Why does body weight often increase again after initial loss? The role of metabolic adaptation

Jarosław Kozakowski; Piotr Dudek

doi:10.36553/wm.184

Published: 2025-09-29

Vol. 7 No. 1 (2025)

Why does body weight often increase again after initial loss? The role of metabolic adaptation

Jarosław Kozakowski , Piotr Dudek

Wiedza Medyczna

Section: Review papers

https://doi.org/10.36553/wm.184

Abstract

Obesity, often referred to as the "tsunami of the 21st century", is a chronic, incurable disease prone to relapses. The crucial intervention aimed at reducing body weight for health benefits is lifestyle modification, but unfortunately, in most cases after the initial period of weight loss, a recurrence of overweight or obesity is observed. A similar process occurs in patients after bariatric surgery. It should be understood that the reason for this phenomenon does not necessarily must be associated with the lack of the patient adherence, but is a consequence of the activation of a strong objective mechanism - metabolic adaptation, i.e. changes in energy homeostasis to counteract lossing of energy. The article briefly describes the most important mechanisms of metabolic adaptation and presents the ways to counteract it.

Keywords:

obesity, weight loss, metabolic adaptation, energy balance, weight regain

Download files

PDF

Citation rules

Kozakowski, J., & Dudek, P. (2025). Why does body weight often increase again after initial loss? The role of metabolic adaptation. Wiedza Medyczna, 7(1), 22–26. https://doi.org/10.36553/wm.184

Cited by / Share

References

Olszaniecka-Glinianowicz M, Mazur A, Chudek J, et al. Obesity in Adults: Position Statement of Polish Association for the Study on Obesity, Polish Association of Endocrinology, Polish Association of Cardiodiabetology, Polish Psychiatric Association, Section of Metabolic and Bariatric Surgery of the Association of Polish Surgeons, and the College of Family Physicians in Poland. Nutrients 2023; 15:1641. doi.org/10.3390/nu15071641.
Google Scholar

Badman MK, Flier JS. The gut and energy balance: visceral allies in the obesity wars. Science 2005; 307(5717):1909-14. DOI:10.1126/science.1109951.
Google Scholar

Theilade S, Christensen MB, Vilsbøll T, et al. An overview of obesity mechanisms in humans: Endocrine regulation of food intake, eating behavior and common determinants of body weight. Diabetes Obes Metab 2021; 23(Supp.1):17-35. DOI:10.1111/dom.14270.
Google Scholar

Martinez JA. Body-weight regulation: causes of obesity. Proc Nutr Soc 2000; 59(3):337-45. DOI:10.1017/s0029665100000380.
Google Scholar

Gainetdinov RR. Mesolimbic dopamine in obesity and diabetes. Am J Physiol Regul Integr Comp Physiol 2007; 293(2):R601-2. DOI:10.1152/ajpregu.00450.2007.
Google Scholar

Naef L, Pitman KA, Borgland SL. Mesolimbic dopamine and its neuromodulators in obesity and binge eating. CNS Spectr 2015; 20(6):574-83. DOI:10.1017/S1092852915000693.
Google Scholar

Martínez-Gómez MG, Roberts BM. Metabolic Adaptations to Weight Loss: A Brief Review. J Strength Cond Res 2022; 36(10):2970-2981. DOI:10.1519/JSC.0000000000003991.
Google Scholar

Wilding JPH, Batterham RL, Davies M, et al. Weight regain and cardiometabolic effects after withdrawal of semaglutide: the STEP 1 trial extension. Diabetes Obes Metab 2022; 24 (8):1553-64.
Google Scholar

Weintraub MA, D’Angelo D, Tchang BG, et. al. Five-year weight loss maintenance with obesity pharmacotherapy. J Clin Endocrinol Metab 2023; 108(9):e832-41.
Google Scholar

Quarenghi M, Capelli S, Galligani G, et al. Weight Regain After Liraglutide, Semaglutide or Tirzepatide Interruption: A Narrative Review of Randomized Studies. J Clin Med 2025; 14(11):3791. DOI:10.3390/jcm14113791.
Google Scholar

