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We measured the effects of iopanoic acid on thyroid hormone metabolism in obese men during severe calorie restriction to study the nutrition regulation of thyroid hormone metabolism. Eight morbidly obese men received a weight-maintenance diet followed by 6 wk of 600 kcal/d. During underfeeding, patients received iopanoic acid or placebo for 2-wk periods in a double-blind crossover fashion. Underfeeding alone (UF) produced a 28.3% decline in the serum triiodothyronine (T3) concentration, and iopanoic acid plus underfeeding (IOP) produced a 49.5% decline in T3 concentration from baseline. Serum reverse T3 concentrations increased 289% during IOP compared with UF alone (p less than 0.001). Serum TSH concentration was unchanged by underfeeding but increased twofold during IOP treatment. Thyroid hormone kinetics demonstrated a decrease in T3 production during IOP compared with UF. These findings suggest that calorie restriction regulates T3 production by modulating only type I 5'-deiodinase activity.

This study examined changes in body fat distribution in 68 women who lost an average of 12.3 kg from an initial weight of 103.6 kg. Weight reduction was accompanied by a small but statistically significant reduction of 1.2% in the waist-to-hip ratio, suggestive of a reduction in upper-body obesity. Subjects with greater upper-body obesity tended to achieve greater reductions in the waist-to-hip ratio. Changes in five circumference measures were highly correlated with losses of fat and showed that subjects with lower-body obesity tended to lose large amounts of fat from both their upper and lower fat depots while subjects with upper-body obesity lost fat primarily from their upper depots. Women with lower-body obesity tended to lose more total body fat than did women with upper body obesity (r = -0.26, p less than 0.04).

During 1977 and 1978, 17 obese but otherwise healthy adult Americans died suddenly of ventricular arrhythmias during or shortly after completing rapid, massive weight reduction induced by very low-calorie diets consisting largely of collagen hydrolysates for 2 to 8 months. A reexamination of the data on these victims has disclosed a significant positive correlation (r = 0.824) between their prediet body mass index and their duration of survival on the very low-calorie diets. Since body mass index reflects degree of fatness, this observation indicates that the ability to defer the lethal effects of severe caloric restriction was a function of the proportion of body fat before dieting. During caloric reduction, the ratio of nitrogen loss to weight loss is inversely related to body fat content; accordingly, we suggest that the fattest dieters survived the longest because they were better able to conserve body (and myocardial) protein. Also, obese people have an enlarged lean body mass which may afford additional protection.

This study validated further the bioelectrical impedance analysis (BIA) method for body composition estimation. At four laboratories densitometrically-determined lean body mass (LBMd) was compared with BIA in 1567 adults (1069 men, 498 women) aged 17-62 y and with 3-56% body fat. Equations for predicting LBMd from resistance measured by BIA, height, weight, and age were obtained for the men and women. Application of each equation to the data from the other labs yielded small reductions in R values and small increases in SEEs. Some regression coefficients differed among labs but these differences were eliminated after adjustment for differences among labs in the subjects' body fatness. All data were pooled to derive fatness-specific equations for predicting LBMd: the resulting R values ranged from 0.907 to 0.952 with SEEs of 1.97-3.03 kg. These results confirm the validity of BIA and indicate that the precision of predicting LBM from impedance can be enhanced by sex- and fatness-specific equations.

The background information is reviewed regarding the American Society for Clinical Nutrition task force consensus statement on calories. Prevention or treatment of obesity necessarily involves manipulation of energy intake and output. The most important public health disorders to which obesity contributes are cardiovascular disease, diabetes mellitus, gallbladder disease, psychosocial disability, and musculoskeletal disorders. Other conditions associated with obesity include renal disease, liver disorders, ventilatory defects, venous stasis and thromboembolisms, gout, cerebrovascular disease, and (in women) endometrial and possible breast cancer. Obese persons are open to greater risk from surgery, anesthesia, and accidents, and they have a high rate of employee absenteeism. Statistics regarding relative body weight and longevity are examined.

An inventory control model is used to describe the regulation of depot fat and contribution made to the satiation process by putative feedback signals. In the two bin inventory control system, adipose tissue is viewed as a large storage reservoir which is periodically refilled by means of adjustments made in meal consumption. The gastrointestinal tract is viewed as a smaller bin which triggers renewed food ingestion when it becomes partially emptied. However, reduction in the contents of the adipose tissue bin below a critical level (reorder point quantity) generates a signal to the brain that appropriately modulates meal size and intermeal interval. Because this model evolved to cope with worst case situations, a strong bias for storage in time of plenty is inherent in the system. This fact helps to account for the high prevalence of obesity in energy-rich societies, where, in contrast to the situation that obtains in primitive societies, the energy cost of obtaining food is minimal.

