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| Name | Class |
|---|---|
| University of Colorado, Boulder | OTHER |
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To more effectively address the problem of weight regain following weight loss for obese individuals, this study will evaluate the underlying biology of the reduced obese state. In depth studies of appetite, energy expenditure, physical activity levels and fat metabolism will be completed in obese and reduced obese individuals; with the latter subdivided into those who have lost weight with diet alone or diet plus exercise. Individuals will be studied following a brief overfeeding period to better understand how differences in biological responses to overeating might be involved in promoting or protecting against weight gain.
The persistent problem of weight regain following weight loss is perhaps the most significant barrier to addressing the current obesity epidemic. The biological drive to regain weight following weight loss is due in part to increased appetite leading to increased energy intake (EI) and reductions in energy expenditure (EE) in part due to changes in energy expended in physical activity (PA). These physiological adaptations to weight loss are most relevant during episodes of dietary indiscretion resulting in overfeeding (OF) when reduced obese (RO) people fail to respond to the state of positive energy balance in a way that maintains the reduced state. There is increasing evidence that RO individuals who exercise (RO-Ex) are less like to regain as compared to RO individuals who are sedentary (RO-Sed). Previous studies were conducted on the effects of OF on EI, EE, PA and fat metabolism in non-obese individuals either prone (OP) or resistant to obesity (OR). Subjects were then followed for 5 years to measure weight change. These studies showed that differences in the response of nocturnal fat oxidation and higher levels of moderate/vigorous PA following OF correlated with 5 year weight gain suggesting that these factors were potentially important mechanisms for weight gain. Previous work has shown that measures of hunger fail to suppress with OF in RO individuals and that nocturnal fat oxidation is reduced in RO-Sed but maintained in RO-Ex following a day that included a bout of exercise. This study will look at the responses of EE, EI, PA and fat metabolism to OF (40% above basal energy for 3 days) in obese, RO-Sed and RO-Ex men and women and correlate these responses to weight change over the subsequent year. The hypothesis is that changes in the response of one or more of these variables to OF will correlate with weight regain. The Significance of the studies lies in the fact that subjects will begin to clarify the metabolic mechanisms that underlie a propensity for weight regain in RO individuals. Innovation: The proposed studies will systematically examine a range of responses to OF and prospectively correlate them with weight gain while taking into account aspects of behavior relevant to weight regain. The hope is that these studies will lay a foundation for future studies that will examine the mechanisms underlying specific adaptive responses that directly relate to weight regain and help with the design of strategies to address and/or respond to these processes.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Control | Active Comparator | Persons with obesity who do not undergo weight loss will participate in an inpatient assessment to measure metabolic responses to a 3 day eucaloric diet or a 3 day overfeeding challenge. Participants will be followed for 1 year after the metabolic studies to track longitudinal changes in body weight and other relevant health outcomes. |
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| Reduced obese + diet + exercise | Experimental | Persons with obesity randomized to a weight loss program consisting of caloric restriction, behavioral support, and supervised endurance exercise training. Following weight loss persons in this group will participate in an inpatient assessment to measure metabolic responses to a 3 day eucaloric diet or a 3 day overfeeding challenge. Participants will be followed for 1 year after the metabolic studies to track longitudinal changes in body weight and other relevant health outcomes. |
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| Reduced obese + diet group | Active Comparator | Persons with obesity randomized to a weight loss program consisting of caloric restriction and behavioral support. Following weight loss persons in this group will participate in an inpatient assessment to measure metabolic responses to a 3 day eucaloric diet or a 3 day overfeeding challenge. Participants will be followed for 1 year after the metabolic studies to track longitudinal changes in body weight and other relevant health outcomes. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Weight Loss | Other | 12-wk weight loss intervention using a meal replacement strategy (Health & Nutrition Technology, Carmel, CA), with an 8-10% weight loss goal |
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| Measure | Description | Time Frame |
|---|---|---|
| Fat oxidation as a correlate of weight regain as measured by room calorimetry | Fat oxidation as a correlate of weight regain will be assessed in both reduced obese groups with room calorimetry on two occasions, once after 3 days of overfeeding and once after 3 days of an energy balanced diet. | 24 hour period on day 7 of two diet conditions - one overfed & one eucaloric condition; weeks 16 & 20 |
| Measure | Description | Time Frame |
|---|---|---|
| Body weight per scale | Body weight will be measured via clinic scale. Change in body weight in response to the weight loss intervention | Baseline, after 12 week weight loss intervention and 1 year after the end of second study condition |
| Body Composition via DXA |
| Measure | Description | Time Frame |
|---|---|---|
| Change in fitness as measured by indirect calorimetry | Fitness will be measured using indirect calorimetry during a graded exercise test to volitional exhaustion | 30 minutes at baseline and 1 year following second diet condition; Reduced group will have an additional measurement at week 12 following weight loss period. |
Inclusion criteria.
