9.45 SU James Krieger PT Summit osa 1 (STRIIMI) · 2019. 4. 5. · *hwwlqj 0ruh :donlqj lqwr

THE METABOLISM MYTHThe Impact o f NEAT on Weight & Body Fat Regula t ion

James Krieger, M.S.

I hate you. You just have a fast

metabolism

It seems like I can eat whatever I want to and never gain any weight

Feb 7, 2005 Dec 4, 2005

“Slow metabolism”?

“Fast metabolism?”

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

What comprises the total amount of

energy you expend each day?

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


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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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?

Do reduced-obese people have low

RMR’s?

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


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RMR (calories per day)


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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26,9 26,8RMR (calories per

kilogram of FFM per day)

Initial 10% Weight Loss 20% Weight Loss

Rosenbaum & Leibel, Obesity, 24:1620-1629, 2016

No Relationship Between RMR & Weight Loss

Christensen et al, Clin Obes, Feb 7, 2017 [Epub ahead of print]

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

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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Do reduced obese people have lower

TEFs?

TEF in Reduced-Obese People

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TEF (calories per day)



Do Reduced Obese People Have Lower TEFs?





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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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Activity Energy Expenditure (calories

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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

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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Non-Resting Energy Expenditure (calories per kilogram of body

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Where Is the Decreased Activity

Coming From?

Measuring NEAT

• 177 subjects confined to a human respiratory chamber

Ravussin et al., J. Clin. Invest., 78:1568-1578, 1986

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

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

Role of NEAT in Resistance to Fat Gain


NEAT Prevents Fat Gain in Rodents

Teske et al., Int J Obes, 36:603-613, 2012

Dark Circles = Obesity Prone, Open Circles = Obesity Resistant

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

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!!!!!

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

NEAT Decreases With Age

Harris et al., Am. J. Physiol. Endocrinol. Metab., 292:1207-1212, 2007

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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Diet Diet + Low EX Diet + High EX

Decrease in Physical Activity Energy Expenditure (kcal/d)

More Weight Loss = More Decreases in Energy Expenditure & NEAT


Tremendous variance in NEAT response to weight loss

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

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

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

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

Biological Regulation of NEAT Is Complicated!

Garland et al., J Exp Biol, 214:206-229, 2011

Obese vs. Lean NEAT

• 20 self-proclaimed “couch potatoes”– 10 obese

– 10 lean

• Movements & energy expenditure measured for 10 days


Obese subjects sat 164 more minutes per day

NEAT was 352 calories per day less in obese subjects

NEAT Remained Low After Weight Loss

Feb 7, 2005 Dec 4, 2005

Low “NEAT-o-type”

High “NEAT-o-type”

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


• 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


Walking contributes to the majority of daily NEAT

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

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

Accelerometers Improve Long-Term Weight Maintenance

Nicklas et al., Obesity, 22:1406-1412, 2014

Ways to Decrease NEAT

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



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.

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

You’re just a NEAT freak.

It seems like I can eat whatever I want to and never gain any weight

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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Documents

9.45 SU James Krieger PT Summit osa 1 (STRIIMI) · 2019. 4. 5. · *hwwlqj 0ruh :donlqj lqwr