9.45 SU James Krieger PT Summit osa 1 (STRIIMI) · 2019. 4. 5. · *hwwlqj 0ruh :donlqj lqwr
Transcript of 9.45 SU James Krieger PT Summit osa 1 (STRIIMI) · 2019. 4. 5. · *hwwlqj 0ruh :donlqj lqwr
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THE METABOLISM MYTHThe Impact o f NEAT on Weight & Body Fat Regula t ion
James Krieger, M.S.
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I hate you. You just have a fast
metabolism
It seems like I can eat whatever I want to and never gain any weight
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Feb 7, 2005 Dec 4, 2005
“Slow metabolism”?
“Fast metabolism?”
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Diminished Calorie Requirements in Obese People Who’ve Lost Weight
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Energy Requirement (calories per day)
Reduced Obese (Maintained 5-8 Wk) Reduced Obese (Maintained >1 Yr) Weight Matched Control
Rosenbaum et al, Am J Clin Nutr, 88(4):906-912, 2008
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What comprises the total amount of
energy you expend each day?
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Components of Daily Energy Expenditure: Physically Active
Thermic Effect of Feeding
8%
Physical Activity32%
Resting Metabolic Rate60%
Exercise Non-Exercise Activity Thermogenesis(NEAT)
Components of Daily Energy Expenditure: Physically Active
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Diminished Calorie Requirements in Obese People Who’ve Lost Weight
Where does this reduced energy requirement come from?
Lower Resting Metabolic Rate?Lower Thermic Effect of Feeding (TEF)?
Lower Physical Activity?
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Energy Requirement (calories per day)
Reduced Obese (Maintained 5-8 Wk) Reduced Obese (Maintained >1 Yr) Weight Matched Control
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Let’s answer these questions…
• Do reduced-obese people have low RMR’s?
• Do reduced-obese people have low TEF’s?
• Do reduced-obese people have lower physical activity levels?
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Do reduced-obese people have low
RMR’s?
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RMR in People Who’ve Lost Weight
• Meticulously controlled inpatient formula diet to ensure weight stability and consistent macronutrient intake
• ~100 kcal RMR reduction in people who have lost at least 10% of weight
– True even if weight loss has been maintained for 1 year
Rosenbaum et al, Am J Clin Nutr, 88(4):906-912, 2008
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Reduced Obese (Maintained 5-8 Wk) Reduced Obese (Maintained >1 Yr) Weight Matched Control
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There’s a Limit To How Much RMR Can Fall
• RMR significantly fell with 10% weight loss, but did not significantly fall with another 10% weight loss
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Initial 10% Weight Loss 20% Weight Loss
Rosenbaum & Leibel, Obesity, 24:1620-1629, 2016
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No Relationship Between RMR & Weight Loss
Christensen et al, Clin Obes, Feb 7, 2017 [Epub ahead of print]
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No Relationship Between RMR & Weight Gain
Weinsier et al., Am J Clin Nutr, 72:1088-1094, 2000Anthanont & Jensen, Am J Clin Nutr, 104:959-963, 2016
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Do Reduced-Obese People Have Low RMR’s?
• Yes but minor
– RMR in post-obese individuals is ~100 kcal lower than weight-matched controls
– True even if weight loss has been maintained for 1 year
• RMR does not continue to fall with continued weight loss
• RMR is not predictive of people’s tendencies to gain or lose weight
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Diminished Calorie Requirements in Obese People Who’ve Lost Weight
Where does this reduced energy requirement come from?
Lower Resting Metabolic Rate?Lower Thermic Effect of Feeding (TEF)?
Lower Physical Activity?
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Energy Requirement (calories per day)
Reduced Obese (Maintained 5-8 Wk) Reduced Obese (Maintained >1 Yr) Weight Matched Control
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Do reduced obese people have lower
TEFs?
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TEF in Reduced-Obese People
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TEF (calories per day)
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Rosenbaum et al, Am J Clin Nutr, 88(4):906-912, 2008
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Do Reduced Obese People Have Lower TEFs?
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Diminished Calorie Requirements in Obese People Who’ve Lost Weight
Where does this reduced energy requirement come from?
Lower Resting Metabolic Rate?Lower Thermic Effect of Feeding (TEF)?
Lower Physical Activity?
0
500
1000
1500
2000
2500
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2357 2443
2871
Energy Requirement (calories per day)
Reduced Obese (Maintained 5-8 Wk) Reduced Obese (Maintained >1 Yr) Weight Matched Control
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Weight Loss Leads to Decrease in Activity Energy Expenditure
• Activity expenditure decreased nearly 400 kcal in people who have lost at least 10% of weight compared to controls1
– True even if weight loss has been maintained for 1 year1
– Part of the decrease is due to an increase in efficiency2
1. Rosenbaum et al, Am J Clin Nutr, 88(4):906-912, 20082. Goldsmith et al, Am J Physiol, 298:R79-R88, 2010
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• 10 reduced-obese subjects who lost 23.2% of body weight
• RMR was 97.5% of predicted
• 24-hour energy expenditure was 75.7% of predicted– Decrease in activity energy expenditure of
582 calories per day!!!!!!!
