Jump to ContentJump to Main Navigation
Show Summary Details
More options …

International Journal of Adolescent Medicine and Health

Editor-in-Chief: Merrick, Joav

Editorial Board Member: Birch, Diana ML / Blum, Robert W. / Greydanus, MD, Dr. HC (Athens), Donald E. / Hardoff, Daniel / Kerr, Mike / Levy, Howard B / Morad, Mohammed / Omar, Hatim A. / de Paul, Joaquin / Rydelius, Per-Anders / Shek, Daniel T.L. / Sher, Leo / Silber, Tomas J. / Towns, Susan / Urkin, Jacob / Verhofstadt-Deneve, Leni / Zeltzer, Lonnie / Tenenbaum, Ariel

6 Issues per year


CiteScore 2016: 0.71

SCImago Journal Rank (SJR) 2016: 0.381
Source Normalized Impact per Paper (SNIP) 2016: 0.383

Online
ISSN
2191-0278
See all formats and pricing
More options …
Volume 27, Issue 3 (Aug 2015)

Issues

The contribution of fat-free mass to resting energy expenditure: implications for weight loss strategies in the treatment of adolescent obesity

Matthew G. Browning
  • Department of Kinesiology and Health Sciences, Virginia Commonwealth University, Richmond, VA, USA
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Ronald K. Evans
  • Corresponding author
  • Department of Kinesiology and Health Sciences, Virginia Commonwealth University, Richmond, VA, USA
  • Email
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
Published Online: 2014-12-03 | DOI: https://doi.org/10.1515/ijamh-2014-0036

Abstract

Owing to the strong relationship between fat-free mass (FFM) and resting energy expenditure (REE), the preservation of FFM is often emphasized in the treatment of adolescent obesity. Typical treatment regimens including an increased dietary consumption of protein and participation in resistance training are common components of adolescent weight management programs, despite limited evidence of a positive influence of FFM on weight loss outcomes in adolescents. Given the larger volume of FFM in obese relative to normal weight adolescents and the common treatment goals of both maximizing weight loss and attenuating the loss of FFM, a better understanding of the influence of FFM on energy balance is needed to determine whether strategies to preserve lean tissue or maximize absolute weight loss should be most emphasized. We review the associations among FFM, REE, and weight loss outcomes, focusing on how these relationships might influence energy balance in obese adolescents.

Keywords: adolescents; energy expenditure; fat-free mass; weight loss

Background

Approximately 20% of adolescents in the United States are obese (1), and without an effective intervention, as many as 80% will become obese adults (2). The most successful adolescent weight management programs offer a combination of diet, exercise, and behavioral counseling (3, 4); however, it is often difficult to determine which practices within each program component elicit the most beneficial effects on weight loss outcomes (5, 6). Independent of how it is achieved, weight loss is a result of energy expenditure exceeding energy intake. Given the inability to discern whether diet or physical inactivity is the stronger contributor to pediatric obesity (7), both energy intake and expenditure must be considered when developing weight loss prevention and intervention programs for adolescents.

Approximately 70% of total daily energy expenditure is attributed to resting energy expenditure (REE), and fat-free mass (FFM) is the largest contributor to REE during both adolescence and adulthood (8). Considering the strong influence of FFM on energy balance, the preservation of FFM following participation in adolescent weight management programs is generally recognized as having a positive impact on long-term outcomes (9, 10). It follows that FFM-sparing strategies (e.g., increased protein intake and resistance training) are often implemented into adolescent weight management programs (11–13). However, over 25% of the excess weight in obese adolescents is attributed to elevations in FFM (14). Therefore, if the common, yet conflicting, goals of retaining or increasing FFM while subsequently maximizing weight loss (15, 16) are to be realized, weight management strategies may need to emphasize one goal over the other.

