Energy density and weight change in a long-term weight-loss trial

Position statement on nutrition therapy for overweight and obesity: nutrition department of the Brazilian association for the study of obesity and metabolic syndrome (ABESO-2022)

Obesity is a chronic disease resulting from multifactorial causes mainly related to lifestyle (sedentary lifestyle, inadequate eating habits) and to other conditions such as genetic, hereditary, psychological, cultural, and ethnic factors. The weight loss process is slow and complex, and involves lifestyle changes with an emphasis on nutritional therapy, physical activity practice, psychological interventions, and pharmacological or surgical treatment. Because the management of obesity is a long-term process, it is essential that the nutritional treatment contributes to the maintenance of the individual's global health. The main diet-related causes associated with excess weight are the high consumption of ultraprocessed foods, which are high in fats, sugars, and have high energy density; increased portion sizes; and low intake of fruits, vegetables, and grains. In addition, some situations negatively interfere with the weight loss process, such as fad diets that involve the belief in superfoods, the use of teas and phytotherapics, or even the avoidance of certain food groups, as has currently been the case for foods that are sources of carbohydrates. Individuals with obesity are often exposed to fad diets and, on a recurring basis, adhere to proposals with promises of quick solutions, which are not supported by the scientific literature. The adoption of a dietary pattern combining foods such as grains, lean meats, low-fat dairy, fruits, and vegetables, associated with an energy deficit, is the nutritional treatment recommended by the main international guidelines. Moreover, an emphasis on behavioral aspects including motivational interviewing and the encouragement for the individual to develop skills will contribute to achieve and maintain a healthy weight. Therefore, this Position Statement was prepared based on the analysis of the main randomized controlled studies and meta-analyses that tested different nutrition interventions for weight loss. Topics in the frontier of knowledge such as gut microbiota, inflammation, and nutritional genomics, as well as the processes involved in weight regain, were included in this document. This Position Statement was prepared by the Nutrition Department of the Brazilian Association for the Study of Obesity and Metabolic Syndrome (ABESO), with the collaboration of dietitians from research and clinical fields with an emphasis on strategies for weight loss.

Lower Energy-Dense Ready Meal Consumption Affects Self-Reported Appetite Ratings with No Effect on Subsequent Food Intake in Women

Slimming World (SW), a commercial weight management organisation, has designed a range of low energy-dense ready meals (LEDRMs) in line with their programme. This randomised crossover study compared commercially available equicaloric ready meals differing in energy density on satiety and food intake. It was hypothesised that the LEDRM would reduce energy intake (EI) whilst increasing fullness and reducing hunger compared to higher energy-dense ready meal (HEDRM, control). A total of 26 female participants (aged 18–65 years; body mass index of 28.8 ± 3.0 kg·m⁻²) attended two test days. The participants ate a standard breakfast, and four hours later, ate either a LEDRM or HEDRM at lunch. EI was measured four hours later at an ad libitum tea. Satiety measurements were recorded throughout the day using visual analogue scales and a weighed food diary was completed for the remainder of the day. The results revealed that the LEDRM reduced hunger and increased fullness (both p < 0.001). There was no difference in EI at the evening meal between the ready meals (p > 0.05), however, during the whole LEDRM testing day, the participants consumed significantly less fat (7.1%) and saturated fat (3.6%) (both p < 0.01), but significantly more carbohydrates, sugars, fibre, protein, and salt (all p < 0.01). The results indicate that the participants felt more satiated after consuming ready meals of the same energy content but larger portion size. Despite no significant difference in short-term EI between the ready meals, the results indicated that the LEDRM produced beneficial subjective satiety responses and, therefore, can help to improve the nutritional content of meals i.e., reduce saturated fat consumption.

Associations between adherence to MIND diet and metabolic syndrome and general and abdominal obesity: a cross-sectional study

BACKGROUND

There is a lack of studies examining the association between Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) and metabolic syndrome (MetS) and obesity. Thus, this study aimed to investigate the association of adherence to the MIND diet with MetS and general and abdominal obesity.

METHODS

This cross-sectional study was performed on 836 Iranian adults, 18-75 years old. A 167-item food frequency questionnaire (FFQ) was used to assess dietary intakes of participants. Anthropometric measurements, blood pressure, fasting blood glucose and lipid profile of each participant were recorded. The guidelines of the National Cholesterol Education Program Adult Treatment Panel III (ATP III) was used to define MetS.