Weigle et al., Metabolism, 37:930-936, 1988
Weight Loss Leads to Decrease in Activity Energy Expenditure
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Decline in Activity Energy Expenditure is Proportional to Weight Loss
• Unlike REE, activity energy expenditure continues to fall with further weight loss, even after correcting for body mass
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Rosenbaum & Leibel, Obesity, 24:1620-1629, 2016
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Diminished Calorie Requirements in Obese People Who’ve Lost Weight
Where does this reduced energy requirement come from?
Lower Resting Metabolic Rate?Lower Thermic Effect of Feeding (TEF)?
Lower Physical Activity?
0
500
1000
1500
2000
2500
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2357 2443
2871
Energy Requirement (calories per day)
Reduced Obese (Maintained 5-8 Wk) Reduced Obese (Maintained >1 Yr) Weight Matched Control
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Where Is the Decreased Activity
Coming From?
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Measuring NEAT
• 177 subjects confined to a human respiratory chamber
Ravussin et al., J. Clin. Invest., 78:1568-1578, 1986
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Measuring NEAT
• Large portion of variability due to NEAT– Accounted for up to 138-685 calories per
day!!!!!!!!!!
Ravussin et al., J. Clin. Invest., 78:1568-1578, 1986
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Role of NEAT in Resistance to Fat Gain
• 16 non-obese subjects
• Overfed 1000 kcal/d
• 8 weeks
Levine et al., Science, 283:212-214, 1999
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Role of NEAT in Resistance to Fat Gain
Levine et al., Science, 283:212-214, 1999
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NEAT Prevents Fat Gain in Rodents
Teske et al., Int J Obes, 36:603-613, 2012
Dark Circles = Obesity Prone, Open Circles = Obesity Resistant
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NEAT Energy Expenditure
Energy Expenditure (calories per hour)
Resting 77
Sitting motionless 80
Sitting while fidgeting 118
Standing motionless 88
Standing while fidgeting 148
Walking at 1 mph 197
Walking at 2 mph 235
Walking at 3 mph 304Levine et al., Am. J. Clin. Nutr., 72:1451-1454, 2000
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NEAT Makes a Difference!
• 38 kcal/hr difference between sitting quietly & sitting while fidgeting– 300 kcal over 8 hours!!!!
• 60 kcal/hr difference between standing motionless & standing while fidgeting– 480 kcal over 8 hours!!!!!
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NEAT Makes a Difference!
RMR’s fall within this range
NEAT can impact energy expenditure by over 2000 calories per day!!!
Black et al., 1996
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NEAT Decreases With Age
Harris et al., Am. J. Physiol. Endocrinol. Metab., 292:1207-1212, 2007
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Weight Loss Decreases NEAT
• 34 overweight women
• 20-week diet with no exercise, or low or high intensity walking
• 6- and 12-mo follow-up
• Physical activity outside of exercise tracked with accelerometer
– Absolute and relative (kcal/kg) decreased after 30 lb weight loss
Wang et al., Med Sci Sports Exerc, 40:1781-1788, 2008
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More Weight Loss = More Decreases in Energy Expenditure & NEAT
Rosenbaum & Leibel, Obesity, 24:1620-1629, 2016
Tremendous variance in NEAT response to weight loss
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Structured Exercise Can Reduce NEAT In Some People
• 34 women engaged in a 13-week brisk walking program
• Women experienced improvement in weight and other health markers
• Some women increased physical activity energy expenditure, while others decreased it
Di Blasio et al., Menopause, 19(1):23-32, 2012
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Structured Exercise Can Reduce NEAT In Some People
• In three different studies, high intensity exercise (70%+ VO2 max) failed to increase daily energy expenditure in obese adolescents1
– Indicates compensation for exercise-induced energy expenditure
1. Thivel et al., Pediatr Obes, 9(2):147-154, 2014
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Our Society Contributes to Low NEAT
Energy savings from mechanization ~ 111 calories per day1
1. Lanningham-Foster et al., 20032. Levine et al., 20113. Shoham et al, 2015
Urbanization is associated with lower NEAT levels2
Car ownership is associated with 24 less minutes of daily moderate-to-vigorous activity3
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NEAT Levels Are Partly Genetic
• NEAT clusters in human families1
• NEAT clusters in rodent strains2
2. Brownlow et al., 1996
1. Webb et al., 1996
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Biological Regulation of NEAT Is Complicated!
