Energy in, energy out

"Cut 500 calories a day and you'll lose a pound a week." You've probably met the sum behind that sentence: a pound of body fat holds about 3,500 calories, and 500 times seven is 3,500. In 2013 Thomas and colleagues found the formula still appearing "in textbooks, on respected government- and health-related websites, and scientific research publications". They tested it against seven weight-loss experiments in which intake was supervised or objectively measured, and concluded that the rule "grossly overestimates actual weight loss".¹ This course read the abstract. This lesson is about why the arithmetic of energy is right and the prediction is wrong, what's been measured about how the body's energy use changes with age, exercise and weight loss, and a dispute between two groups of senior researchers over what drives the whole account. It describes what studies found about weight. It says nothing about what your weight, or anyone's, should be.

An account, not an explanation

Energy balance is bookkeeping. The energy stored in your body changes by what comes in as food minus what goes out in running the body and moving it. The World Health Organization's obesity fact sheet puts it in one line: "Overweight and obesity result from an imbalance of energy intake (diet) and energy expenditure (physical activity)."²

Nobody in the dispute at the end of this lesson denies that. Kevin Hall and eleven colleagues call the principle of energy balance "a law of physics that is agnostic as to obesity mechanisms".³

"Agnostic" is the word to hold on to. The account tells you that if someone gained weight, intake exceeded expenditure. It doesn't tell you why. Hall and Guo, reviewing the field in 2017 (this course read the abstract), name the misreading this invites: the fact of energy imbalance "is often misinterpreted to suggest that obesity is caused by gluttony and sloth and can be treated by simply advising people to eat less and move more." Their view is that "various components of energy balance are dynamically interrelated and weight loss is resisted by counterbalancing physiological processes."⁴ That second sentence is most of this lesson.

Measuring what goes out

Lesson 2 used doubly labelled water as the yardstick food questionnaires failed against, because it gives total energy expenditure without asking anyone anything. Nearly every expenditure figure in this lesson comes from it, so here is the one thing about it that this lesson needs.

Doubly labelled water doesn't measure calories. It measures carbon dioxide: how much the body produced over the days of the test.⁵ Turning carbon dioxide into calories takes one more number, the respiratory quotient, or RQ. This definition is the course's own: RQ is the carbon dioxide a body produces divided by the oxygen it uses, and it depends on the mix of fuel being burned. A calculation from carbon dioxide alone has to assume that mix, and a change of diet changes it.

Lesson 1's metabolic-ward study shows the change is real: when seventeen men moved from a high-carbohydrate diet to a ketogenic one, their RQ fell by 0.111.⁶ That is the study whose two measures disagreed, 151 calories a day by doubly labelled water against 57 in the sealed chambers, though the two covered different days. This course read the abstract, which does not say how much of that gap came from the assumed RQ, so this lesson won't either.

The course's inference: doubly labelled water is at its strongest comparing people on similar diets, and more open to argument when the comparison is between diets, which is the case in a fight over one trial at the end of this lesson.

Why 500 calories a day isn't a pound a week

Do the rule's sum first. Someone starts eating 500 calories a day less than they burn, and keeps eating that same amount. In a week that's 500 times 7, which is 3,500 calories: one pound, by the rule. Take it further yourself.

Hall and Chow wrote a one-page letter on the rule in 2013, which this course read in full. The error, they say, isn't the number: "the reader may be led to the erroneous conclusion that the deficiency of the 3500-kcal rule is the numerical value ‘3500’." The figure came from the energy stored in a pound of fat tissue, and they say it's "appropriate for modest weight changes in overweight and obese people, but is an overestimate in others." The real problem: "The most serious error of the 3500-kcal rule is its failure to account for dynamic changes in energy balance that occur during an intervention."⁷

The 500-calorie deficit was measured against what the body burned at the start. As weight falls, the body burns less: a smaller body costs less to run (the research file's summary), and there's some adaptation on top of that. So the same intake becomes a smaller deficit each week, and loss slows towards a new steady weight at which intake and expenditure match again.