In previous studies reporting increased FFM following participation in an adolescent weight management program, body weight was either unchanged or increased (16–18). Considering the substantial contribution of FFM to excess body weight in obese adolescents, a further understanding of the relationship between FFM and REE may provide insight as to whether total weight reduction or the preservation of FFM exerts the greater influence on long-term weight loss outcomes. Additionally, while REE is positively related to both body weight and FFM, the REE-to-FFM ratio (REE-to-FFM) is dependent upon the composition of FFM (i.e., organ tissue, skeletal muscle, fluid, and bone) (19, 20). Given that the proportion of each component varies between adolescents and adults and lean and obese individuals (10, 19, 21), the influence of FFM on long-term energy balance with respect to the treatment of adolescent obesity deserves further exploration. Last, examining the physiologic basis behind fundamental weight loss strategies and the supporting evidence for their inclusion in pediatric weight management programs may provide further awareness and improve current treatment efforts (22). Therefore, the purpose of this review is to 1) describe the influence of FFM on REE, 2) summarize the existing evidence regarding the efficacy of FFM-sparing treatment strategies in obese adolescents, and 3) examine the interrelationships between changes in FFM, REE, and body weight during negative energy balance.

Fat-free mass and resting energy expenditure

Fat-free mass composition and REE-to-FFM

Resting energy expenditure is a measure of the body’s total basal cellular activity. Therefore, REE-to-FFM is a function of the volume of energetic cells, or the body cell mass, relative to the FFM compartment (23). The volume of body cell mass in relation to FFM during adolescence differs with respect to age, body weight, and gender (24, 25) due to differences in water, protein, glycogen, and mineral content (19, 26). Finally, the mass of each of these FFM constituents must also be considered with respect to their distribution across the body tissues, as both the contribution of organ mass to FFM and the energy expenditure of the individual organs appears to be greater in adolescents than adults (19, 24).

During adolescence, FFM is comprised of 42% skeletal muscle and 8% organ tissue, with the remainder attributed to bone and extracellular fluid (19, 20). Liver, heart, kidney, brain (∼450 kcal·kg–1·day–1), and skeletal muscle (∼15 kcal·kg–1·day–1) tissue account for nearly all of the REE, while bone and extracellular fluid and matrix contribute <1 kcal·kg–1·day–1 (19, 20). Of note, obese youth have a 1.8% greater hydration of FFM compared to their lean counterparts (14), suggestive of a relatively smaller contribution of more metabolically active tissues to FFM, thereby, decreasing REE-to-FFM. However, due to current limitations in the assessment of body composition (discussed below in the Methodological considerations section) and differences in methodologies used across studies, it is unclear whether REE-to-FFM is decreased in obese relative to lean adolescents (21, 27–29). In contrast, the considerably greater resting energy requirement of organ relative to skeletal muscle tissue (20) indicates that an increase in the skeletal muscle-to-organ mass ratio, as occurs during both the transition from adolescence into adulthood and in obesity, would coincide with a decreased REE-to-FFM (19). Not only REE-to-FFM but also REE in relation to the total body weight is higher in adolescents than adults (24), suggesting that maintenance of obesity-related elevations in FFM along with a reduction in the energy expenditure attributed to FFM during young adulthood would be energetically disadvantageous to long-term weight control.

Methodological considerations

Since REE-to-FFM is a function of the composition of FFM and the composition of FFM influences the accuracies of the various body composition measurement techniques (14, 30, 31), consideration must also be given to the body composition assessment method used when evaluating the relationship between REE and FFM. The preferred method for estimating body composition in youth is the combination of measures of fat, water, protein, and mineral content to yield a four-component model (32). However, due to technical and cost limitations associated with this method, body composition is most often assessed using more practical, but less accurate, two-compartment models that divide the body into FFM and fat mass. Whereas the calculation of FFM from total body water and dual energy X-ray absorptiometry (DXA) assumes a constant hydration of FFM, greater hydration levels in obese adolescents could influence the accuracy of these methods. For instance, DXA was found to overestimate the loss of fat mass and gains in skeletal muscle in obese adolescents when compared to magnetic resonance imaging (31). On the other hand, bioelectrical impedance analysis may be more sensitive to differences in FFM hydration between obese and normal weight youth (30), although this method generally provides less accurate estimates of body composition than both DXA and air displacement plethysmography (33). Last, the composition of exercise-spared FFM during/following weight loss is not well defined (34) and deserves further evaluation when considering the variability in exercise programming across adolescent weight management programs.

