Lichtman S W, Pisarska K, Berman E R, Pestone M, Dowling H, Offenbacher E, Weisel H, Heshka S, Matthews D E, Heymsfield S B
Department of Medicine, St. Luke's-Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, NY.
N Engl J Med. 1992 Dec 31;327(27):1893-8. doi: 10.1056/NEJM199212313272701.
Some obese subjects repeatedly fail to lose weight even though they report restricting their caloric intake to less than 1200 kcal per day. We studied two explanations for this apparent resistance to diet--low total energy expenditure and underreporting of caloric intake--in 224 consecutive obese subjects presenting for treatment. Group 1 consisted of nine women and one man with a history of diet resistance in whom we evaluated total energy expenditure and its main thermogenic components and actual energy intake for 14 days by indirect calorimetry and analysis of body composition. Group 2, subgroups of which served as controls in the various evaluations, consisted of 67 women and 13 men with no history of diet resistance.
Total energy expenditure and resting metabolic rate in the subjects with diet resistance (group 1) were within 5 percent of the predicted values for body composition, and there was no significant difference between groups 1 and 2 in the thermic effects of food and exercise. Low energy expenditure was thus excluded as a mechanism of self-reported diet resistance. In contrast, the subjects in group 1 underreported their actual food intake by an average (+/- SD) of 47 +/- 16 percent and overreported their physical activity by 51 +/- 75 percent. Although the subjects in group 1 had no distinct psychopathologic characteristics, they perceived a genetic cause for their obesity, used thyroid medication at a high frequency, and described their eating behavior as relatively normal (all P < 0.05 as compared with group 2).
The failure of some obese subjects to lose weight while eating a diet they report as low in calories is due to an energy intake substantially higher than reported and an overestimation of physical activity, not to an abnormality in thermogenesis.
一些肥胖受试者尽管声称将每日热量摄入限制在1200千卡以下，但仍反复无法减重。我们对224名前来接受治疗的肥胖受试者进行研究，探讨这种明显的节食抵抗的两种原因——总能量消耗低和热量摄入报告不足。第1组由9名女性和1名男性组成，他们有节食抵抗史，我们通过间接测热法和身体成分分析评估了他们14天的总能量消耗及其主要产热成分和实际能量摄入。第2组由67名女性和13名男性组成，他们没有节食抵抗史，在各种评估中作为对照组。
有节食抵抗的受试者（第1组）的总能量消耗和静息代谢率在根据身体成分预测值的5%以内，第1组和第2组在食物和运动的热效应方面没有显著差异。因此，低能量消耗被排除为自我报告的节食抵抗机制。相比之下，第1组的受试者实际食物摄入量平均少报（±标准差）47±16%，身体活动多报51±75%。尽管第1组的受试者没有明显的精神病理特征，但他们认为肥胖有遗传原因，频繁使用甲状腺药物，并将自己的饮食行为描述为相对正常（与第2组相比，所有P<0.05）。
一些肥胖受试者在食用他们报告为低热量的饮食时未能减重，是由于能量摄入量远高于报告值以及对身体活动的高估，而非产热异常。