Noria SF, Shelby RD, Atkins KD, et al. Weight Regain After Bariatric Surgery: Scope of the Problem, Causes, Prevention, and Treatment. Curr Diab Rep 2023; 23(3):31-42. DOI:10.1007/s11892-023-01498-z.
Google Scholar

Cooper TC, Simmons EB, Webb K, et al. Trends in weight regain following Roux-en-Y gastric bypass(RYGB) bariatric surgery. Obes Surg 2015; 25(8):1474-81. doi.org/10. 1007/s11695- 014- 1560-z.
Google Scholar

Lauti M, Kularatna M, Hill AG, et al. Weight regain following sleeve gastrectomy-a systematic review. Obes Surg 2016; 26(6):1326-34. doi.org/10.1007/s11695-016-2152-x.
Google Scholar

King WC, Hinerman AS, Belle SH, et al. Comparison of the performance of common measures of weight regain after bariatric surgery for association with clinical outcomes. JAMA 2018; 320(15):1560-9. https:/doi.org/10.1001/.
Google Scholar

Müller MJ, Enderle J, Pourhassan M, et al. Metabolic adaptation to caloric restriction and subsequent refeeding: the Minnesota Starvation Experiment revisited. Am J Clin Nutr 2015; 102(4):807-19. DOI:10.3945/ajcn.115.109173.
Google Scholar

Dabas J, Shunmukha Priya S, Alawani A, et al. What could be the reasons for not losing weight even after following a weight loss program? J Health Popul Nutr 2024; 43(1):37. DOI:10.1186/s41043-024-00516-4.
Google Scholar

Schwartz A, Doucet E. Relative changes in resting energy expenditure during weight loss: a systematic review. Obes Rev 2010; 11(7):531-47. DOI:10.1111/j.1467-789X.2009.00654.x.
Google Scholar

McInnis K, Brown JL, Finlayson G, et al. Appetite Changes in Weight Regain and Weight Maintenance After Roux-en-Y Gastric Bypass. Obes Surg 2022; 32(7):1-12. DOI:10.1007/s11695-022-06061-5.
Google Scholar

Most J, Redman LM. Impact of calorie restriction on energy metabolism in humans. Exp Gerontol 2020; 133:110875. DOI:10.1016/j.exger.2020.110875.
Google Scholar

Catenacci VA, Pan Z, Ostendorf D, et al. A randomized pilot study comparing zero-calorie alternate-day fasting to daily caloric restriction in adults with obesity. Obesity (Silver Spring) 2016; 24(9):1874-83. DOI:10.1002/oby.21581.
Google Scholar

Stekovic S, Hofer SJ, Tripolt N, et al. Alternate Day Fasting Improves Physiological and Molecular Markers of Aging in Healthy, Non-obese Humans. Cell Metab 2019; 30(3):462-476.e6. DOI:10.1016/j.cmet.2019.07.016.
Google Scholar

Busetto L, Bettini S, Makaronidis J, et al. Mechanisms of weight gain. Eur J Int Med 2021; 93:3-7.
Google Scholar

Aronne LJ, Hall KD, Jakicic MJ, et al. Describing the Weight-Reduced State: Physiology, Behavior, and Interventions. Obesity (Silver Spring) 2021; 29(Supp. 1):S9-S24. DOI:10.1002/oby.23086.
Google Scholar

Rosenbaum M, Goldsmith RL, Haddad F, et al. Triiodothyronine and leptin repletion in humans similarly reverse weight-loss-induced changes in skeletal muscle. Am J Physiol Endocrinol Metab 2018; 315(5):E771-E779. DOI:10.1152/ajpendo.00116.2018.
Google Scholar

Löffler MC, Betz MJ, Blondin DP, et al. Challenges in tackling energy expenditure as obesity therapy: From preclinical models to clinical application. Mol Metab 2021; 51:101237. DOI:10.1016/j.molmet.2021.101237.
Google Scholar

Bilski J, Pierzchalski P, Szczepanik M, et al. Multifactorial Mechanism of Sarcopenia and Sarcopenic Obesity. Role of Physical Exercise, Microbiota and Myokines. Cells 2022; 11:160. doi.org/10.3390/cells11010160.
Google Scholar