FFM-sparing treatment strategies

High-protein diets and resistance training

Owing to the strong contribution of FFM to REE, dietary and exercise strategies known to preserve or even increase FFM are often implemented into adolescent weight management programs (12, 13, 35–37). Even during severe caloric restriction (≤800 kcal·day–1), increased protein consumption has been shown to preserve both the amount and composition of FFM in obese adolescents (11, 35). Whereas exercise is known to attenuate the loss of FFM during negative energy balance, this effect is more pronounced following resistance compared to aerobic training. However, when considering the inverse relationship between FFM and REE-to-FFM and the reduction in REE-to-FFM from adolescence into adulthood (19), the weight loss and health outcomes associated with increased protein consumption and resistance training may be of greater significance than their respective effects on FFM. In accordance, the magnitude of reduction in body weight (i.e., the degree of negative energy balance) rather than the proportion of calories coming from protein intake or the relative retention of FFM appears to be the strongest determinant of the change in REE-to-FFM in obese adolescents (10, 11, 35).

Considerations for growth and development

In contrast to the treatment of adult obesity, the impact of weight loss on growth and development is of concern in the pediatric population. During adolescence, growth contributes to approximately 7% of REE-to-FFM (25) or 2%–4% of the total energy requirements (38). Importantly, growth appears to continue unimpeded in obese adolescents consuming as few as 500 kcal·kg–1·day–1 (35, 39, 40), perhaps due to the earlier onset of puberty in obese compared to lean youth (41, 42). Additionally, the degree of reduction in FFM during weight loss is inversely related to the initial body fatness (43, 44). This inherent preferential loss of fat mass further alleviates concerns regarding the loss of FFM in obese adolescents. In turn, the risk of sarcopenic obesity also appears to be of minimal concern in adolescents, as the ratio of skeletal muscle to adipose tissue is highest during youth and young adulthood (45). Although body weight may normalize following moderate weight loss or by simply attenuating weight gain in younger youth (46), the observation that many obese adolescents will benefit only from substantial weight loss (47) further supports the utilization of strategies to maximize weight loss taking precedence over those to retain FFM.

Efficacy of high-protein diets and resistance training in obese adolescents

Since developmental gains in FFM appear to be unaffected by obesity treatment during adolescence, FFM-sparing program components on long-term weight loss outcomes may be more efficacious in adults than adolescents. Whereas an increase in dietary protein content has been shown to attenuate weight regain in adults (48), both short- and long-term weight loss outcomes were similar among obese adolescents consuming diets comprised of between 15% and 30% protein (12, 36, 49). These findings may be partly explained by the lack of difference in hunger control observed between adolescents following either high- or low-protein diets (49, 50). Similarly, the lack of evidence supporting the efficacy of resistance training in the treatment of adolescent obesity (13, 16) may be explained by the greater caloric expenditure required for the performance of aerobic as opposed to resistance training (51). In accordance, the former is generally associated with slightly greater improvements in body weight and composition in obese adolescents, despite greater gains in skeletal muscle following resistance training (31, 52, 53), perhaps due to a resultant reduction in REE-to-FFM. Taken together, further evaluation of the effects of high-protein diets and resistance training on long-term weight loss outcomes is needed to determine which dietary and exercise practices are most efficacious in the treatment of adolescent obesity.

Fat-free mass and weight loss outcomes

FFM, REE-to-FFM, and weight loss

Given the inability to clearly link FFM-sparing treatment strategies to improved weight loss outcomes in obese adolescents, a better understanding of the influence of FFM on energy balance during weight loss is needed. Considering the five-fold greater contribution of FFM (∼18 kcal·kg–1·day–1) than fat mass (∼3.5 kcal·kg–1·day–1) to REE (54, 55), the preservation of FFM during weight loss is generally believed to elicit the most beneficial effect on energy balance. However, 75% of the FFM lost during energy deficit is attributed to reductions in less metabolically active components (e.g., skeletal muscle, fluid, extracellular matrix) (55–57), while protein catabolism accounts for only 5% of the total weight loss initially and 2.5% over the next several months (34, 56). Such findings may explain the aforementioned lack of difference between high- and low-protein intakes on weight loss outcomes in obese adolescents, as even during long-term fasting, only 25% of the reduction in FFM is due to the loss of protein (57). Therefore, reported reductions in REE-to-FFM in adolescents who successfully preserved FFM during weight loss (10) may be attributed to hormonal changes (58) and/or the loss of fat mass, which, as previously mentioned, is not metabolically inert but can be a significant contributor to REE in obese individuals (59).