RESULTS

Mean age of study participants was 47.7 ± 10.7 years. The prevalence of MetS was 36.1% and mean body mass index (BMI) and waist circumference (WC) was 27.7 ± 4.69 kg/m² and 92.0 ± 12.4 cm respectively. Those who were in the third tertile of the MIND diet score compared to the first tertile had 12% lower odds of having the MetS (ORs: 0.88; 95% CI 0.62-1.24) but the association was not significant (P = 0.77). There was a significant inverse association between the MIND diet score and odds of reduced high-density lipoprotein cholesterol (HDL-C) (ORs: 0.59; 95% CI 0.41-0.85; P = 0.008) and general obesity (ORs: 1.190.80-1.78; 95% CI 0.80-1.78; P = 0.02) in crude model and after controlling for confounders.

CONCLUSIONS

We found that the MIND diet score is inversely associated with odds of reduced HDL and general obesity in Iranian adults.

Dietary quality differences between women with and without weight loss in nutritional treatment

BACKGROUND & AIMS

The obesity nutritional treatment is structured to weight loss and diet is considered an important indicator of treatment effectiveness. The purpose of this study is to compare the diet quality among women who lost weight to women who maintained or gained weight during the nutritional treatment.

METHODS

This is a retrospective study that included 66 obese women in nutritional treatment for weight loss, over six months, divided in tercile according to their weight loss. The diet quality was evaluated by score, which was obtained with a food frequency questionnaire.

RESULTS

The diet quality comparison was made among the group with weight loss (GL; n = 22) and the group that maintained or gained weight during the nutritional treatment (GG; n = 22) showed that both groups had improvement in their diet quality scores from pre-treatment to post-treatment. Nevertheless, the GG had higher sugar consumption than the GL in the pre-treatment (p = 0.02) and in the post-treatment (p 0.01) periods. In the post-treatment, GL increased their scores for leafy vegetables (0.013), fruit (0.004), sweets (p 0.03), and soft drinks (p 0.02). GL improved their scores for fried food (p 0.01) and sweets (p 0.008).

CONCLUSION

This indicates that in the weight loss treatment special attention should be given to the incentive to the fruit and leafy vegetables consumption and, to reduce the consumption of sweets.

Determinants of weight loss maintenance: a systematic review

BACKGROUND

Discerning the determinants of weight loss maintenance is important in the planning of future interventions and policies regarding overweight and obesity. We have therefore systematically synthesized recent literature on determinants of weight loss maintenance for individuals with overweight and obesity.

METHODS

With the use of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement, prospective studies were identified from searches in PubMed and PsycINFO from 2006 to 2016. We included articles investigating adults with overweight and obesity undergoing weight loss without surgery or medication. Included articles were scored on their methodological quality, and a best-evidence synthesis was applied to summarize the results.

RESULTS

Our search resulted in 8,222 articles of which 67 articles were selected. In total, 124 determinants were identified of which 5 were demographic, 59 were behavioural, 51 were psychological/cognitive and 9 were social and physical environmental determinants. We found consistent evidence that demographic determinants were not predictive of weight loss maintenance. Behavioural and cognitive determinants that promote a reduction in energy intake, an increase in energy expenditure and monitoring of this balance are predictive determinants.

CONCLUSION

This review identifies key determinants in weight loss maintenance. However, more research regarding cognitive and environmental determinants of weight loss maintenance is needed to advance our knowledge on determinants of weight loss maintenance.

Subjective Satiety Following Meals Incorporating Rice, Pasta and Potato

The satiating capacity of carbohydrate staples eaten alone is dependent upon the energy density of the food but relative satiety when starchy staples are incorporated into mixed meals is uncertain. Our aim was to assess the satiating effects of three carbohydrate staples; jasmine rice, penne pasta, and Agria potato, each consumed within a standard mixed meal. Cooked portions of each staple containing 45 g carbohydrate were combined with 200 g of meat sauce and 200 g of mixed vegetables in three mixed meals. The quantities of staple providing 45 g carbohydrate were: Rice, 142 g; pasta, 138 g and potato 337 g. Participants (n = 14) consumed each of the mixed meals in random order on separate days. Satiety was assessed with using visual analogue scales at baseline and for 3 h post meal. In an area-under-the-curve comparison, participants felt less hungry (mean (SD)) following potato 263 (230) than following rice 374 (237) or pasta 444 (254) mm∙min, and felt fuller, more satisfied, and wanted to eat less following the potato compared with the rice and pasta meals (p for all <0.01). The superior satiating effect of potato compared with rice and pasta in a mixed meal was consistent with its lower energy density.