Hunter GR, Singh H, Carter SJ, et al. Sarcopenia and Its Implications for Metabolic Health. J Obes 2019; 8031705. DOI:10.1155/2019/8031705.
Google Scholar

Caturano A, Amaro A, Berra CC, et al. Sarcopenic obesity and weight loss-induced muscle mass loss. Curr Opin Clin Nutr Metab Care 2025; 28:339-350. DOI:10.1097/MCO.0000000000001131.
Google Scholar

Kokura Y, Ueshima J, Saino Y, Maeda K. Enhanced protein intake on maintaining muscle mass, strength, and physical function in adults with overweight/obesity: a systematic review and meta-analysis. Clin Nutr ESPEN 2024; 63:417-426.
Google Scholar

Smith GI, Yoshino J, Kelly SC, et al. High-protein intake during weight loss therapy eliminates the weight-loss-induced improvement in insulin action in obese postmenopausal women. Cell Rep 2016; 17:849-861.
Google Scholar

Batsis JA, Batchek DJ, Petersen CL, et al. Protein supplementation may dampen positive effects of exercise on glucose homeostasis: a pilot weight loss intervention. Nutrients 2023; 15(23):4947. DOI:10.3390/nu15234947.
Google Scholar

Hunter GR, Bickel CS, Fisher G, et al. Combined aerobic/strength training and energy expenditure in older women. Med Sci Sports Exerc 2013; 45(7):1386-93. DOI:10.1249/MSS.0b013e3182860099.
Google Scholar

Bąk-Sosnowska M, Białkowska M, Bogdański P, i wsp. Zalecenia kliniczne dotyczące postępowania u chorych na otyłość 2024. Stanowisko Polskiego Towarzystwa Leczenia Otyłości. Medycyna Praktyczna. Wydanie specjalne, Wrzesień 2024.
Google Scholar

Mousavi A, Shojaei S, Azarboo A, et al. The role of glucagon-like peptide-1 receptor agonists in weight regain treatment or prevention after bariatric surgery: a systematic review and meta-analysis. Eat Weight Disord 2025; 30(1):70. DOI:10.1007/s40519-025-01770-z.
Google Scholar

Çalık Başaran N, Dotan I, Dicker D. Post metabolic bariatric surgery weight regain: the importance of GLP-1 levels. Int J Obes (Lond) 2025; 49(3):412-417. DOI:10.1038/s41366-024-01461-2.
Google Scholar

Wharton S, Yin P, Burrows M, et al. Extended-release naltrexone/bupropion is safe and effective among subjects with type 2 diabetes already taking incretin agents: a post-hoc analysis of the LIGHT trial. Int J Obes (Lond) 2021; 45(8):1687-1695. DOI:10.1038/s41366-021-00831-4.
Google Scholar

Dechelotte P, Breton J, Trotin-Picolo C, et al. The Probiotic Strain H. alvei HA4597® Improves Weight Loss in Overweight Subjects under Moderate Hypocaloric Diet: A Proof-of-Concept, Multicenter Randomized, Double-Blind Placebo-Controlled Study. Nutrients 2021; 13:1902. doi.org/10.3390/nu13061902.
Google Scholar

Kang CH, Jung ES, Jung SJ, et al. Pasteurized Akkermansia muciniphila HB05 (HB05P) Improves Muscle Strength and Function: A 12-Week, Randomized, Double-Blind, Placebo-Controlled Clinical Trial. Nutrients 2024; 16:4037. doi.org/10.3390/nu16234037.
Google Scholar

Jarosław Kozakowski

https://orcid.org/0000-0001-8412-6193

Affiliation:

Department of Endocrinology, Department of Endocrinology Medical Center of Postgraduate Education Bielański Hospital, Warsaw, PolandCentre of Postgraduate Medical Education, Warsaw, Poland Poland

Bio Statement (e.g., department and rank)

Pierwszy Autor tej pracy.

Wieloletni pracownik Kliniki Endokrynologii CMKP. Autor wielu prac z dziedziny obesitologii.

Piotr Dudek

pldudek@wp.pl
https://orcid.org/0000-0003-2046-4614

Affiliation:

Department of Endocrinology Medical Center of Postgraduate Education Bielański Hospital, Warsaw, Poland Poland