. Conclusions Weight regain is more likely with lower fasting GLP-1 at baseline and following weight-loss, but psychological aspects of eating behaviour appear as important in attenuating weight-loss maintenance.