• de OliveiraJônatasJSchool of Medicine, University of Sao Paulo, Sao Paulo, Brazil. Electronic address: oliveira.jonatas@usp.br., Isis de Carvalho Stelmo, Leandro Silva Figueredo, and Carolina Cristina de Freitas.
• School of Medicine, University of Sao Paulo, Sao Paulo, Brazil. Electronic address: oliveira.jonatas@usp.br.
• Nutrition. 2024 Jan 1; 117: 112252112252.

ObjectivesThe management of the phenomenon of adaptive thermogenesis poses a challenge to the successful treatment of overweight/obesity with a nutritional intervention that minimizes the loss of muscle mass, with little cognitive restraint use and disorganization of eating behavior. On the other hand, it creates a significant calorie deficit for the reduction of body fat. The aim of this case report was to discuss the effects of a very low-calorie ketogenic diet in a woman with obesity and low resting metabolic rate.Case DescriptionA 36-y-old white woman with a history of obesity and bulimia nervosa who has had difficulty losing and maintaining weight despite numerous dietary and pharmacologic treatments.ResultsThere was a loss of 12 kg in 115 d, reaching 13.4 kg, with 11.4 kg of fat mass (FM). The resting metabolic rate showed an increase of 79% in relation to the initial rate, reaching normal levels for the predictive equations and maintaining this level in the first-year follow-up. Additionally, improvement of metabolic laboratory parameters and eating behavior traits were described.ConclusionsIn this specific case of bulimia nervosa resulting in hypometabolism (low resting metabolic rate/fat-free mass) and obesity, the very low-calorie ketogenic diet intervention has demonstrated a possibility of weight loss with little cognitive restraint use, thereby increasing resting metabolic rate in the short and medium terms, ultimately promoting a negative energy balance. In relation to the numeric results, it seems positive; however, more research is necessary to evaluate the effects on the overall relationship with food and its long-term repercussions.Copyright © 2023 Elsevier Inc. All rights reserved.

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