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A Parable
Jonathan Krakoff, M.D.
Chief, Obesity and Diabetes Clinical Research Section
Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes,
Digestive and Kidney Diseases
National Institutes of Health
Phoenix, Arizona
For the National Press Foundation
February 23rd, 2016
Inpatient unit
Metabolic kitchen
Whole Room Indirect Calorimeters (2)
Bomb calorimetry
Automated vending machines
re
it u
nd
pe
Ex
Int
e
ak
Body Weight
1700s, Antoine-Laurent de
Lavoisier theorized:
Burning candle needs oxygen
& releases heat
So do organisms need oxygen
and release heat as they combust
food
Energy Expenditure
Nutrient metabolism creates energy
Extraction of chemical energy occurs via oxidation
(burning) of fuels to CO2 and H2O
Measure gas whole body O2 consumption & CO2
release
Energy production=energy liberated from oxidizing
carbohydrates + lipids + proteins
When you measure the change in 02 and C02=
Indirect Calorimetry
Activity
related
Total
Daily EE
Thermic
effect of
food
Resting
Metabolic
Rate
Energy from
physical activity
Bigger people
burn more energy
Activity
related
Total
Daily EE
Thermic
effect of
food
Resting
Metabolic
Rate
Energy from
physical activity
What happens to EE
when we overeat?
Energy from food
consumption
101%
increas
e in EE
15
% change in Energy expenditure
10.4
10
5
0
-5
-10
-7.4
Lunc
h
Dinner
Snac
k
2.2
Sleep
2
1.8
EE per min (kcal)
1.6
1.4
1.2
1
0:00
4:00
EU = Energy Balance
FST = fasting
8:00
12:00
16:00
20:00
2.4
2.2
2
1.8
4:00
8:00
12:00
EU = Energy
Balance
16:00
20:00
r=0.71,
p<0.01
Spendthrift
Thrifty
Weyer et al, Int. J. Obesity, 2001
Study outline
Oral Glucose Tolerance Test to assure did not have diabetes
Screening
Baseline
42 days
caloric
restriction
r=-0.84, p=0.0006
Study outline
Screening
Baseline
Indirect
Calorimetry
5 x 200% overfeeding
1 Fasting
Random order
Intervention 3 day wash out period with weight maintaining diet between calorimeter
Diets
stays
@ 6 months
Long term Annual x 7 years
Follow Up
Summary
Energy expenditure measured in energy balance
is a very weak predictor of weight gain
We have identified spendthrift and thrifty
phenotypes defined by fasting and overfeeding
which:
Identify individuals likely to do less well with caloric
restriction
Are at risk for future weight gain
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