How much weight would an individual gain by eating an extra chocolate chip cookie every day for life? One approach to answering this question, frequently used in textbooks1 and scientific articles, is based on the assumption that a pound (454 g) of fat tissue has about 3500 kilocalories (kcal). Thus, a daily 60-kcal cookie would be expected to produce 0.2 kg (0.5 lb) weight gain in a month, 2.7 kg (6 lb) in a year, 27 kg (60 lb) in a decade, and many hundreds of pounds in a lifetime. This of course does not happen. In this article, the physiology of weight gain and loss is reviewed, and the amount of reduction of caloric intake necessary to avoid becoming overweight or obese is estimated.
Solid curves demonstrate the predicted effects of a decrease in energy intake initiated at age 25 years on the weight gain that results from progressive changes in diet and physical activity in 2 situations. Panel A represents deviations from the natural course of weight gain (the dashed line) for the average US women interpolated from National Health and Nutrition Examination Survey (NHANES) I to IV data covering a 28-year period.4 Panel B represents the hypothetical case of a man aged 25 years whose body mass index increased from 25 to 35 over 28 years (dashed line). Mathematical models were based on Hall et al.10
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