As the majority of REE is attributed to organ metabolism, REE-to-FFM decreases with increasing FFM due to a reduction in the relative contribution of organ mass to FFM. In other words, disproportionate increases in less metabolically active FFM components (e.g., bone, fluid, and skeletal muscle) relative to the more active organ tissue may not exert as beneficial of an effect on energy balance as is often perceived and could explain the lack of evidence supporting the use of resistance training in the treatment of adolescent obesity (13). From this, simultaneous reductions in both body fatness and FFM may not be detrimental to long-term energy balance, particularly when considering the excess FFM in obese adolescents (14). Furthermore, when considering the generally modest reductions in body weight following participation in most adolescent weight management programs, the relatively minor loss of more metabolically active tissues during weight loss suggest that absolute weight loss should be encouraged over the retention of FFM.

FFM and weight maintenance

The relationship between the change in FFM during weight loss and long-term weight regulation in obese adolescents is relatively unexplored. Schwingshandl et al. (9) reported a beneficial effect of FFM sparing on weight regain after 1 year in a mixed group of 20 obese children and adolescents. In that study, not all participants received the same intervention, and body composition and weight changes were inconsistent. Further evidence of an inverse relationship between the change in FFM following weight loss and subsequent weight regain in adolescents is needed, as increased FFM may lead to augmented hunger signaling (60), potentially exacerbated by reductions in the satiety hormone leptin following weight loss (61). While reductions in energy intake have been observed over the short-term in obese adolescents who gained FFM during treatment (18, 60), the preservation of and/or increases in FFM could bear a negative effect on future dietary habits, as FFM is the strongest predictor of energy intake in adult males (62). Alternatively, maintenance of body composition at a lower absolute FFM would require less energy intake (63) and result in an increased REE-to-FFM (19).

Summary

While fat loss is certainly preferential to reductions in FFM, retention of FFM without reductions in weight or body fatness may not always be energetically advantageous to long-term outcomes. The influence of FFM on energy balance is mediated by REE-to-FFM, and REE-to-FFM is inversely proportional to FFM. Considering the strong dependency of REE on not only FFM but also total body weight in obese adolescents, whether long-term energy balance is more strongly influenced by weight loss-induced reductions in REE and REE-to-FFM or the increased REE relative to total body weight (10) requires further exploration. Regardless of whether REE, REE-to-FFM, or REE-to-body weight is the strongest determinant of energy balance, it seems that simultaneous maximization of each would have the most desirable effect on long-term weight loss outcomes (55).

Acknowledgments

MGB and RKE prepared the manuscript and critically reviewed the submission. Both authors read and approved the final manuscript. The authors declare that they have no competing interests. No funding was received for the drafting of this manuscript.

References

  • 1.

    Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of obesity and trends in body mass index among US children and adolescents, 1999–2010. J Am Med Assoc 2012;307:483–90.Google Scholar

  • 2.

    Dietz WH. Overweight in childhood and adolescence. N Engl J Med 2004;350:855–7.CrossrefPubMedGoogle Scholar

  • 3.

    Koplan JP, Liverman CT, Kraak VI. Preventing childhood obesity: health in the balance: executive summary. J Am Diet Assoc 2005;105:131–8.CrossrefPubMedGoogle Scholar

  • 4.

    Koplan JP, Liverman CT, Kraak VI. Preventing childhood obesity: health in the balance. Koplan JP, Liverman CT, Kraak VI, editors. Washington DC: National Academy of Sciences, 2005.Google Scholar

  • 5.

    Tsiros MD, Sinn N, Coates AM, Howe PR, Buckley JD. Treatment of adolescent overweight and obesity. Eur J Pediatr 2008;167:9–16.CrossrefPubMedGoogle Scholar

  • 6.

    Barlow SE. Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: summary report. Pediatrics 2007;120(Suppl 4):S164–92.Google Scholar

  • 7.