Hall's 2011 paper in The Lancet built a mathematical model of this and put a figure on the pace: "the bodyweight response to a change of energy intake is slow, with half times of about 1 year." A half-time of a year means, in this course's gloss, that roughly half the eventual change has happened by the end of the first year and the rest comes ever more slowly. The same paper adds that "adults with greater adiposity have a larger expected weight loss for the same change of energy intake, and to reach their steady-state weight will take longer than it would for those with less initial body fat."⁸ (Adiposity is body fat.) So the same 500 calories draws different curves in different people.

This course read that paper's abstract, which gives no worked figures for a 500-calorie deficit, so the lesson doesn't print a number for where the curve ends. The same bend runs the other way, for weight gain.

Your metabolism at 25, 45 and 70

"My metabolism isn't what it was" is one of the commonest explanations people give for gaining weight in middle age. In 2021 Pontzer and some eighty colleagues tested it with a pooled database of doubly labelled water measurements: "n = 6,421; 64% female", from 29 countries, aged eight days to 95 years.⁹ This course read the abstract and, in the full text, the results and discussion.

What they did first was adjust for body size. A bigger body burns more simply because there's more of it, and fat-free mass (everything but fat) "accounted for most (83%) of the variation in daily expenditure."⁹ The question was what's left once size is taken out.

Two more findings matter. Sex made no difference once body composition was counted: "Sex had no effect on total expenditure in multivariate models with fat free mass and fat mass". And individuals differ a lot, with "TEE and its components varying more than ± 20% even when controlling for fat free mass, fat mass, sex, and age".⁹ (TEE is total energy expenditure.)

Now the limits. The database is cross-sectional: it compares people of different ages at one moment rather than following the same people as they age. And the authors say they had relatively few measurements of basal expenditure between 45 and 65, which reduces the precision of their estimates for resting expenditure at exactly the ages this question is about.⁹

What survives: once body size and composition are accounted for, the average adult doesn't burn noticeably less at 50 than at 25. The research file's reading is that middle-age weight gain needs some other explanation than a falling metabolic rate. What that explanation is, this study doesn't say.

Exercise and a ceiling

The simple model of exercise is additive: a run that costs 300 calories adds 300 calories to the day. Pontzer's 2016 study tested an alternative, a constrained model, "in which total energy expenditure increases with physical activity at low activity levels but plateaus at higher activity levels as the body adapts to maintain total energy expenditure within a narrow range."¹⁰

They measured 332 adults in five populations, expenditure by doubly labelled water and activity by accelerometer, a motion sensor worn on the body. After adjusting for body size and composition, "total energy expenditure was positively correlated with physical activity, but the relationship was markedly stronger over the lower range of physical activity. For subjects in the upper range of physical activity, total energy expenditure plateaued".¹⁰ The full text, which this course read in its results and discussion, puts the plateau across roughly the most active 30 percent, and finds that physical activity accounts for only about 7 to 9 percent of the variation in total expenditure once body size and population are allowed for.

A larger follow-up by Careau, Pontzer and colleagues, 1,754 people, estimated the average offset. The body compensates by burning less at rest, and "this suggests that only 72% of the extra calories we burn from additional activity translates into extra calories burned that day."¹¹ This course read that abstract. It also found that compensation "varied considerably between people of different body compositions", and offers two readings it cannot choose between: people who compensate more may be more likely to gain fat, or "as we get fatter, our body might compensate more strongly". For weight, the implication either way is that exercise alone moves the energy account less than the calories a machine reports, which the research file notes fits trials where exercise alone produced modest weight loss.

None of this is an argument against exercise. The research file notes that exercise's health benefits are separate from its effect on the energy account, and training is taught in Strength and Fitness.

The Biggest Loser, six years on

The Biggest Loser was an American television competition in which contestants lost very large amounts of weight over thirty weeks. Fothergill, Hall and colleagues followed up 14 of the 16 contestants they had studied, six years later.¹² This course read the abstract, and the introduction and discussion of the full text.

