Using the Energy Gap to Prevent Weight Regain

描述（由申请人提供）：肥胖治疗的主要障碍不是产生体重减轻，而是长期保持体重减轻。大多数先前的研究都旨在了解减肥的相关因素，并比较不同的减肥干预措施。我们认为减肥和维持减肥是不同的过程，一些对减肥有效的策略并不适用于保持体重。具体地说，我们认为大多数节食者用来减肥的策略——食物限制——不太可能成功地保持体重。我们认为，身体有一种生理驱动来维持高水平的能量消耗（即高能量吞吐量）。高能量消耗可以通过保持高水平的身体活动或增加体重来获得。肥胖的人在某种程度上是通过变胖的过程来达到高水平的能量消耗的。体重减轻后，由于新陈代谢下降，总能量消耗减少。我们把这种减少称为“能量缺口”，填补“能量缺口”是维持减肥的挑战。我们相信，大多数人试图通过限制能量摄入来填补“能量缺口”。从长期来看，这是困难的，因为它既反对生物，也反对环境。我们之前从国家体重控制登记处获得的数据表明，那些长期成功保持减肥的人通过体育活动弥补了“能量缺口”，从而在高能量消耗（即高能量消耗）的情况下实现了能量平衡。我们建议通过将个体随机分配到不同的方法来填补减肥后的“能量缺口”来评估这一假设。我们假设，那些被指定通过体育活动来弥补“能量缺口”的人，比那些被指定仅通过限制食物摄入或同时增加体育活动和限制食物摄入来弥补“能量缺口”的人，体重反弹得更少。我们进一步建议使用前沿技术来评估高水平活动产生的高能量吞吐量如何影响能量平衡的组成部分以及摄入与消耗的匹配。如果我们的假设是正确的，估计“能量缺口”可以在临床实践中进行，并可以为维持减肥所需的生活方式改变提供定量处方。它将提供一种新的策略，帮助公众更成功地保持减肥效果。

DESCRIPTION (provided by applicant): The major obstacle for obesity treatment is not producing weight loss but in maintaining weight losses over time. Most previous research has been aimed at understanding the factors involved in weight loss and comparing different interventions for weight loss. We propose that weight loss and weight loss maintenance are different processes and that some strategies that work well for losing weight do not work well for keeping weight off. Specifically, we propose that the strategy used by most dieters to keep weight off - food restriction - is not likely to lead to success in keeping weight off. We believe that the body has a physiological drive to maintain a high level of energy expenditure (i.e. high energy throughput). The high energy expenditure can be obtained by maintaining a high level of physical activity or by increasing body weight. Obese individuals have achieved a high level of energy expenditure in part through the process of becoming obese. After weight loss, total energy expenditure is reduced due to declines in metabolism. We have termed this reduction as the "energy gap" and filling the "energy gap" is the challenge for weight loss maintenance. We believe that most people try to fill the "energy gap" by restricting energy intake. This is difficult over the long-term because it opposes both biology and the environment. Our previous data from the National Weight Control Registry suggest that those individuals who are successful in long-term weight loss maintenance close the "energy gap" by physical activity, thus allowing energy balance to be achieved at high energy expenditure (i.e. high energy throughput). We propose to evaluate this hypothesis by randomly assigning individuals to different methods for filling the "energy gap" following weight loss. We hypothesize that those who are assigned to close the "energy gap" with physical activity will regain less weight than those assigned to close the "energy gap" with food restriction alone or with a combination of increased physical activity and food restriction. We further propose to use leading edge techniques to assess how a high energy throughput produced by a high level of activity affects components of energy balance and matching of intake with expenditure. If our hypothesis is correct, estimating the "energy gap" could be done in clinical practice and could provide a quantitative prescription for lifestyle changes required for weight loss maintenance. It would provide a new strategy to help the public be more successful at maintaining a weight loss.