    Bleich SN, Ku R, Wang YC. Relative contribution of energy intake and energy expenditure to childhood obesity: a review of the literature and directions for future research. Int J Obes (Lond) 2011;35:1–15.CrossrefGoogle Scholar

  • 8.

    Gallagher D, Visser M, Wang Z, Harris T, Pierson, Jr. RN, et al. Metabolically active component of fat-free body mass: influences of age, adiposity, and gender. Metabolism 1996;45: 992–7.CrossrefGoogle Scholar

  • 9.

    Schwingshandl J, Sudi K, Eibl B, Wallner S, Borkenstein M. Effect of an individualised training programme during weight reduction on body composition: a randomised trial. Arch Dis Child 1999;81:426–8.PubMedCrossrefGoogle Scholar

  • 10.

    Lazzer S, Boirie Y, Montaurier C, Vernet J, Meyer M, et al. A weight reduction program preserves fat-free mass but not metabolic rate in obese adolescents. Obes Res 2004;12:233–40.PubMedCrossrefGoogle Scholar

  • 11.

    Stallings VA, Pencharz PB. The effect of a high protein-low calorie diet on the energy expenditure of obese adolescents. Eur J Clin Nutr 1992;46:897–902.PubMedGoogle Scholar

  • 12.

    Rolland-Cachera MF, Thibault H, Souberbielle JC, Soulie D, Carbonel P, et al. Massive obesity in adolescents: dietary interventions and behaviours associated with weight regain at 2 y follow-up. Int J Obes Relat Metab Disord 2004;28:514–9.CrossrefGoogle Scholar

  • 13.

    Alberga AS, Sigal RJ, Kenny GP. A review of resistance exercise training in obese adolescents. Phys Sportsmed 2011;39:50–63.CrossrefPubMedGoogle Scholar

  • 14.

    Wells JC, Fewtrell MS, Williams JE, Haroun D, Lawson MS, et al. Body composition in normal weight, overweight and obese children: matched case-control analyses of total and regional tissue masses, and body composition trends in relation to relative weight. Int J Obes (Lond), 2006;30:1506–13.CrossrefGoogle Scholar

  • 15.

    Prado WL, Siegfried A, Damaso AR, Carnier J, Piano Ad, et al. Effects of long-term multidisciplinary inpatient therapy on body composition of severely obese adolescents. J Pediatr (Rio J) 2009;85:243–8.Google Scholar

  • 16.

    Schranz N, Tomkinson G, Olds T. What is the effect of resistance training on the strength, body composition and psychosocial status of overweight and obese children and adolescents? A Systematic review and meta-analysis. Sports Med 2013;43:893–907.CrossrefPubMedGoogle Scholar

  • 17.

    Marcano H, Fernandez M, Paoli M, Santomauro M, Camacho N, et al. Limited weight loss or simply no weight gain following lifestyle-only intervention tends to redistribute body fat, to decrease lipid concentrations, and to improve parameters of insulin sensitivity in obese children. Int J Pediatr Endocrinol 2011;2011:241703.PubMedCrossrefGoogle Scholar

  • 18.

    Tjonna AE, Stolen TO, Bye A, Volden M, Slordahl SA, et al. Aerobic interval training reduces cardiovascular risk factors more than a multitreatment approach in overweight adolescents. Clin Sci (Lond) 2009;116:317–26.PubMedCrossrefGoogle Scholar

  • 19.

    Weinsier RL, Schutz Y, Bracco D. Reexamination of the relationship of resting metabolic rate to fat-free mass and to the metabolically active components of fat-free mass in humans. Am J Clin Nutr 1992;55:790–4.PubMedGoogle Scholar

  • 20.

    Muller MJ, Bosy-Westphal A, Kutzner D, Heller M. Metabolically active components of fat-free mass and resting energy expenditure in humans: recent lessons from imaging technologies. Obes Rev 2002;3:113–22.PubMedCrossrefGoogle Scholar

  • 21.

    DeLany JP, Bray GA, Harsha DW, Volaufova J. Energy expenditure in African American and white boys and girls in a 2-y follow-up of the Baton Rouge Children’s Study. Am J Clin Nutr 2004;79:268–73.Google Scholar

  • 22.

