Significant Behavioral Changes Needed to Maintain Weight Loss, According to Commentary in the Journal of the American Dietetic Association

AURORA, Colo. (Oct. 31, 2009) – Americans are getting heavier. Most weight control methods short of bariatric surgery are generally ineffective in preventing obesity or reducing weight. The term energy gap was coined to estimate the change in energy balance (intake and expenditure) behaviors required to achieve and sustain reduced body weight outcomes in individuals and populations. In a commentary published in the Nov. 2009 issue of the Journal of the American Dietetic Association, researchers from University of Colorado Denver’s School of Medicine and Procter & Gamble Company more precisely clarify the concept of the energy gap (or energy gaps) and discuss how the concept can be properly used as a tool to help understand and address obesity.

Investigators from CU Denver’s School of Medicine and the Procter & Gamble Company, Mason, OH, discuss the two key factors related to the energy gap concept: prevention of excess weight gain and maintenance of achieved weight loss. It is estimated that the energy gap for prevention of weight gain among those who have lost weight is approximately 100 kcal/day in adults and 100-150 kcal/day in children and adolescents. Any combination of increased energy expenditure and decreased energy intake of 100 kcal/day in adults and 100-150 kcal/day for children and adolescents could theoretically prevent weight gain in 90 percent of the US population. This suggests that this small changes approach could be very effective for preventing excessive weight gain in adults and children.

The energy gap to maintain weight loss is generally much larger, amounting to 200 kcal/day for a 100 kg person losing 10 percent of body weight or 300 kcal/day for the same person losing 15 percent of body weight.

 “This analysis indicates that to create and maintain substantial weight loss (ie, obesity treatment), large behavioral changes are needed,” said James O. Hill, PhD, CU Denver Center for Human Nutrition and professor at CU Denver’s School of Medicine. “This is in stark contrast to primary obesity prevention in which small behavioral changes can eliminate the small energy imbalance that occurs before the body has gained substantial weight. Because the body has not previously stored this ‘new’ excess energy, it does not defend against the behavioral strategies as happens when the body loses weight.”

According to Hill, prevention of excessive weight gain can be accomplished with small behavior changes such as the following: getting a pedometer and walking an additional 2000 steps/day (approximately one mile); increasing steps by walking the dog; walking while talking on the phone and taking walking meetings. Small changes in diet can be achieved by reducing portion sizes – just by leaving a few bites of food on the plate; replacing sugary beverages with those containing non-caloric sweeteners (ie. diet drinks) and choosing versions of food that are reduced in fat and calories.

The energy gap concept is useful for individualizing behavioral strategies for weight loss maintenance. For example, if the energy gap for a given weight-loss maintenance is estimated to be 300 kcal/day, this can lead to a specific individually tailored goal for changing diet and physical activity rather than generic advice to eat less and exercise more. This could be 300 kcal/day of additional physical activity, a reduction of 300 kcal/day from usual energy intake, or a combination of tactics such as adding 150 kcal/day of physical activity and reducing 150 kcal/day from usual energy intake.

Hundreds of tips for small changes in diet and physical activity can be found at

The article is “Using the Energy Gap to Address Obesity: A Commentary” by James O. Hill, PhD; John C. Peters, PhD; and Holly R. Wyatt, MD, associate professor, CU Denver School of Medicine. It appears in the Journal of the American Dietetic Association, Volume 109, Issue 11 (Nov. 2009), published by Elsevier.

Full text of the article featured above is available upon request. Contact Lynelle Korte at 314-447-9227 or [email protected] to obtain copies.

Faculty at the University of Colorado Denver’s School of Medicine work to advance science and improve care. These faculty members include physicians, educators and scientists at University of Colorado Hospital, The Children’s Hospital, Denver Health, National Jewish Health, and the Denver Veterans Affairs Medical Center. Degrees offered by the CU Denver School of Medicine include doctor of medicine, doctor of physical therapy, and masters of physician assistant studies.  The School is located on the University of Colorado’s Anschutz Medical Campus, one of four campuses in the University of Colorado system. For additional news and information, please visit the CU Denver newsroom online.

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