Low energy density diet, weight loss maintenance, and risk of cardiovascular disease following a recent weight reduction program: A randomized control trial

Background:

Little is known about the effects of a low energy dense diet on weight maintenance and cardiovascular risks following a recent weight reduction. Therefore, we assessed if weight maintenance, lipid profiles, and glycemic control differ between low energy density (LED) diet and usual diet consumers following a recent weight reduction.

Materials and Methods:

In this randomized controlled clinical trial study in a parallel design, we recruited 70 patients with the history of weight reduction in the recent 1 year. LED diet contained 30% fat, 15% protein, and 55% carbohydrate was administered to the test group, and a usual diet including 35% fat, 15% protein, and 50% carbohydrate was prescribed to the control group for 7 months. Dietary intake was assessed by using 3 days food records. Biochemical markers and anthropometric measures were done according to the standard protocol.

Results:

Weight reduced in LED diet consumers compared to usual diet consumers (−0.3 ± 0.2 vs. 1.3 ± 0.4%, P = 0.002). The results was the same regarding waist circumference (−0.4 ± 0.2 vs. 0.3 ± 0.1%, P = 0.004). Fasting blood sugar also decreased in LED diet group (−9.5 ± 0.8 vs. 0.4 ± 1.0%, P = 0.0001). LED diet group had a drop in percent change of their total cholesterol (−0.4 ± 0.5 vs. 2.05 ± 0.4%, P = 0.04) and low-density lipoprotein-cholesterol (4.8 ± 0.9 vs. −0.3 ± 0.9%, P = 0.002).

Conclusion:

Our findings confirmed beneficial effects of LED diet on attenuating weight regain in subjects with history of recent weight reduction. It might be derived from higher consumption of fruits, vegetables, and fiber among LED diet than usual diet consumers.

Energy density, energy intake, and body weight regulation in adults

The role of dietary energy density (ED) in the regulation of energy intake (EI) is controversial. Methodologically, there is also debate about whether beverages should be included in dietary ED calculations. To address these issues, studies examining the effects of ED on EI or body weight in nonelderly adults were reviewed. Different approaches to calculating dietary ED do not appear to alter the direction of reported relations between ED and body weight. Evidence that lowering dietary ED reduces EI in short-term studies is convincing, but there are currently insufficient data to determine long-term effectiveness for weight loss. The review also identified key barriers to progress in understanding the role of ED in energy regulation, in particular the absence of a standard definition of ED, and the lack of data from multiple long-term clinical trials examining the effectiveness of low-ED diet recommendations for preventing both primary weight gain and weight regain in nonobese individuals. Long-term clinical trials designed to examine the impact of dietary ED on energy regulation, and including multiple ED calculation methods within the same study, are still needed to determine the importance of ED in the regulation of EI and body weight.

Parent readiness to change differs for overweight child dietary and physical activity behaviors

Parent involvement is important to help overweight children lose weight. However, parent readiness to make changes around child eating and physical activity (PA) behaviors can differ across domains. Using a cross-sectional design, our aim was to examine which factors were associated with parents being in the Action/Maintenance stage of change in each domain. From November 2008 to August 2009, parents of overweight/obese children (n=202) attending a tertiary care obesity clinic in Providence, RI, answered questions assessing their stage of change, beliefs about child health and weight, and provider behaviors. Separate multivariate logistic regression models were created to determine which factors were associated with parent readiness to make changes for child dietary and PA behaviors. Almost 62% of parents were in the Action stage of change for child dietary behaviors, but only 41% were in the Action stage of change for PA behaviors. Parents who believed their own weight was a health problem were less likely to be ready to make changes to their child's dietary behaviors. Physician discussion of strategies was related to readiness to make changes for child dietary behaviors, but not PA behaviors. In the PA domain, parents of younger children were more likely to be ready to make changes. Training health care providers to address PA readiness and be aware of factors influencing dietary and PA readiness may result in more effective conversations with parents and improve behavior change efforts for pediatric weight loss.