    Casazza K, Fontaine KR, Astrup A, Birch LL, Brown AW, et al. Myths, presumptions, and facts about obesity. N Engl J Med 2013;368:446–54.CrossrefPubMedGoogle Scholar

  • 23.

    Moore FD, Olesen KH, McMurrery JD, Parker HV, Ball MR, et al. The body cell mass and its supporting environment. Philadelphia: WB Saunders, 1963.Google Scholar

  • 24.

    Wang Z. High ratio of resting energy expenditure to body mass in childhood and adolescence: a mechanistic model. Am J Hum Biol 2012;24:460–7.PubMedCrossrefGoogle Scholar

  • 25.

    Wang Z, Heymsfield SB, Ying Z, Pierson, Jr RN, Gallagher D, et al. A cellular level approach to predicting resting energy expenditure: evaluation of applicability in adolescents. Am J Hum Biol 2010;22:476–83.CrossrefPubMedGoogle Scholar

  • 26.

    Livesey G, Elia M. Estimation of energy expenditure, net carbohydrate utilization, and net fat oxidation and synthesis by indirect calorimetry: evaluation of errors with special reference to the detailed composition of fuels. Am J Clin Nutr 1988;47: 608–28.PubMedGoogle Scholar

  • 27.

    Wilms L, Larsen J, Pedersen PL, Kvetny J. Evidence of mitochondrial dysfunction in obese adolescents. Acta Paediatr 2010;99:906–11.PubMedCrossrefGoogle Scholar

  • 28.

    van Mil EG, Westerterp KR, Kester AD, Saris WH. Energy metabolism in relation to body composition and gender in adolescents. Arch Dis Child 2001;85:73–8.PubMedCrossrefGoogle Scholar

  • 29.

    Bandini LG, Schoeller DA, Dietz WH. Energy expenditure in obese and nonobese adolescents. Pediatr Res 1990;27: 198–203.PubMedCrossrefGoogle Scholar

  • 30.

    Lazzer S, Bedogni G, Lafortuna CL, Marazzi N, Busti C, et al. Relationship between basal metabolic rate, gender, age, and body composition in 8,780 white obese subjects. Obesity (Silver Spring) 2010;18:71–8.Google Scholar

  • 31.

    Lee S, Kuk JL. Changes in fat and skeletal muscle with exercise training in obese adolescents: comparison of whole-body MRI and dual energy X-ray absorptiometry. Obesity (Silver Spring) 2013;21:2063–71.CrossrefGoogle Scholar

  • 32.

    Wells JC, Fuller NJ, Dewit O, Fewtrell MS, Elia M, et al. Four-component model of body composition in children: density and hydration of fat-free mass and comparison with simpler models. Am J Clin Nutr 1999;69:904–12.PubMedGoogle Scholar

  • 33.

    Lazzer S, Bedogni G, Agosti F, De Col A, Mornati D, et al. Comparison of dual-energy X-ray absorptiometry, air displacement plethysmography and bioelectrical impedance analysis for the assessment of body composition in severely obese Caucasian children and adolescents. Br J Nutr 2008;100:918–24.CrossrefPubMedGoogle Scholar

  • 34.

    Heymsfield SB, Thomas D, Nguyen AM, Peng JZ, Martin C, et al. Voluntary weight loss: systematic review of early phase body composition changes. Obes Rev 2011;12:e348–61.CrossrefGoogle Scholar

  • 35.

    Brown MR, Klish WJ, Hollander J, Campbell MA, Forbes GB. A high protein, low calorie liquid diet in the treatment of very obese adolescents: long-term effect on lean body mass. Am J Clin Nutr 1983;38:20–31.PubMedGoogle Scholar

  • 36.

    Krebs NF, Gao D, Gralla J, Collins JS, Johnson SL. Efficacy and safety of a high protein, low carbohydrate diet for weight loss in severely obese adolescents. J Pediatr 2010;157:252–8.PubMedCrossrefGoogle Scholar

  • 37.

    Davis JN, Kelly LA, Lane CJ, Ventura EE, Byrd-Williams CE, et al. Randomized control trial to improve adiposity and insulin resistance in overweight Latino adolescents. Obesity (Silver Spring) 2009;17:1542–8.CrossrefGoogle Scholar

  • 38.