They measured resting metabolic rate (RMR, the energy used at rest) and body composition, and defined "metabolic adaptation" as "the residual RMR after adjusting for changes in body composition and age": the slowing that a smaller body doesn't explain.

At the end of the competition, weight loss averaged "58.3 ± 24.9 kg" and RMR had fallen by "610 ± 483 kcal/day". After six years, "41.0 ± 31.3 kg of the lost weight was regained", while RMR was still "704 ± 427 kcal/day below baseline" and metabolic adaptation was "-499 ± 207 kcal/day".¹² (Here "±" is the spread between the 14 people, not the uncertainty of an estimate.)

That's the half of the story that made headlines: a slowing of about 500 calories a day, still there six years on. Now the half that didn't.

The authors read that as the body pushing back in proportion to how far weight is held below where it was: "metabolic adaptation is a proportional, but incomplete, response to contemporaneous efforts to reduce body weight from its defended baseline or “set point” value".¹² The slowing tracked the weight people were keeping off, which is a different claim from "a broken metabolism made them regain".

The same discussion carries two facts the headlines dropped. Despite the regain, "the mean weight loss was 11.9 ± 16.8% compared to baseline and 57% of the participants maintained at least 10% weight loss". And the authors warn that "the extreme and public nature of this weight loss intervention makes it difficult to translate our results to more typical weight loss programs."¹² With 14 people and an extreme programme, the 500-calorie figure isn't typical: the paper itself cites a meta-analysis of cross-sectional studies finding people who had lost weight had "a 3–5% lower RMR" than people who hadn't.

Two models of what drives it

Everyone above agrees on the account. The dispute is about which way the causes run.

The carbohydrate-insulin model

In 2021 Ludwig and sixteen co-authors, including Walter Willett, whom lessons 1 and 2 met defending cohort research, set out the carbohydrate-insulin model, or CIM, in the American Journal of Clinical Nutrition.¹³ This course read the abstract and seven sections of the full text.

Their objection to the usual framing: "Conceptualizing obesity as a disorder of energy balance restates a principle of physics without considering the biological mechanisms that promote weight gain." Their alternative "proposes a reversal of causal direction. According to the CIM, increasing fat deposition in the body-resulting from the hormonal responses to a high-glycemic-load diet-drives positive energy balance."¹³

The mechanism, in the research file's summary of the full text: a meal with a high glycemic load (rapidly digested carbohydrate) raises insulin, which pushes fuel into storage. A few hours later the fuel circulating in the blood falls, the brain reads that as a shortage, hunger rises, and energy expenditure may fall. The CIM, in their words, "posits a state akin to “internal starvation”", and they say "Studies of cellular metabolism and energy sensing are needed to test this hypothesis."¹³ So on this view overeating is the result of fat storage, not its cause.

The energy balance model

In 2022 Hall and eleven co-authors replied in the same journal.³ This course could read only the abstract. They say the CIM paper "conflated and confused the principle of energy balance, a law of physics that is agnostic as to obesity mechanisms, with the EBM as a theoretical model of obesity that is firmly based on biology", and attacked "a caricature of the EBM".

Their model, the energy balance model or EBM: "the brain is the primary organ responsible for body weight regulation operating mainly below our conscious awareness via complex endocrine, metabolic, and nervous system signals to control food intake in response to the body's dynamic energy needs as well as environmental influences." And they place the rival inside it: "the new CIM can be considered a special case of the more comprehensive EBM but with a narrower focus on diets high in glycemic load as the primary factor responsible for common obesity."³

Each side says the other describes it unfairly: the CIM paper objects that textbook statements of the EBM treat "all calories metabolically alike".¹³ Neither model says calories don't count. They disagree about what makes people take in more of them.