Energy density of the Scottish diet estimated from food purchase data: relationship with socio-economic position and dietary targets

Frequent consumption of energy-dense foods has been strongly implicated in the global increase of obesity. The World Cancer Research Fund suggests a population-level energy density (ED) goal for diets of 523 kJ/100 g (125 kcal/100 g) as desirable for reducing weight gain and related co-morbidities. However, there is limited information about the ED of diets of contemporary populations. The aims of the present study were to (1) estimate the mean ED of the Scottish diet, (2) assess differences in ED over time by socio-economic position, by household (HH) composition and for HH meeting dietary targets for fat and fruit and vegetables, and (3) assess the relationship between ED and the consumption of foods and nutrients, which are indicative of diet quality. ED of the diet was estimated from food (including milk) from UK food purchase survey data. The average ED of the Scottish diet was estimated as 718 kJ/100 g with no change between the survey periods 2001 and 2009. Individuals living in the most deprived areas had a higher mean ED than those living in the least deprived areas (737 v. 696 kJ/100 g). Single-parent HH had the highest mean ED (765 kJ/100 g) of all the HH surveyed. The mean ED of HH achieving dietary targets for fat and fruit and vegetables was 576 kJ/100 g compared with 731 kJ/100 g for non-achievers. HH within the lowest quintile of ED were, on average, closest to meeting most dietary guidelines. Food purchase data can be used to monitor the quality of the diet in terms of dietary ED of the population and subgroups defined by an area-based measure of socio-economic status.

Behavioral lifestyle intervention in the treatment of obesity

This article provides an overview of research regarding adult behavioral lifestyle intervention for obesity treatment. We first describe two trials using a behavioral lifestyle intervention to induce weight loss in adults, the Diabetes Prevention Program (DPP) and the Look AHEAD (Action for Health in Diabetes) trial. We then review the three main components of a behavioral lifestyle intervention program: behavior therapy, an energy- and fat-restricted diet, and a moderate- to vigorous-intensity physical activity prescription. Research regarding the influence of dietary prescriptions focusing on macronutrient composition, meal replacements, and more novel dietary approaches (such as reducing dietary variety and energy density) on weight loss is examined. Methods to assist with meeting physical activity goals, such as shortening exercise bouts, using a pedometer, and having access to exercise equipment within the home, are reviewed. To assist with improving weight loss outcomes, broadening activity goals to include resistance training and a reduction in sedentary behavior are considered. To increase the accessibility of behavioral lifestyle interventions to treat obesity in the broader population, translation of efficacious interventions such as the DPP, must be undertaken. Translational studies have successfully altered the DPP to reduce treatment intensity and/or used alternative modalities to implement the DPP in primary care, worksite, and church settings; several examples are provided. The use of new methodologies or technologies that provide individualized treatment and real-time feedback, and which may further enhance weight loss in behavioral lifestyle interventions, is also discussed.

A randomised controlled trial and mediation analysis of the 'Healthy Habits', telephone-based dietary intervention for preschool children

Background

Consumption of non-core foods in childhood is associated with excessive weight gain in childhood. Parents play a vital role in establishing healthy diet behaviours in young children. The aim of this study was to assess the effectiveness of a telephone-based intervention in reducing child consumption of non-core foods, and to examine parent and home food environment mediators of change in child consumption.

Methods

The ‘Healthy Habits’ trial utilised a clustered randomised controlled design.

Setting/participants

Parents were recruited from 30 preschools (N = 394 participants, mean age 35.2±5.6 years). Parents randomized to the intervention group received four telephone contacts and print materials. Parents allocated to the control condition receive generic print materials only. Non-core food consumption was assessed using a validated child dietary questionnaire at baseline, 2 and 6 months post recruitment in 2010.

Results

The intervention was effective in reducing child consumption of non-core foods at 2 months (intention to treat analysis: z=-2.83, p<.01), however this effect was not maintained at 6 months. Structural equation modelling using 2 month data indicated that child access to non-core foods in the home and child feeding strategies mediated the effect of the intervention.

Conclusion

The telephone-based intervention shows promise in improving short term dietary behaviour in preschool age children, however further development is needed to sustain the effect in the long-term.

Trial registration

Australian Clinical Trials Registry: ACTRN12609000820202

Short- and long-term eating habit modification predicts weight change in overweight, postmenopausal women: results from the WOMAN study

BACKGROUND

Standard behavioral obesity treatment produces poor long-term results. Focusing on healthy eating behaviors rather than energy intake may be an alternative strategy. In addition, important behaviors might differ for short- vs long-term weight control.

OBJECTIVE

Our aim was to describe and compare associations between changes in eating behaviors and weight after 6 and 48 months.

DESIGN

We performed secondary analysis of data collected during a randomized weight-loss intervention trial with 48-month follow-up.

PARTICIPANTS

We studied 481 overweight and obese postmenopausal women enrolled in the Women on the Move through Activity and Nutrition (WOMAN) Study.