    Prentice AM, Lucas A, Vasquez-Velasquez L, Davies PS, Whitehead RG. Are current dietary guidelines for young children a prescription for overfeeding? Lancet 1988;2:1066–9.CrossrefPubMedGoogle Scholar

  • 39.

    Dao HH, Frelut ML, Peres G, Bourgeois P, Navarro J. Effects of a multidisciplinary weight loss intervention on body composition in obese adolescents. Int J Obes Relat Metab Disord 2004;28:290–9.PubMedCrossrefGoogle Scholar

  • 40.

    Villar Villar G, Nievas Soriano B, Ruibal Francisco JL, Perez Rodriguez O, Rueda Esteban S. Analysis of puberal development and influence of weight loss in obese adolescent girls. An Pediatr (Barc) 2004;60:544–9.CrossrefGoogle Scholar

  • 41.

    Marcovecchio ML, Chiarelli F. Obesity and growth during childhood and puberty. World Rev Nutr Diet 2013;106:135–41.PubMedGoogle Scholar

  • 42.

    De Leonibus C, Marcovecchio ML, Chiavaroli V, de Giorgis T, Chiarelli F, et al. Timing of puberty and physical growth in obese children: a longitudinal study in boys and girls. Pediatr Obes 2013;9:292–9.CrossrefPubMedGoogle Scholar

  • 43.

    Hall KD. Body fat and fat-free mass inter-relationships: Forbes’s theory revisited. Br J Nutr 2007;97:1059–63.CrossrefGoogle Scholar

  • 44.

    Thomas D, Das SK, Levine JA, Martin CK, Mayer L, et al. New fat free mass-fat mass model for use in physiological energy balance equations. Nutr Metab (Lond) 2010;7:39.CrossrefGoogle Scholar

  • 45.

    Schautz B, Later W, Heller M, Muller MJ, Bosy-Westphal A. Total and regional relationship between lean and fat mass with increasing adiposity – impact for the diagnosis of sarcopenic obesity. Eur J Clin Nutr 2012;66:1356–61.CrossrefPubMedGoogle Scholar

  • 46.

    Goldschmidt AB, Wilfley DE, Paluch RA, Roemmich JN, Epstein LH. Indicated prevention of adult obesity: how much weight change is necessary for normalization of weight status in children? J Am Med Assoc Pediatr 2013;167:21–6.Google Scholar

  • 47.

    Butryn ML, Wadden TA, Rukstalis MR, Bishop-Gilyard C, Xanthopoulos MS, et al. Maintenance of weight loss in adolescents: current status and future directions. J Obes 2010;2010:789280.PubMedGoogle Scholar

  • 48.

    Lejeune MP, Kovacs EM, Westerterp-Plantenga MS. Additional protein intake limits weight regain after weight loss in humans. Br J Nutr 2005;93:281–9.CrossrefPubMedGoogle Scholar

  • 49.

    Gately PJ, King NA, Greatwood HC, Humphrey LC, Radley D, et al. Does a high-protein diet improve weight loss in overweight and obese children? Obesity (Silver Spring) 2007;15:1527–34.CrossrefGoogle Scholar

  • 50.

    Duckworth LC, Gately PJ, Radley D, Cooke CB, King RF, et al. RCT of a high-protein diet on hunger motivation and weight-loss in obese children: an extension and replication. Obesity (Silver Spring) 2009;17:1808–10.CrossrefGoogle Scholar

  • 51.

    Hunter GR, Byrne NM, Gower BA, Sirikul B, Hills AP. Increased resting energy expenditure after 40 minutes of aerobic but not resistance exercise. Obesity (Silver Spring) 2006;14:2018–25.CrossrefGoogle Scholar

  • 52.

    Ho M, Garnett SP, Baur LA, Burrows T, Stewart L, et al. Impact of dietary and exercise interventions on weight change and metabolic outcomes in obese children and adolescents: a systematic review and meta-analysis of randomized trials. J Am Med Assoc Pediatr 2013;167:759–68.Google Scholar

  • 53.

    Davis JN, Tung A, Chak SS, Ventura EE, Byrd-Williams CE, et al. Aerobic and strength training reduces adiposity in overweight Latina adolescents. Med Sci Sports Exerc 2009;41:1494–503.CrossrefPubMedGoogle Scholar

  • 54.