Each side's trial

The EBM side's key test is Hall's 2021 inpatient trial.¹⁴ Twenty adults lived at the NIH Clinical Center and ate as much as they liked of a plant-based, low-fat diet (75.2 percent carbohydrate, high glycemic load) for two weeks and an animal-based ketogenic diet (10.0 percent carbohydrate, low glycemic load) for two weeks. The trial's authors took the CIM to predict that the low-fat, high-glycemic diet would make people eat more. They ate less: the low-fat diet "led to 689 ± 73 kcal" a day "less energy intake than the low-carbohydrate diet over 2 weeks", and 544 less over the final week, which the abstract names as a primary outcome too. The gap narrowed from the first week to the second. The authors conclude that "the predictions of the carbohydrate-insulin model were inconsistent with our observations." One participant "withdrew due to hypoglycemia during the low-carbohydrate diet". Hypoglycemia is low blood sugar, and it is one reason the callout at the top names diabetes. This course read the abstract. Two limits are the research file's own, not taken from a published critique: the diets differed in many ways at once, and two weeks is exactly the length the CIM authors say is too short.

The CIM side's key test is Ebbeling and colleagues' 2018 feeding trial, Ludwig among the authors.¹⁵ 164 adults who had first lost an average of 10.5 percent of their weight[16] were fed diets of 60, 40 or 20 percent carbohydrate for 20 weeks, with calories adjusted to hold weight steady, and total expenditure measured by doubly labelled water. Expenditure rose by "52 kcal/d (95% confidence interval 23 to 82) for every 10% decrease in the contribution of carbohydrate", and the low-carbohydrate group's change was "209 kcal/d (91 to 326) greater" than the high-carbohydrate group's. Among the third with the highest insulin secretion, the difference was larger, "308 kcal/d in the intention-to-treat analysis", which is the pattern the insulin mechanism predicts. Their conclusion: "Consistent with the carbohydrate-insulin model, lowering dietary carbohydrate increased energy expenditure during weight loss maintenance." This course read the abstract.

Hall, Guo and Speakman downloaded the trial's public data and code and reanalysed it.⁵ This course read their short article in full. Three objections. The analysis plan "was changed after all subjects had completed the trial", and "The original preregistered analysis plan did not result in significant diet differences in TEE". Participants were given all their food, yet "the reported energy intake was 460 ± 46 kcal/day (p < 0.0001) less than the reported TEE", which suggests eating outside the study, and "A statistically significant TEE diet effect (p < 0.05) required inclusion of subjects with >600 kcal/day of unaccounted energy." And the objection this lesson has prepared you for: "No significant diet differences in CO2 production were found", so "TEE diet differences were entirely due to assumed RQ differences between the diets". So the difference in calories came from the calculation assuming each diet burned a different fuel mix.

The critics also report what cuts against them. In their own exploratory analysis, expenditure "was 255 ± 88 kcal/day (p = 0.004) greater on the low- versus high-carbohydrate diet at the study midpoint and 224 ± 81 kcal/day (p = 0.007) greater at the end", and they "cannot rule out diet differences in other components of TEE that were not quantified".⁵

Ebbeling and colleagues answered in 2020 with a measure that doesn't use doubly labelled water at all: how many calories each group had to be fed to hold its weight.¹⁶ That was higher on the low-carbohydrate diet, by amounts "ranging from 181 (95% CI: 8-353) to 246 (64-427) kcal/d" across their models, and they say their data "lend qualified support for the validity of the DLW method with diets varying in macronutrient composition". This course read the abstract. Every model's interval stays above zero, though the lower end of the first is 8 calories a day, so the size of the effect is far less certain than its direction.

The pooled trials

Two meta-analyses of controlled feeding studies point opposite ways. Hall and Guo pooled 32 studies that swapped carbohydrate for fat at equal calories and found "both energy expenditure (26 kcal/d; P <.0001) and fat loss (16 g/d; P <.0001) were greater with lower fat diets."⁴ Ludwig and colleagues took the trials from a previous meta-analysis, added newer ones, and reanalysed 29, median length four days, split at 2.5 weeks: in 23 shorter trials expenditure was about 50 calories a day lower on lower-carbohydrate diets, and in 6 longer ones about 135 higher. Their conclusion: "Lower-carbohydrate diets transiently reduce TEE, with a larger increase after ∼2.5 wk."¹⁷ Both were read at abstract level. Only six trials sit on the longer side.