MAIN OUTCOME MEASURES

We measured changes in weight from baseline to 6 and 48 months.

STATISTICAL ANALYSES PERFORMED

Linear regression models were used to examine the associations between 6- and 48-month changes in eating habits assessed by the Conner Diet Habit Survey and changes in weight. Analyses were conducted in the combined study population and stratified by randomization group.

RESULTS

At 6 months in the combined population, weight loss was independently associated with decreased desserts (P<0.001), restaurant eating (P=0.042), sugar-sweetened beverages (P=0.009), and fried foods (P<0.001), and increased fish consumption (P=0.003). Results were similar in intervention participants; only reduced desserts and fried foods associated with weight loss in controls. At 48 months in the combined population, weight loss was again associated with decreased desserts (P=0.003) and sugar-sweetened beverages (P=0.011), but also decreased meats/cheeses (P=0.024) and increased fruits/vegetables (P<0.001). Decreased meats/cheeses predicted weight loss in intervention participants; desserts, sugar-sweetened beverages, and fruits/vegetables were independently associated in controls.

CONCLUSIONS

Changes in eating behaviors were associated with weight change, although important behaviors differed for short- and long-term weight change and by randomization group. Future studies should determine whether interventions targeting these behaviors could improve long-term obesity treatment outcomes.

Dietary energy density and body weight in adults and children: a systematic review

Energy density is a relatively new concept that has been identified as an important factor in body weight control in adults and in children and adolescents. The Dietary Guidelines for Americans 2010 encourages consumption of an eating pattern low in energy density to manage body weight. This article describes the systematic evidence-based review conducted by the 2010 Dietary Guidelines Advisory Committee (DGAC), with support from the US Department of Agriculture's Nutrition Evidence Library, which resulted in this recommendation. An update to the committee's review was prepared for this article. PubMed was searched for English-language publications from January 1980 to May 2011. The literature review included 17 studies (seven randomized controlled trials, one nonrandomized controlled trial, and nine cohort studies) in adults and six cohort studies in children and adolescents. Based on this evidence, the 2010 Dietary Guidelines Advisory Committee concluded that strong and consistent evidence in adults indicates that dietary patterns relatively low in energy density improve weight loss and weight maintenance. In addition, the committee concluded that there was moderately strong evidence from methodologically rigorous longitudinal cohort studies in children and adolescents to suggest that there is a positive association between dietary energy density and increased adiposity. This review supports a relationship between energy density and body weight in adults and in children and adolescents such that consuming diets lower in energy density may be an effective strategy for managing body weight.

Functional food and satiety. Impact of a satiating context effect on appetite control of non-obese men

The aim of this study was to verify if the addition of satiating nutrients and a satiating context effect could influence appetite sensations, spontaneous energy intake and food appreciation under conditions of standardized energy density of a meal. Eighteen non-obese men were submitted to a control, a satiating, and a context effect condition composed of a standardized breakfast and an ad libitum test lunch (macaroni entrée plus chocolate cake). The satiating macaroni contained more proteins, unsaturated fats, fibres and calcium than the control macaroni despite similar energy density, appearance and palatability. In the context effect condition, participants believed they were eating "a highly satiating macaroni", but were served the control macaroni. Appreciation of the macaronis, quantities of macaroni and cake consumed and 4-h satiating potential were measured for each condition. Quantities of macaroni and dessert consumed did not differ between conditions. Satiating potential was greater for the context effect meal compared to the control and/or the satiating meals up to 4h after its consumption. The context effect macaroni obtained higher appreciation rates than the control and the satiating macaronis. The context effect may positively influence the appreciation toward a meal and contribute to increase its satiety potential for many hours.

