Dependence of weight loss during very-low-calorie diets on total energy expenditure rather than on resting metabolic rate, which is associated with fat-free mass.

The assumption that total energy expended is related to resting metabolic rate (RMR) has not been validated. Intuitively, weight lost should be determined by the difference between the total energy consumed and the total energy expended. The ratio of actual daily energy usage to RMR by subjects dieting for 11 wk on a 1695-kJ (405-kcal) very-low-calorie diet (VLCD) was variable 1.9 +/- 0.3 (range 1.47-2.36). Weight loss correlated with total energy expenditure measured by 2H2 18O and not RMR, body mass index or body composition. Although RMR may be a reliable indicator of fat-free mass, there is little evidence that subjects with similar RMR will lose comparable weight or have comparable difficulty in weight maintenance.

Long-term outcome of a self-help very-low-calorie-diet weight-loss program.

This paper presents 90-wk data on five seriously overweight subjects originally brought together for 1-2 wk in simple residential accommodation to share the experience of beginning a program of very-low-calorie dieting. All subjects have remained well below their starting weight; four of the five subjects have continued to lose weight (weight losses 33.7-66.8 kg), now weighing less than at the end of the first 26 wk previously reported (1). It is proposed that this self-help group model, incorporating a very-low-calorie diet, is valuable for the long-term management of obesity.

Glycogen storage: illusions of easy weight loss, excessive weight regain, and distortions in estimates of body composition.

Glycogen is stored in the liver, muscles, and fat cells in hydrated form (three to four parts water) associated with potassium (0.45 mmol K/g glycogen). Total body potassium (TBK) changes early in very-low-calorie diets (VLCDs) primarily reflect glycogen storage. Potassium released from glycogen can distort estimates of body composition during dieting. TBK changes due to glycogen mobilization were measured in 11 subjects after 4 d dieting with a VLCD. The influence of water-laden glycogen on weight fluctuations during the dieting process, the exaggerated regain if carbohydrate loading occurs, and the implications for weight control programs and overestimation of nitrogen losses with dieting are discussed.

Effect of changes of water and electrolytes on the validity of conventional methods of measuring fat-free mass.

Fat-free mass was measured by hydrodensitometry, electrical impedance and total body potassium before and after water and electrolyte loss induced by (a) the administration of the diuretic frusemide, and (b) sweat loss. All methods of measuring fat-free mass were shown by pilot experiments to have procedural reliability. The diuretic caused a reduction in apparent fat-free mass of 2.63 kg by the impedance method, of 2.33 kg by hydrodensitometry and of 1.8 kg by total body potassium. Water and electrolyte loss from sweating caused a fat-free loss of 2.3 kg, 2.7 kg and 1.3 kg by the same three procedures. Urinary potassium accounted for about one fifth of the observed 40K fat-free mass loss. Each method was thus clearly sensitive to the induced water loss. These data suggest that in evaluating the composition of weight loss, existing methods of measuring body composition do not distinguish between water and other more critical components of fat-free mass. It is thus essential that stable hydration levels are established for any longitudinal comparison of weight loss by these methods.