Exclusion criteria.
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Sheila Steinke, MS | Contact | 303.724.3304 | sheila.steinke@cuanschutz.edu | |
| Emilee Mickaliger, BS | Contact | emilee.mickaliger@cuanschutz.edu |
| Name | Affiliation | Role |
|---|---|---|
| Daniel Bessesen, MD | University of Colorado Anschutz Health and Wellness Center | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| University of Colorado Hospital | Recruiting | Aurora | Colorado | 80045 | United States |
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| ID | Term |
|---|---|
| D009765 | Obesity |
| ID | Term |
|---|---|
| D050177 | Overweight |
| D044343 | Overnutrition |
| D009748 | Nutrition Disorders |
| D009750 | Nutritional and Metabolic Diseases |
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| ID | Term |
|---|---|
| D015444 | Exercise |
| ID | Term |
|---|---|
| D009043 | Motor Activity |
| D009068 | Movement |
| D009142 | Musculoskeletal Physiological Phenomena |
| D055687 | Musculoskeletal and Neural Physiological Phenomena |
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Persons with obesity will be randomized to receive weight loss with or without supervised exercise. Metabolic phenotyping studies will be performed in both groups in the weight reduced state and compared to a group of obese persons not undergoing weight loss. All participants will be followed for a period of 1 year following metabolic phenotyping to track longitudinal changes in weight and other relevant outcomes measures.
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| Exercise training | Other | 16-wk supervised endurance exercise training program |
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| Overfeeding | Other | 3-day hypercaloric diet designed to overfeed by 40% above total daily energy requirements |
|
Body composition will be measured via DXA, Change in body composition in response to the weight loss intervention |
| Baseline, after 12 week weight loss intervention and 1 year after the end of second study condition |
| Change in substrate utilization as measured by room calorimetry | Substrate utilization will be measured by room calorimetry (change = overfeeding diet condition - eucaloric diet condition) | 24 hour period, on day 7 of two diet conditions - eucaloric and overfed; week 1 and 4 for controls and week 16 & 20 for reduced groups |
| Change in nocturnal lipolysis as measured by use of stable isotope tracer | Lipolysis will be measured using stable isotope tracers (change = overfeeding diet condition - eucaloric diet condition) | 24 hour period, on day 7 of two diet conditions - eucaloric and overfed; week 1 and 4 for controls and weeks 16 and 20 for reduced |
| Change in total energy expenditure (TEE) as measured by room calorimetry | TEE will be measured by room calorimetry (change = overfeeding diet condition - eucaloric diet condition) | 24 hour period, on day 7 of two diet conditions - eucaloric and overfed; week 1 and 4 for controls and weeks 16 and 20 for reduced |
| Change in spontaneous physical activity (SPA) as measured by accelerometers | SPA will be measured using accelerometers (change = overfeeding diet condition - eucaloric diet condition) | 7 days, on days 4-10 of two diet conditions - eucaloric and overfed; week 1 and 4 for controls and weeks 16 and 20 for reduced |
| Change in spontaneous food intake measured with an ad libitum diet | Spontaneous food intake will be measured during a 3 day ad libitum diet (change = overfeeding diet condition - eucaloric diet condition) | 3 days - on days 8-10 - of two diet conditions - eucaloric and overfed; week 1 and 4 for controls and weeks 16 and 20 for reduced |