    Wang Z, Heshka S, Gallagher D, Boozer CN, Kotler DP, et al. Resting energy expenditure-fat-free mass relationship: new insights provided by body composition modeling. Am J Physiol Endocrinol Metab 2000;279:E539–45.Google Scholar

  • 55.

    Alpert SS. The cross-sectional and longitudinal dependence of the resting metabolic rate on the fat-free mass. Metabolism 2007;56:363–72.CrossrefPubMedGoogle Scholar

  • 56.

    Heymsfield SB, Thomas D, Martin CK, Redman LM, Strauss B, et al. Energy content of weight loss: kinetic features during voluntary caloric restriction. Metabolism 2012;61:937–43.PubMedCrossrefGoogle Scholar

  • 57.

    Wishnofsky M. Caloric equivalents of gained or lost weight. Am J Clin Nutr 1958;6:542–6.PubMedGoogle Scholar

  • 58.

    Stiegler P, Cunliffe A. The role of diet and exercise for the maintenance of fat-free mass and resting metabolic rate during weight loss. Sports Med 2006;36:239–62.CrossrefPubMedGoogle Scholar

  • 59.

    Hall KD. Mechanisms of metabolic fuel selection: modeling human metabolism and body-weight change. IEEE Eng Med Biol Mag 2010;29:36–41.PubMedCrossrefGoogle Scholar

  • 60.

    Carnier J, de Mello MT, Ackel DC, Corgosinho FC, Campos RM, et al. Aerobic training (AT) is more effective than aerobic plus resistance training (AT+RT) to improve anorexigenic/orexigenic factors in obese adolescents. Appetite 2013;69:168–73.CrossrefPubMedGoogle Scholar

  • 61.

    Celi F, Bini V, Papi F, Contessa G, Santilli E, et al. Leptin serum levels are involved in the relapse after weight excess reduction in obese children and adolescents. Diabetes Nutr Metab 2003;16:306–11.PubMedGoogle Scholar

  • 62.

    Lassek WD, Gaulin SJC. Costs and benefits of fat-free muscle mass in men: relationship to mating success, dietary requirements, and native immunity. Evol Hum Behav 2009;30:322–8.CrossrefGoogle Scholar

  • 63.

    Bosomworth NJ. The downside of weight loss: realistic intervention in body-weight trajectory. Can Fam Physician 2012;58:517–23.PubMedGoogle Scholar

About the article

Corresponding author: Ronald K. Evans, PhD, Department of Kinesiology and Health Sciences, Virginia Commonwealth University, 500 Academic Centre, 1020 West Grace St, Richmond, VA 23284, USA, Phone: +1-(804) 827-6848, E-mail:


Received: 2014-06-12

Accepted: 2014-08-09

Published Online: 2014-12-03

Published in Print: 2015-08-01


Citation Information: International Journal of Adolescent Medicine and Health, ISSN (Online) 2191-0278, ISSN (Print) 0334-0139, DOI: https://doi.org/10.1515/ijamh-2014-0036.

Export Citation

©2015 by De Gruyter. Copyright Clearance Center

Citing Articles

Here you can find all Crossref-listed publications in which this article is cited. If you would like to receive automatic email messages as soon as this article is cited in other publications, simply activate the “Citation Alert” on the top of this page.

[1]
Gary S. Goldfield, Glen P. Kenny, Angela S. Alberga, Heather E. Tulloch, Steve Doucette, Jameason D. Cameron, and Ronald J. Sigal
Applied Physiology, Nutrition, and Metabolism, 2017, Volume 42, Number 4, Page 361
[2]
Jaapna Dhillon, Bruce A. Craig, Heather J. Leidy, Akua F. Amankwaah, Katherene Osei-Boadi Anguah, Ashley Jacobs, Blake L. Jones, Joshua B. Jones, Chelsey L. Keeler, Christine E.M. Keller, Megan A. McCrory, Rebecca L. Rivera, Maribeth Slebodnik, Richard D. Mattes, and Robin M. Tucker
Journal of the Academy of Nutrition and Dietetics, 2016, Volume 116, Number 6, Page 968

Comments (0)

Please log in or register to comment.
Log in