Predicting Weight Gain and Weight Loss Associated With Overeating or Fasting
Condition: Obesity; Diet Therapy; Weight Loss; Weight Gain; Nutrition Therapy
MeSH terms: Body Weight; Weight Loss; Weight Gain
Study type: Interventional
Phase: Phase 2

Summary: 
      This study will investigate how to better predict why some individuals gain or lose weight
      more easily than others. It will examine whether the increase in the amount of energy a body
      burns in 24 hours with overeating or the decrease over 24 hours with fasting can help
      determine how easily someone gains or loses weight.

      Healthy people between 18 and 60 years of age who have a body mass index (BMI) between 18.5
      kg/m(2) and 24 kg/m(2) (for overfeeding study) or a BMI greater than 27 kg/m(2) with a body
      weight less than 350 pounds (weight loss study) may be eligible for this study. The study
      requires a 10-week admission to the NIH Clinical Center (2-week baseline, 6-week
      overfeeding/weight loss, 2-week post-weight change).

      Participants undergo the following tests and procedures during the hospital admission:

        -  Medical history, physical examination and laboratory studies

        -  Questionnaires to assess eating behavior, food preferences, body composition, and
           activity level

        -  Body composition assessment (height, weight, waist circumference, and fat mass and
           muscle content through DXA and MRI scans)

        -  Oral glucose tolerance test

        -  Meal test to measure the response of certain hormones to food

        -  Activity monitors to determine activity level

        -  Metabolic chamber study to measure calories burned over 24 hours and monitor body
           temperature

        -  Free-living energy use study to measure calories burned under normal home conditions
           over 7 days

        -  Fat and muscle biopsies

        -  Dietary intervention: Measurements of food intake and energy loss over a 6-week
           overfeeding (1.5 times the subject s normal food intake) or weight loss (one-half the
           subject s normal food intake) program

      Followup procedures after the inpatient stay:

        -  Height and weight measurements at 6 months (overfeeding study participants) and monthly
           for the first year, at 3-month intervals for the second year, and then yearly for 3 more
           years (weight loss study participants)

        -  Yearly visits (2-night inpatient stay) for all participants for repeat meal test, DXA,
           oral glucose tolerance test, behavioral questionnaires and, in women who can become
           pregnant, pregnancy test
    

Detailed description: 
      For obese individuals, losing weight and keeping it off are extremely difficult, whereas some
      other individuals are thin and report trouble gaining weight. In most weight loss and
      overfeeding studies there is a large variation in the amount of weight lost or gained, and it
      is not clear whether an individual s response to an intervention can be predicted.
      Measurement of the amount of energy an individual uses over 24 hours (24 hour energy
      expenditure or 24-EE) and the response of 24-EE to overfeeding and fasting may help predict
      which individuals will have the greatest changes in weight with changes in energy balance. In
      previous work, 24-EE responses to overfeeding and fasting were related such that individuals
      with the greatest increase in 24-EE upon overfeeding tended to have the smallest decrease in
      24-EE upon fasting ( spendthrift phenotype) and those individuals with less increase in 24-EE
      during overfeeding had a greater decrease in 24-EE with fasting ( thrifty phenotype). Those
      with the spendthrift phenotype who had a greater increase in 24-EE in response to overfeeding
      gained less weight over time. Furthermore, studies have shown that diets with very low
      protein content may magnify the variability in response to overfeeding.

      The aim of this study is to determine if a phenotype defined by 24-EE responses to
      overfeeding and underfeeding is related to weight loss or gain in 4 different under- and
      overfeeding settings: an inpatient weight loss group for obese individuals who will be
      administered one of two diets based on a 50% reduction of their daily energy needs for six
      weeks (standard reduction diet or calorie reduced diet that is still high in protein; 6 week
      weight reduction, 10 week stay, n=20/standard reduction diet group and n=10/relative high
      protein diet), and two overfeeding groups for lean, weight gain resistant individuals: a
      low-protein overfeeding group at 150% of daily energy needs for 6 weeks overfeeding (6%
      protein, 64% carbohydrate, 30% fat; 10 week stay, n=10), and a normal protein overfeeding
      group at 150% of daily energy needs for 6 weeks overfeeding (20% protein, 50% carbohydrate,
      30% fat; 10 week stay, n=10). We will also examine additional metabolic and behavioral
      measurements to determine how they relate to weight change and changes in 24-EE. These
      include sympathetic nervous system activity, behavior, adipose and muscle tissue energy
      content, and abdominal adipocyte size. The study will evaluate the relationship between the
      percent increase in 24-EE in response to overfeeding/underfeeding and the amount of weight
      change over time in each subject. These findings may provide important information for
      predicting and adapting specific individualized interventions for obesity.
    

Intervention name(s): Weight Loss; Overfeeding; Overfeeding Low Pro
Intervention type(s): Behavioral; Behavioral; Behavioral
Intervention description(s): liquid diet at 50% of weight maintaining intake; Overfeeding at 150% of weight maintaining intake; Overfeeding 150% of normal intake at <5% protein
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: 24 Hour Energy Expenditure; Respiratory Chamber; Obesity; Weight Loss; Overfeeding