Abstract
Dynamic energy balance can give clinicians important answers for why obesity is so resistant to control. When food intake is reduced for weight control, all components of energy expenditure change, including metabolic rate at rest (resting energy expenditure [REE]), metabolic rate of exercise, and adaptive thermogenesis. This means that a change in energy intake influences energy expenditure in a dynamic way. Mechanisms associated with reduction of total energy expenditure following weight loss are likely to be related to decreased body mass and enhanced metabolic efficiency. Reducing calorie intake results in a decrease in body weight, initially with a marked reduction in fat free mass and a decrease in REE, and this change is maintained for several years in a reduced state. Metabolic adaptation, which is not explained by changes in body composition, lasts for more than several years. These are powerful physiological adaptations that induce weight regain. To avoid a typically observed weight-loss and regain trajectory, realistic weight loss goals should be established and maintained for more than 1 year. Using a mathematical model can help clinicians formulate advice about diet control. It is important to emphasize steady efforts for several years to maintain reduced weight over efforts to lose weight. Because obesity is difficult to reverse, clinicians must prioritize obesity prevention. Obesity prevention strategies should have high feasibility, broad population reach, and relatively low cost, especially for young children who have the smallest energy gaps to change.