Garland et al., J Exp Biol, 214:206-229, 2011
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Obese vs. Lean NEAT
• 20 self-proclaimed “couch potatoes”– 10 obese
– 10 lean
• Movements & energy expenditure measured for 10 days
Levine et al., Science, 307:584-586, 2005
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Obese subjects sat 164 more minutes per day
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NEAT was 352 calories per day less in obese subjects
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NEAT Remained Low After Weight Loss
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Feb 7, 2005 Dec 4, 2005
Low “NEAT-o-type”
High “NEAT-o-type”
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The High NEAT-O-Type: A Case Study
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The High NEAT-O-Type: A Case Study
• Predicted RMR (Mifflin)– 1,847 calories per day
• Measured RMR– 1,671 calories per day
– 90% of predicted
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The High NEAT-O-Type: A Case Study
• Predicted Total Daily Energy Expenditure (TDEE)– Measured RMR x 1.6
• 2,674 calories per day
– NAS equations• Lightly active: 2,841 calories per day
• Active: 3,156 calories per day
• Measured TDEE– 3,363 calories per day
– 107% - 126% of predicted
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The High NEAT-O-Type: A Case Study
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Walking contributes to the majority of daily NEAT
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Getting More Walking into Your Day
• Walk to work• Walk during lunch hour• Take family walk after dinner• Set up treadmill in front of TV• Mow lawn with push mower• Take stairs instead of escalator or
elevator• Park farther from destination• Walk to co-worker’s desk instead of
emailing or calling them• Get off a stop early and walk• Buy a dog and walk it• Pace sidelines at kids’ athletic games• Buy a pedometer or accelerometer
Omron HJ-112
*Dwyer et al., 2006
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Pedometers & Accelerometers Help Increase NEAT
• Pedometers help increase physical activity in a large number of studies1-7
• Accelerometers also increase physical activity8-10
1. Pal et al., BMC Public Health, 9:309, 20092. Tudor-Locke & Lutes, Sports Med, 39:981-993, 20093. McMurdo et al., J Am Geriatr Soc, 58:2099-2106, 20104. Funk & Taylor, Curr Diabetes Rev, 9:462-471, 20135. Mansi et al., BMC Musculoskelet Disord, 15:231, 20146. Cayir et al, Eur J Sport Sci, 15:351-356, 20157. Nowicki et al., J Nephrol, 23:297-305, 20108. Cadmus-Bertram et al, Am J Prev Med, 49:414-418, 20159. Wang et al, Telemed J E Health, 21(10):782-792, 201510. Jauho et al, Prev Med Rep, 2:628-634, 2015
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Accelerometers Improve Long-Term Weight Maintenance
Nicklas et al., Obesity, 22:1406-1412, 2014
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Ways to Decrease NEAT
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Increasing NEAT in the Workplace
1. Levine & Miller, 20072. Thompson et al, 20143. Mansoubi et al, 2016
“Walk & Work Desk” ↑ energy expenditure by 119 kcal/hr1
“Walk & Work Desk” resulted in 4 lb weight loss over 12 weeks2
Sit-to-Stand desks increase NEAT during working hours, but changes are compensated during non-working hours so no overall increase3
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Increasing NEAT in the Workplace
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Increasing NEAT in the Workplace
Time Period 1 minute of walking/hour; additional energy expenditure
2 minutes of walking/hour; additional energy expenditure
5 minutes of walking/hour; additional energy expenditure
1 hour 3 7.4 16.5
8 hour workday 24 59.2 132
1 week of 8 hour workdays
120 296 660
1 month of 8 hour workdays
480 1184 2640
6 months of 8 hour workdays
2880 7104 15840
12 months of 8 hour workdays
5760 14208 31680
Swartz, A.M., et al. Energy expenditure of interruptions to sedentary behavior. Int J Behav NutrPhys Act. 8:69, 2011.
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Resistance Training May Help NEAT
• Prevented decrease in NEAT during very low calorie diet1
• Enhanced NEAT by 120 kcal/d in elderly2
• Improved NEAT by 216 kcal/d on non-exercise days, versus 148 kcal decrease with aerobic exercise3
• Caused a decrease in muscle work efficiency4
– May mitigate adaptive thermogenesis by preventing the increase in efficiency that occurs with weight loss 1. Hunter et al., Med Sci Sports Exerc, 47:1950-1957, 2015
2. Hunter et al., J Appl Physiol, 89:977-984, 20003. Drenowatz et al, Springerplus, 4:798, 20154. Rosenbaum et al., Obesity, 26(10):1576-1583, 2018
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You’re just a NEAT freak.
It seems like I can eat whatever I want to and never gain any weight
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Summary
• NEAT plays a critical role in weight management
• NEAT, not resting metabolism, is a primary factor that influences people’s different tendencies to gain & lose weight
• NEAT levels are partly genetic & biologically regulated
• Weight loss can lead to a decrease in NEAT– More weight loss leads to larger decreases
– Response is highly variable between people
• Resistance training may improve NEAT and mitigate adaptive thermogenesis
• Conscious, consistent efforts to improve NEAT must be made to help with long-term fat loss success– Activity monitors will help in these efforts
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