Associations between the proportion of fat-free mass loss during weight loss, changes in appetite, and subsequent weight change: results from a randomized 2-stage dietary intervention trial

Am J Clin Nutr. 2020 Mar 1;111(3):536-544. doi: 10.1093/ajcn/nqz331.


Background: Dynamic changes in body composition which occur during weight loss may have an influential role on subsequent energy balance behaviors and weight.

Objectives: The aim of this article is to consider the effect of proportionate changes in body composition during weight loss on subsequent changes in appetite and weight outcomes at 26 wk in individuals engaged in a weight loss maintenance intervention.

Methods: A subgroup of the Diet, Obesity, and Genes (DiOGenes) study (n = 209) was recruited from 3 European countries. Participants underwent an 8-wk low-calorie diet (LCD) resulting in ≥8% body weight loss, during which changes in body composition (by DXA) and appetite (by visual analog scale appetite perceptions in response to a fixed test meal) were measured. Participants were randomly assigned into 5 weight loss maintenance diets based on protein and glycemic index content and followed up for 26 wk. We investigated associations between proportionate fat-free mass (FFM) loss (%FFML) during weight loss and 1) weight outcomes at 26 wk and 2) changes in appetite perceptions.

Results: During the LCD, participants lost a mean ± SD of 11.2 ± 3.5 kg, of which 30.4% was FFM. After adjustment, there was a tendency for %FFML to predict weight regain in the whole group (β: 0.041; 95% CI: -0.001, 0.08; P = 0.055), which was significant in men (β: 0.09; 95% CI: 0.02, 0.15; P = 0.009) but not women (β: 0.01; 95% CI: -0.04, 0.07; P = 0.69). Associations between %FFML and change in appetite perceptions during weight loss were inconsistent. The strongest observations were in men for hunger (r = 0.69, P = 0.002) and desire to eat (r = 0.61, P = 0.009), with some tendencies in the whole group and no associations in women.

Conclusions: Our results suggest that composition of weight loss may have functional importance for energy balance regulation, with greater losses of FFM potentially being associated with increased weight regain and appetite. This trial was registered at as NCT00390637.

Keywords: DiOGenes; appetite; body composition; fat mass; fat-free mass; low-calorie diet; obesity; weight loss; weight regain.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Appetite*
  • Body Mass Index
  • Caloric Restriction
  • Dietary Carbohydrates / analysis
  • Dietary Carbohydrates / metabolism
  • Dietary Proteins / analysis
  • Dietary Proteins / metabolism
  • Energy Intake
  • Female
  • Glycemic Index
  • Humans
  • Male
  • Middle Aged
  • Obesity / diet therapy*
  • Obesity / metabolism
  • Obesity / physiopathology
  • Weight Loss
  • Young Adult


  • Dietary Carbohydrates
  • Dietary Proteins

Associated data