Predicting Weight Gain and Weight Loss Associated With Overeating or Fasting
Predicting Weight Gain and Weight Loss Associated With Overeating or Fasting
This study will investigate how to better predict why some individuals gain or lose weight
 more easily than others. It will examine whether the increase in the amount of energy a body
 burns in 24 hours with overeating or the decrease over 24 hours with fasting can help
 determine how easily someone gains or loses weight.

 Healthy people between 18 and 60 years of age who have a body mass index (BMI) between 18.5
 kg/m(2) and 24 kg/m(2) (for overfeeding study) or a BMI greater than 27 kg/m(2) with a body
 weight less than 350 pounds (weight loss study) may be eligible for this study. The study
 requires a 10-week admission to the NIH Clinical Center (2-week baseline, 6-week
 overfeeding/weight loss, 2-week post-weight change).

 Participants undergo the following tests and procedures during the hospital admission:

 -  Medical history, physical examination and laboratory studies

 -  Questionnaires to assess eating behavior, food preferences, body composition, and
 activity level

 -  Body composition assessment (height, weight, waist circumference, and fat mass and
 muscle content through DXA and MRI scans)

 -  Oral glucose tolerance test

 -  Meal test to measure the response of certain hormones to food

 -  Activity monitors to determine activity level

 -  Metabolic chamber study to measure calories burned over 24 hours and monitor body
 temperature

 -  Free-living energy use study to measure calories burned under normal home conditions
 over 7 days

 -  Fat and muscle biopsies

 -  Dietary intervention: Measurements of food intake and energy loss over a 6-week
 overfeeding (1.5 times the subject s normal food intake) or weight loss (one-half the
 subject s normal food intake) program

 Followup procedures after the inpatient stay:

 -  Height and weight measurements at 6 months (overfeeding study participants) and monthly
 for the first year, at 3-month intervals for the second year, and then yearly for 3 more
 years (weight loss study participants)

 -  Yearly visits (2-night inpatient stay) for all participants for repeat meal test, DXA,
 oral glucose tolerance test, behavioral questionnaires and, in women who can become
 pregnant, pregnancy test
For obese individuals, losing weight and keeping it off are extremely difficult, whereas some
 other individuals are thin and report trouble gaining weight. In most weight loss and
 overfeeding studies there is a large variation in the amount of weight lost or gained, and it
 is not clear whether an individual s response to an intervention can be predicted.
 Measurement of the amount of energy an individual uses over 24 hours (24 hour energy
 expenditure or 24-EE) and the response of 24-EE to overfeeding and fasting may help predict
 which individuals will have the greatest changes in weight with changes in energy balance. In
 previous work, 24-EE responses to overfeeding and fasting were related such that individuals
 with the greatest increase in 24-EE upon overfeeding tended to have the smallest decrease in
 24-EE upon fasting ( spendthrift phenotype) and those individuals with less increase in 24-EE
 during overfeeding had a greater decrease in 24-EE with fasting ( thrifty phenotype). Those
 with the spendthrift phenotype who had a greater increase in 24-EE in response to overfeeding
 gained less weight over time. Furthermore, studies have shown that diets with very low
 protein content may magnify the variability in response to overfeeding.

 The aim of this study is to determine if a phenotype defined by 24-EE responses to
 overfeeding and underfeeding is related to weight loss or gain in 4 different under- and
 overfeeding settings: an inpatient weight loss group for obese individuals who will be
 administered one of two diets based on a 50% reduction of their daily energy needs for six
 weeks (standard reduction diet or calorie reduced diet that is still high in protein; 6 week
 weight reduction, 10 week stay, n=20/standard reduction diet group and n=10/relative high
 protein diet), and two overfeeding groups for lean, weight gain resistant individuals: a
 low-protein overfeeding group at 150% of daily energy needs for 6 weeks overfeeding (6%
 protein, 64% carbohydrate, 30% fat; 10 week stay, n=10), and a normal protein overfeeding
 group at 150% of daily energy needs for 6 weeks overfeeding (20% protein, 50% carbohydrate,
 30% fat; 10 week stay, n=10). We will also examine additional metabolic and behavioral
 measurements to determine how they relate to weight change and changes in 24-EE. These
 include sympathetic nervous system activity, behavior, adipose and muscle tissue energy
 content, and abdominal adipocyte size. The study will evaluate the relationship between the
 percent increase in 24-EE in response to overfeeding/underfeeding and the amount of weight
 change over time in each subject. These findings may provide important information for
 predicting and adapting specific individualized interventions for obesity.
-  INCLUSION CRITERIA:

 -  BMI greater than or equal to 27 kg/m(2) for the weight loss protocol but body weight
 less than 350 pounds to accommodate the DXA scanner.

 -  BMI less than or equal to 24 kg/m(2) (and BMI greater than or equal to 18.5 kg/m(2)
 for the overfeeding protocols. A history of low BMI and difficulty gaining weight.

 -  Age 18-60 years, to minimize potential co-morbid conditions which may indirectly
 affect EE. Minors under the age of 18 will be excluded because growth and pubertal
 issues are significant parameters that could affect our outcomes and also because the
 time requirements of the study are such that they would interfere with school
 schedules. Women who are post-menopausal will be excluded from the study as changes in
 their metabolism could affect the baseline measurements which are hypothesized to
 predict weight change.

 -  Healthy, as determined by medical history, physical examination, and laboratory tests

 EXCLUSION CRITERIA:

 -  Current smoking

 -  Type 2 diabetes (according to the World Health Organization diagnostic criteria)

 -  Impaired glucose tolerance (according to the World Health Organization diagnostic
 criteria) for those participating in the overfeeding study arms only

 -  Endocrine disorders (Cushing s Disease, pituitary disorders, and hypo- and
 hyperthyroidism)

 -  Chronic pulmonary disorders, including chronic obstructive pulmonary disease that
 would limit ability to follow the protocol (investigator judgment) and obstructive
 sleep apnea syndrome; only subjects with mild or exercise-induced asthma on no
 medications or on beta-adrenergic agonists only (such as albuterol) will be allowed to
 enter the study (provided use of these agents is not required for one week before
 study entry).

 -  Cardiovascular diseases (coronary heart disease, heart failure, arrhythmias, and
 peripheral artery disease)

 -  Hypertension (blood pressure measurement higher than 140/90 mm Hg (overfeeding study)
 or 160/95 (weight loss study) on two or more occasions or use of anti-hypertensive
 medications)

 -  Diagnosed gastrointestinal diseases, including inflammatory bowel diseases (e.g.,
 Crohn s disease and ulcerative colitis), malabsorption syndromes (e.g., celiac
 disease), gastric ulcer (active); only subjects with gastro-esophageal reflux will be
 allowed to enter the study

 -  Presence of a pacemaker or other implantable devices/shrapnel which may interfere with
 the MRI or CorTemp measurements

 -  Liver disease (cirrhosis, active hepatitis B or C, and AST or ALT greater than or
 equal to 1.5 times normal)

 -  Renal disease (serum creatinine concentrations greater than or equal to 1.5 mg/dl
 and/or overt proteinuria)

 -  Central nervous system disease (cerebrovascular accidents, dementia, and
 neurodegenerative disorders)

 -  Cancer requiring treatment in the past five years, except for non-melanoma skin
 cancers or cancers that have clearly been cured or in the opinion of the investigator
 carry an excellent prognosis (e.g., Stage 1 cervical cancer)

 -  Alcohol (more than 3 drinks per day) and/or drug abuse (such as amphetamines, cocaine,
 heroin, or marijuana)

 -  Current or past history of: bipolar disorder, schizophrenia or presence of psychotic
 symptoms, bulimia nervosa or anorexia nervosa, or current major depressive disorder

 -  Pregnancy or lactation

 -  Taking weight loss medications

 -  Weight change of plus or minus 5% in the last 3 months

 Conditions not specifically mentioned above may serve as criteria for exclusion at the
 discretion of the investigators. Additionally, potential subjects might be excluded if they
 demonstrate a style of interpersonal relationships that would inhibit successful completion
 of the study.