| Change in hunger and satiety using Visual Analog Scale | Hunger and satiety will be measured using visual analog scales (change = overfeeding diet condition - eucaloric diet condition) | 3 days - on days 8-10 - of two diet conditions - eucaloric and overfed; week 1 and 4 for controls and weeks 16 and 20 for reduced |
| Change in 24h hormone and metabolite profiles as measured by assay of plasma samples | 24h hormone and metabolite profiles will be assayed in plasma samples obtained during inpatient study visits (change = overfeeding diet condition - eucaloric diet condition) | 3 days - days 8-10 - of two diet conditions - eucaloric and overfed; week 1 and 4 for controls and weeks 16 and 20 for reduced |
| Lipolysis as a correlate of weight regain as measured by stable isotope tracer | Lipolysis as a correlate of weight regain will be assessed in both reduced obese groups with a stable isotope tracer on two occasions, once after 3 days of overfeeding and once after 3 days of an energy balanced diet. | 24 period, on day 7 of two diet conditions - eucaloric and overfed; week 1 and 4 for controls and weeks 16 and 20 for reduced |
| Total energy expenditure (TEE) as a correlate of weight regain as measured by room calorimetry | TEE as a correlate of weight regain will be assessed in both reduced obese groups with room calorimetry on two occasions, once after 3 days of overfeeding and once after 3 days of an energy balanced diet. | 24 period, on day 7 of two diet conditions - eucaloric and overfed; week 1 and 4 for controls and weeks 16 and 20 for reduced |
| Spontaneous physical activity (SPA) as a correlate of weight regain as measured by accelerometers | SPA as a correlate of weight regain will be assessed in both reduced obese groups with accelerometers on two occasions, once after 3 days of overfeeding and once after 3 days of an energy balanced diet. | 7 days, on days 4-10 of two diet conditions - eucaloric and overfed; week 1 and 4 for controls and weeks 16 and 20 for reduced |
| Spontaneous food intake as a correlate of weight regain as measured with an ad libitum diet | SPA as a correlate of weight regain will be assessed in both reduced obese groups with an ad libitum diet on two occasions, once after 3 days of overfeeding and once after 3 days of an energy balanced diet. | 3 days - days 8-10 of two diet conditions - eucaloric and overfed; week 1 and 4 for controls and weeks 16 and 20 for reduced |
| 24h hormone and metabolite profiles as a correlate of weight regain as measured by assay of plasma samples | 24h hormone and metabolite profiles as a correlate of weight regain will be assessed in both reduced obese groups by assay of plasma samples on two occasions, once after 3 days of overfeeding and once after 3 days of an energy balanced diet. | 24 period, on day 7 of two diet conditions - eucaloric and overfed; week 1 and 4 for controls and weeks 16 and 20 for reduced |
| Total daily energy expenditure as a correlate of weight regain as measured by doubly labeled water | Total daily energy expenditure as a correlate of weight regain will be measured in both reduced obese groups using doubly labeled water after the second diet condition intervention | two 1 week periods at 1 month and 1 year after second diet condition; week 8 and week 56 for controls and week 24 and week 72 for reduced |
| Correlates of Weight Regain as measured by questionnaire | Correlates of weight regain will be assessed in both reduced obese groups with questionnaires periodically over the intervention and follow-up period | 30 minutes at baseline and every 8 weeks for 1 year following second diet condition; weeks 12, 20, 28, 36, 44, 52 for controls and weeks 28, 36, 44, 52, 60, 68, for reduced. |
| D001835 |
| Body Weight |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |