Obesity Surgery

, Volume 29, Issue 10, pp 3299–3308 | Cite as

Influence of Energy Balance on the Rate of Weight Loss Throughout One Year of Roux-en-Y Gastric Bypass: a Doubly Labeled Water Study

  • Michele Novaes RavelliEmail author
  • Dale A. Schoeller
  • Alex Harley Crisp
  • Timothy Shriver
  • Eduardo Ferriolli
  • Carlos Ducatti
  • Maria Rita Marques de Oliveira
Original Contributions



To investigate the influence of changes in energy balance and body composition on the rate of weight loss throughout 1 year of Roux-en-Y gastric bypass.


Variables were collected pre-, 6, and 12 months (M) post-surgery from 18 women (BMI ≥ 40 and ≤ 50 kg m−2, 20 to 45 years). Total energy expenditure (TEEm), fat-free mass (FFM), and fat mass (FM) were measured by doubly labeled water. Self-reported energy intake (EIsr) was obtained from three non-consecutive food diaries. Metabolic adaptation was assessed via deviations from TEE predictive equation, and the calculated energy intake (EIc) via the sum of TEE and change in body stores.


BMI significantly decreased (mean ± SD) from 45 ± 2 kg m−2 to 32 ± 3 kg m−2 at 6 M, and to 30 ± 3 kg m−2 at 12 M after surgery. The TEEm reduced significantly at both time points when compared with pre-surgery (6 M: − 612 ± 317 kcal day−1; 12 M: − 447 ± 516 kcal day−1). At 6 M, a metabolic adaptation was observed and the energy balance was − 1151 ± 195 kcal day−1, while at 12 M it was − 332 ± 158 kcal day−1. Changes in the values of TEEm were associated with changes in body weight at 12 M post-surgery. A significant underreporting was observed for EIsr (1057 ± 385 kcal day−1) vs. EIc (2083 ± 309 kcal day−1) at 12 M post-operative.


The higher rate of weight loss at 6 M post-surgery was a response to energy imbalance, which was caused by high restriction in energy intake even with the presence of metabolic adaptation at this time. The EIsr was not sufficiently accurate to assess the energy consumption of this population.

Registration of Clinical Trials (Observational Study)

Brazilian Clinical Trials Registry: RBR-8k5jsj. Universal Trial Number: U1111-1206-0858.


Bariatric surgery Energy balance Body composition Metabolic adaptation Doubly labeled water 



Natalie Racine (Biotechnology Center, University of Wisconsin, Madison/WI, USA), who provided editing particularly with respect to English grammar and for discussions of the measurement of TEE by DLW. Dr. Karina Pfrimer (Ribeirao Preto Medical School, University of Sao Paulo—USP) who provided discussions of the measurement of TEE by DLW. The Bariatric Clinic, Piracicaba—Brazil, in name of Dr. Irineu Razera Junior and his collaborators, who authorized the conduct of the research in the clinic and partnership in the activities carried out.


This study was funded by the Sao Paulo Research Foundation (FAPESP—Fundação de Amparo à Pesquisa do Estado de São Paulo) (grant numbers: 2013/04420-4; 2013/03998-2; 2016/02306-8).

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

The study protocol was approved by the Ethical Committee of the Medical School of Botucatu of the State University of São Paulo, UNESP. Informed consent was obtained from all participants included in the study.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.School of Pharmaceutical SciencesSao Paulo State University – UNESPAraraquaraBrazil
  2. 2.Department of NeurologyUniversity of Wisconsin – MadisonMadisonUSA
  3. 3.Biotechnology CenterUniversity of Wisconsin – MadisonMadisonUSA
  4. 4.Ribeirao Preto Medical SchoolUniversity of Sao Paulo – USPRibeirão PretoBrazil
  5. 5.Stable Isotope Center, Bioscience InstituteSao Paulo State University – UNESPBotucatuBrazil
  6. 6.Education Department, Institute of BiosciencesSao Paulo State University – UNESPBotucatuBrazil

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