It has been suggested that sufficient fiber in the diet will tend to prevent excessive food intake and depot fat accumulation by decreasing the caloric density of the diet, stowing rate of food ingestion, increasing the effort involved in eating, promoting intestinal satiety, and interfering slightly with efficiency of energy absorption. The increase in the prevalence of obesity in Western countries since 1900 has taken place concurrently with marked changes in the nature of the diet. Per capita intake of dietary fiber associated with starchy foods has greatly decreased, but intake of fiber associated with fruits and green vegetables has increased. Thus, although the type of fiber in the diet has changed, the total quantity may not have diminished considerably. Studies of the effect of caloric dilution with cellulose and other metabolically inert bulking agents have disclosed little or no inhibitory effect on the spontaneous energy intake of nonobese laboratory animals and human subjects. Nevertheless, there is evidence that obese rats and humans may defend their excess weight against nutritive dilution with less tenacity than their nonobese counterparts. The hypothesis that dietary fiber can protect against obesity therefore deserves further testing since an increase in the fiber content of the diet may tend to prevent overeating and excessive weight gain even if it does not reduce spontaneous energy intake in nonobese organisms.

The study was designed to determine whether overfeeding rats with a diet containing medium-chain triglyceride (MCT) as the major fat source (45% of calories) would impede the expected gain in weight and body fat as compared to rats overfed with isocaloric amounts of diet containing long-chain triglyceride (LCT). For 6 wk rats were fed either MCT diet or LCT diet twice daily via a gastrostomy tube. MCT-fed rats gained 20% less weight (P less than 0.001) and possessed fat depots weighing 23% less (p less than 0.001) than LCT)-fed rats. Mean adipocyte size was smaller (p less than 0.005) in MCT- than in LCT-fed rats. Weights of carcass protein and water were similar for both groups as were concentrations of serum insulin and levels of physical activity. The decreased deposition of fat in the MCT-fed rats may have resulted from obligatory oxidation of MCT-derived fatty acids in the liver after being transported there via the portal vein, leaving almost no MCT derivatives for incorporation into body fat. MCT may have potential for dietary prevention of human obesity.

A new method for the estimation of body composition in human subjects is described which entails the measurement of total body electrical conductivity. The method is based on the principle that the electrical conductivity of lean tissue is far greater than that of fat. Comparative studies in 19 adults of widely varying fatness have demonstrated excellent correlations between the total electrical conductivity of the subjects and both their total body water (r = 0.87) and total body potassium (r = 0.86). This noninvasive method, which is safe, simple, rapid, and convenient, should prove useful in the nutritional assessment of individuals and populations.

Adipose tissue, the logical target component in weight reduction regimens, was measured in five obese subjects during weight reduction, and in four normal weight controls. The two compartment model of Ljunggren, consisting of adipose tissue (AT) and adipose tissue-free mass (AFM), was further developed by finding experimental values for total water, extracellular water (ECW), lipid, and cell solids in 16 biopsied subjects. The AFM was estimated from body potassium content (40K counting) by use of an age/sex specific constant for the K content in the fat free body. Five obese subjects maintained for 46 days on regimens averaging 800 kcal/day had initial AT from 48% to 60% of body weight compared with AT 27% to 46% in four normal controls. Weight reductions averaged 17.4 kg (12% of initial weight), with approximately equal reductions in adipose tissue, adipose-free mass, and water. Initial fluid compartment ratios in the obese were unusually high (ECW:ICW in AFM was 0.74 +/- 0.23 [S.D.] compared with 0.42 +/- 0.05 in normals); these values returned toward normal (to 0.59 +/- 0.06) with weight reduction. The fact that it was possible to disclose a hitherto unappreciated abnormality of hydration in the adipose-free mass of obese subjects and its change toward normal with weight reduction, suggests that the adipose:adipose-free model may have a special utility when body composition measurements are used to monitor the effects of weight reduction regimens on various body constituents.

Fat patterning was studied in a sample of 76 obese women before and after weight reduction by principal components analysis. Circumferences were selected as variables rather than skinfolds because circumferences correlated more highly with body composition determined either by total body water or total body potassium. A separate sample of 136 males and females, measured once, was employed to validate the results. The validation sample yielded similar findings. Two significant components were found, the first contrasting upper and lower fatness and the second trunk and extremity fatness. Waist circumference was the best predictor of upper-body fat patterning. For the lower body, thigh circumference loaded more highly than did the iliac crest circumference. Arm circumference did not contribute significantly to upper-lower fat patterning.

The spontaneous food intake of six normal-weight male volunteers was measured for 24 days while the subjects were inpatients on a metabolic unit. They were fed a palatable diet of conventional foods and were kept unaware that their food intake was being measured. On days 7-18 the caloric content of their diet was covertly reduced by 25% by substituting aspartame-sweetened analogues for all menu items containing sucrose. Subjects did not alter their food intake for 3 days. Then between days 4-6 on the aspartame diet, they increased their intake to compensate for 40% of the missing calories. Food intake stabilized at 85% of baseline and remained the same for the rest of the 12-day dilution period. Subjects did not show a shift in either sweetened or unsweetened food choices while their diet was being diluted. In adjusting for the missing calories, they simply ate more of their customary diet. The replacement of sucrose by aspartame tended to curb the weight gain observed on the baseline diet.