Leibel · The New England journal of medicine 1995 · non-randomized comparative metabolic intervention study · n=41

Changes in energy expenditure resulting from altered body weight.

Cited 2011 times in the scientific literature.

Level 3 - non-randomized controlled study

non-randomized experimental cohort study with within-subject repeated measures across weight states

PubMed 7632212 · doi:10.1056/NEJM199503093321001 · record verified 2026-08-29

What was done

Researchers measured 24-hour total energy expenditure, resting energy expenditure, nonresting energy expenditure, and the thermic effect of feeding in 18 obese subjects and 23 subjects who had never been obese. Measurements were obtained at usual baseline body weight and compared with measurements after losing 10% to 20% of body weight by underfeeding or gaining 10% of body weight by overfeeding.

What was found

Maintenance of weight at 10% or more below baseline was associated with a mean (± SD) reduction in total energy expenditure of 6 ± 3 kcal/kg of fat-free mass/day in never-obese subjects (P < 0.001) and 8 ± 5 kcal/kg of fat-free mass/day in obese subjects (P < 0.001). Resting and nonresting energy expenditure each decreased by 3 to 4 kcal/kg fat-free mass/day in both groups. Conversely, maintaining a 10% weight gain increased total energy expenditure by 9 ± 7 kcal/kg fat-free mass/day in never-obese subjects (P < 0.001) and 8 ± 4 kcal/kg fat-free mass/day in obese subjects (P < 0.001), with nonresting energy expenditure increasing by approximately 8 to 9 kcal/kg fat-free mass/day and thermic effect of feeding increasing by 1 to 2 kcal/kg fat-free mass/day. These changes were not related to baseline adiposity or sex.

Why it matters

This study demonstrated that metabolic energy expenditure adjusts to oppose sustained weight loss or gain, offering a physiological mechanism for why long-term weight-loss maintenance is difficult.

Limits

The sample size was small (41 total participants). The abstract does not specify whether participants underwent both overfeeding and underfeeding, the sequence of interventions, the exact duration of weight-maintenance periods, or long-term outcomes beyond the experimental maintenance phases.

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