Dietary energy density and successful weight loss maintenance

Research shows a positive relationship between dietary energy density (ED) and body mass index (BMI), but dietary ED of weight loss maintainers is unknown. This preliminary investigation was a secondary data analysis that compared self-reported dietary ED and food group servings consumed in overweight adults (OW: BMI=27-45kg/m(2)), normal weight adults (NW: BMI=19-24.9 kg/m(2)), and weight loss maintainers (WLM: current BMI=19-24.9kg/m(2) [lost≥10% of maximum body weight and maintained loss for ≥5years]) participating in 2 studies, with data collected from July 2006 to March 2007. Three 24-h phone dietary recalls from 287 participants (OW=97, NW=85, WLM=105) assessed self-reported dietary intake. ED (kcal/g) was calculated by three methods (food+all beverages except water [F+AB], food+caloric beverages [F+CB], and food only [FO]). Differences in self-reported consumption of dietary ED, food group servings, energy, grams of food/beverages, fat, and fiber were assessed using one-way MANCOVA, adjusting for age, sex, and weekly energy expenditure from self-reported physical activity. ED, calculated by all three methods, was significantly lower in WLM than in NW or OW (FO: WLM=1.39±0.45kcal/g; NW=1.60±0.43 kcal/g; OW=1.83±0.42 kcal/g). Self-reported daily servings of vegetables and whole grains consumed were significantly higher in WLM compared to NW and OW (vegetables: WLM=4.9±3.1 servings/day; NW=3.9±2.0 servings/day; OW=3.4±1.7 servings/day; whole grains: WLM=2.2±1.8 servings/day; NW=1.4±1.2 servings/day; OW=1.3±1.3 servings/day). WLM self-reported consuming significantly less energy from fat and more fiber than the other two groups. Self-reported energy intake per day was significantly lower in WLM than OW, and WLM self-reported consuming significantly more grams of food/beverages per day than OW. These preliminary findings suggest that consuming a diet lower in ED, characterized by greater intake of vegetables and whole grains, may aid with weight loss maintenance and should be further tested in prospective randomized controlled trials.

Effects of the Dietary Approaches to Stop Hypertension (DASH) eating plan on cardiovascular risks among type 2 diabetic patients: a randomized crossover clinical trial

OBJECTIVE

To determine the effects of the Dietary Approaches to Stop Hypertension (DASH) eating pattern on cardiometabolic risks in type 2 diabetic patients.

RESEARCH DESIGN AND METHODS

A randomized crossover clinical trial was undertaken in 31 type 2 diabetic patients. For 8 weeks, participants were randomly assigned to a control diet or the DASH eating pattern.

RESULTS

After following the DASH eating pattern, body weight (P = 0.007) and waist circumference (P = 0.002) reduced significantly. Fasting blood glucose levels and A1C decreased after adoption of the DASH diet (-29.4 ± 6.3 mg/dl; P = 0.04 and -1.7 ± 0.1%; P = 0.04, respectively). After the DASH diet, the mean change for HDL cholesterol levels was higher (4.3 ± 0.9 mg/dl; P = 0.001) and LDL cholesterol was reduced (-17.2 ± 3.5 mg/dl; P = 0.02). Additionally, DASH had beneficial effects on systolic (-13.6 ± 3.5 vs. -3.1 ± 2.7 mmHg; P = 0.02) and diastolic blood pressure (-9.5 ± 2.6 vs. -0.7 ± 3.3 mmHg; P = 0.04).

CONCLUSIONS

Among diabetic patients, the DASH diet had beneficial effects on cardiometabolic risks.

Effects of caloric restriction with varying energy density and aerobic exercise on weight change and satiety in young female adults

This study examines the combined effects of caloric restriction on body composition, blood lipid, and satiety in slightly overweight women by varying food density and aerobic exercise. Twenty-three women were randomly assigned to one of two groups for a four-week weight management program: the high-energy density diet plus exercise (HDE: n = 12, 22 ± 2 yrs, 65 ± 7 kg, 164 ± 5 cm, 35 ± 4 % fat) and low-energy density diet plus exercise (LDE: n = 11, 22 ± 1 yrs, 67 ± 7 kg, 161 ± 2 cm, 35 ± 4 % fat) groups. Subjects maintained a low-calorie diet (1,500 kcal/day) during the program. Isocaloric (483 ± 26 for HDE, 487 ± 27 kcal for LDE) but different weight (365 ± 68 for HDE, 814 ± 202 g for LDE) of lunch was provided. After lunch, they biked at 60% of maximum capacity for 40 minutes, five times per week. The hunger level was scaled (1: extremely hungry; 9: extremely full) at 17:30 each day. Before and after the program, the subjects' physical characteristics were measured, and fasting blood samples were drawn. The daily energy intake was 1,551 ± 259 for HDE and 1,404 ± 150 kcal for LDE (P > 0.05). After four weeks, the subjects' weights and % fat decreased for both LDE (-1.9 kg and -1.5%, P < 0.05) and HDE (-1.6 kg and -1.4%, respectively, P < 0.05). The hunger level was significantly higher for HDE (2.46 ± 0.28) than for LDE (3.10 ± 0.26) (P < 0.05). The results suggest that a low-energy density diet is more likely to be tolerated than a high-energy density diet for a weight management program combining a low-calorie diet and exercise, mainly because of a reduced hunger sensation.