That split is the CIM's standing answer to short ward studies: "Short-term studies of metabolic outcomes may also produce misleading results, related to adaptive processes after changes in macronutrients."¹³ The EBM side's answer is the reanalysis of Ebbeling's trial. In the terms this institute uses, this is a contested empirical question, not settled in either direction.

What would settle it, in the research file's synthesis: long, tightly controlled feeding trials, analysis plans registered in advance and followed, expenditure measured in a sealed metabolic chamber as well as by doubly labelled water, and ideally both sides designing the trial together. The CIM authors ask for feeding studies "of sufficient duration to distinguish transient from chronic macronutrient effects (≥1 mo)".¹³ The EBM paper's abstract, all this course read of it, sets out no agenda.

Weight, dieting and eating disorders

Everything above is about bodies measured in groups. Two cautions go with it.

NICE's eating-disorder guideline for England lists what should make a clinician think about referral, and one item is "an unusually low or high body mass index (BMI) or body weight for their age". Another recommendation reads: "Do not use single measures such as BMI or duration of illness to determine whether to offer treatment for an eating disorder."¹⁸ The research file draws the plain consequence: a person in a larger body can have an eating disorder, and a number on a scale doesn't rule one in or out. NICE also says: "Although eating disorders can develop at any age, be aware that the risk is highest for young men and women between 13 and 17 years of age." This course read the guideline's recommendations page.

Two cohorts of teenagers point the same way. In Victoria, Australia, about 1,700 students aged 14 and 15 were followed for three years. "Female subjects who dieted at a severe level were 18 times more likely to develop an eating disorder than those who did not diet", and moderate dieters five times as likely; psychiatric illness predicted onset independently of dieting.¹⁹ In the US, Project EAT followed 2,516 adolescents for five years and concluded that "Dieting and unhealthful weight-control behaviors predict outcomes related to obesity and eating disorders 5 years later."²⁰ This course read both abstracts in full.

Both are observational, the kind of evidence Sleep lesson 3 taught you to read for direction: dieting may be an early sign of an eating disorder as well as a cause. The Australian outcome was partial syndromes, not full diagnoses, and neither abstract gives confidence intervals. Neither study tested supervised weight management in adults. What they support is caution about dieting in adolescence. If any of this is close to home, the numbers are in the callout at the top.

What people get wrong

"My metabolism has been slowing since my twenties." Adjusted for body size, average daily expenditure was flat from 20 to 60 in Pontzer's database, with the caveats given above.

"3,500 calories is a pound, so the maths is simple." The figure is roughly right for the energy in a pound of fat tissue. The mistake is treating the deficit as fixed when expenditure falls with weight, which is why the rule overpredicts.

"Exercise adds its calories on top." On average about 72 percent of the extra reached the day's total in Careau's data, and among the most active people in Pontzer's the daily total plateaued.

"Calories don't matter, it's insulin." Neither side says so. The CIM's claim is that high-glycemic diets make people take in more calories than they burn, not that intake and expenditure stop counting.

"Only calories matter, so what you eat is irrelevant." The EBM's own authors say intake is controlled by the brain in response to the body and to "environmental influences", which include the food itself. Hall's 2021 trial found a 689-calorie daily difference in intake over two weeks, and 544 in the final week, between two diets people could eat freely.

Practice

Connections

Back. Lesson 1's controlled feeding studies are where this lesson's disputes are fought, and lesson 2's doubly labelled water turned out to rest on an assumed RQ. Sleep lesson 3's point about observational evidence is the caveat on Pontzer's database and the teenage dieting cohorts.

Forward. Lesson 4 asks the practical question the models argue over: when people are put on different diets for a year, which does better, and why does sticking with a diet predict more than which diet it was?

Go deeper

• Hall and Chow, 2013, free at PubMed Central. Read in full here; it's one page. The clearest statement of what's wrong with the 3,500-calorie rule and what isn't.
• Pontzer and colleagues, 2021, free as an author manuscript at PubMed Central. Read here: the abstract, results and discussion. The life-course data, with the authors' own cautions.
• Ludwig and colleagues, 2021 and Hall and colleagues, 2022, both in the American Journal of Clinical Nutrition. This course read the first's abstract and seven sections, and only the second's abstract. Read them as a pair, each side in its own words.
• Hall, Guo and Speakman, 2019, free at PubMed Central. Read in full here. A short reanalysis that shows how an argument over one trial is actually conducted, including the results that cut against the authors.

Sources

1. D. M. Thomas and colleagues, "Can a weight loss of one pound a week be achieved with a 3500-kcal deficit? Commentary on a commonly accepted rule", International Journal of Obesity 37(12), 2013, pp. 1611 to 1613, doi 10.1038/ijo.2013.51. Read: the abstract. Supports: the rule's spread, the seven experiments and "grossly overestimates".
2. World Health Organization, "Obesity and overweight" fact sheet, who.int, dated 8 December 2025. Read: the page in full, 24 September 2026. Supports: the imbalance sentence.
3. K. D. Hall and colleagues, "The energy balance model of obesity: beyond calories in, calories out", American Journal of Clinical Nutrition 115(5), 2022, pp. 1243 to 1254, doi 10.1093/ajcn/nqac031. Read: the abstract only. Supports: every quotation from the EBM side's statement.
4. K. D. Hall and J. Guo, "Obesity Energetics: Body Weight Regulation and the Effects of Diet Composition", Gastroenterology 152(7), 2017, pp. 1718 to 1727, doi 10.1053/j.gastro.2017.01.052. Read: the abstract. Supports: the misinterpretation and counterbalancing sentences, and the meta-analysis of 32 studies.
5. K. D. Hall, J. Guo and J. R. Speakman, "Do low-carbohydrate diets increase energy expenditure?", International Journal of Obesity 43(12), 2019, pp. 2350 to 2354, doi 10.1038/s41366-019-0456-3. Read: the full text (a short article with no abstract). Supports: that doubly labelled water measures carbon dioxide, and every quotation from the reanalysis, including the unaccounted-energy sentence.
6. K. D. Hall and colleagues, "Energy expenditure and body composition changes after an isocaloric ketogenic diet in overweight and obese men", American Journal of Clinical Nutrition 104(2), 2016, pp. 324 to 333, doi 10.3945/ajcn.116.133561. Read: the abstract. Supports: the fall in RQ and the 151 and 57 calorie figures. The definition of RQ is this course's own, not the research file's.
7. K. D. Hall and C. C. Chow, "Why is the 3500 kcal per pound weight loss rule wrong?", International Journal of Obesity 37(12), 2013, p. 1614, doi 10.1038/ijo.2013.112. Read: the full text (a one-page letter with no abstract). Supports: all three quotations.
8. K. D. Hall and colleagues, "Quantification of the effect of energy imbalance on bodyweight", The Lancet 378(9793), 2011, pp. 826 to 837, doi 10.1016/S0140-6736(11)60812-X. Read: the abstract. Supports: the half-time, adiposity, the 30 kJ and 0.9 MJ figures and intake keeping pace. The kilocalorie conversions are the research file's; the explanation of a half-time is this course's.
9. H. Pontzer and colleagues, "Daily energy expenditure through the human life course", Science 373(6556), 2021, pp. 808 to 812, doi 10.1126/science.abe5017. Read: the abstract; the full text (the author manuscript), all results sections and discussion. Supports: every figure and quotation in its section. The "different explanation" for middle-age gain is the research file's summary.
10. H. Pontzer and colleagues, "Constrained Total Energy Expenditure and Metabolic Adaptation to Physical Activity in Adult Humans", Current Biology 26(3), 2016, pp. 410 to 417, doi 10.1016/j.cub.2015.12.046. Read: the abstract; the full text, results and discussion. Supports: every figure and quotation in its section. That the model is debated, and that exercise's health benefits are separate, are the research file's notes.
11. V. Careau and colleagues, "Energy compensation and adiposity in humans", Current Biology 31(20), 2021, pp. 4659 to 4666, doi 10.1016/j.cub.2021.08.016. Read: the abstract. Supports: 1,754 people, the compensation through resting expenditure, the 72 percent, and the variation with body composition and its two readings. That this fits the exercise trials is the research file's note.
12. E. Fothergill and colleagues, "Persistent metabolic adaptation 6 years after 'The Biggest Loser' competition", Obesity 24(8), 2016, pp. 1612 to 1619, doi 10.1002/oby.21538. Read: the abstract; the full text, introduction and discussion. Supports: every figure and quotation in its section.
13. D. S. Ludwig and colleagues, "The carbohydrate-insulin model: a physiological perspective on the obesity pandemic", American Journal of Clinical Nutrition 114(6), 2021, pp. 1873 to 1885, doi 10.1093/ajcn/nqab270. Read: the abstract; the full text's introduction, the sections on dietary drivers, the glycemic-load mechanism and short-term studies, the response to "move the goalposts", the research agenda and the conclusion. Supports: every quotation from the CIM side's statement. The step-by-step mechanism is the research file's summary of the full text. Willett's co-authorship is from the author list.
14. K. D. Hall and colleagues, "Effect of a plant-based, low-fat diet versus an animal-based, ketogenic diet on ad libitum energy intake", Nature Medicine 27(2), 2021, pp. 344 to 353, doi 10.1038/s41591-020-01209-1. Read: the abstract. Supports: the design, the 689 and 544 figures, the primary outcomes, the conclusion and the withdrawal. The two limits are the research file's.
15. C. B. Ebbeling and colleagues, "Effects of a low carbohydrate diet on energy expenditure during weight loss maintenance: randomized trial", BMJ 363, 2018, k4583, doi 10.1136/bmj.k4583. Read: the abstract. Supports: the design, the 52, 209 and 308 figures, and the conclusion.
16. C. B. Ebbeling and colleagues, "Energy Requirement Is Higher During Weight-Loss Maintenance in Adults Consuming a Low- Compared with High-Carbohydrate Diet", Journal of Nutrition 150(8), 2020, pp. 2009 to 2015, doi 10.1093/jn/nxaa150. Read: the abstract. Supports: the 10.5 percent run-in loss, the energy requirement figures and the qualified support for doubly labelled water.
17. D. S. Ludwig and colleagues, "Do Lower-Carbohydrate Diets Increase Total Energy Expenditure? An Updated and Reanalyzed Meta-Analysis of 29 Controlled-Feeding Studies", Journal of Nutrition 151(3), 2021, pp. 482 to 490, doi 10.1093/jn/nxaa350. Read: the abstract. Supports: the sample drawn from a previous meta-analysis plus new trials, the 29 trials, the four-day median, the split and both estimates, and the conclusion.
18. National Institute for Health and Care Excellence, Eating disorders: recognition and treatment, NICE guideline NG69, published 23 May 2017, last updated 16 December 2020, recommendations. Read: the recommendations page. Supports: recommendations 1.2.4, 1.2.6 and 1.2.8 as quoted. That an eating disorder can occur in a larger body is the research file's reading of 1.2.6 and 1.2.8.
19. G. C. Patton and colleagues, "Onset of adolescent eating disorders: population based cohort study over 3 years", BMJ 318(7186), 1999, pp. 765 to 768, doi 10.1136/bmj.318.7186.765. Read: the abstract in full. Supports: the design, the 18 and five times figures, and psychiatric morbidity.
20. D. Neumark-Sztainer and colleagues, "Obesity, disordered eating, and eating disorders in a longitudinal study of adolescents: how do dieters fare 5 years later?", Journal of the American Dietetic Association 106(4), 2006, pp. 559 to 568, doi 10.1016/j.jada.2006.01.003. Read: the abstract in full. Supports: the sample and the conclusion.