When Somebody Loses Weight, Where Does The Fat Go ?

BMJ 2014;349:g7257 doi: 10.1136/bmj.
g7257 (Published 16 December 2014) Page 1 of 3
Feature
FEATURE
CHRISTMAS 2014: GASTROENTEROLOGICAL TRACTS
When somebody loses weight, where does the fat go?

OPEN ACCESS
Ruben Meerman researcher, Andrew J Brown professor

School of Biotechnology and Biomolecular Sciences, University of New South Wales, Sydney, 2052, Australia
Abstract The complete oxidation of a single triglyceride molecule

Ruben Meerman and Andrew Brown explain why the answer might involves many enzymes and biochemical steps, but the entire
not be what you expect process can be summarised as:
C55H104O6+78O255CO2+52H2O+energy
Considering the soaring overweight and obesity rates and strong
interest in this topic, there is surprising ignorance and confusion Stoichiometry shows that complete oxidation of 10 kg of human
about the metabolic process of weight loss among the general fat requires 29 kg of inhaled oxygen producing 28 kg of CO2
public and health professionals alike. We encountered and 11 kg of H2O. This tells us the metabolic fate of fat but
widespread misconceptions about how humans lose weight remains silent about the proportions of the mass stored in those
among general practitioners, dietitians, and personal trainers 10 kg of fat that depart as carbon dioxide or water during weight
(fig 1). Most people believed that fat is converted to energy loss.
or heat, which violates the law of conservation of mass. We To calculate these values, we traced every atoms pathway out
suspect this misconception is caused by the energy in/energy of the body. The carbon and hydrogen atoms obviously depart
out mantra and the focus on energy production in university as CO2 and H2O, respectively. The fate of a triglyceride
biochemistry courses. Other misconceptions were that the molecules six oxygen atoms is a conundrum solved in 1949
metabolites of fat are excreted in the faeces or converted to by Lifson and colleagues.3 They used labelled heavy oxygen
muscle. We present a novel calculation to show how we lose (O18) to show that the oxygen atoms of body water and
weight. respiratory carbon dioxide are rapidly exchanged through the
Weight we want to lose formation of carbonic acid (H2CO3). A triglycerides six oxygen
atoms will therefore be shared by CO2 and H2O in the same 2:1
Excess carbohydrate or protein in the diet is converted to ratio in which oxygen exists in each substance. In other words,
triglyceride and stored in the lipid droplets of adipocytes. Excess four will be exhaled and two will form water.
dietary fat needs no conversion other than lipolysis and
re-esterification. People who wish to lose weight while Novel calculation
maintaining their fat-free mass are, biochemically speaking,
attempting to metabolise the triglycerides stored in their The proportion of a triglyceride molecules mass exhaled in
adipocytes. CO2 is the proportion of its molecular weight (daltons)
The chemical formula for an average triglyceride molecule can contributed by its 55 carbon atoms plus four of its oxygen atoms:
be deduced from fatty acid composition studies. In 1960, Hirsch (661 Da (C55)+64 Da (O4))/(861 Da (C55H104O6))100=84%
and colleagues published data that yield an average fatty acid The proportion of mass that becomes water is:
with the formula C17.4H33.1O2.1 This 50 year old result is in
(105 Da (H104)+32 Da (O2))/(861 Da (C55H104O6))100=16%
remarkable agreement with more recent data.2 Three average
fatty acids esterified to the glycerol backbone (+3C, +6H) give These results show that the lungs are the primary excretory
an average triglyceride with the formula C54.8H104.4O6. The organ for weight loss (fig 2). The water formed may be
three most common fatty acids stored in human adipose tissues excreted in the urine, faeces, sweat, breath, tears, or other bodily
are oleate (C18H34O2), palmitate (C16H32O2), and linoleate fluids.
(C18H32O2),1 2 which all esterify to form C55H104O6.
Correspondence to: R Meerman rubenmeerman@me.com
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BMJ 2014;349:g7257 doi: 10.1136/bmj.g7257 (Published 16 December 2014) Page 2 of 3
FEATURE
Lifting the veil on weight loss biochemistry courses to correct widespread misconceptions
about weight loss.
At rest, an average 70 kg person consuming a mixed diet
(respiratory quotient 0.8) exhales about 200 ml of CO2 in 12 Competing interests: I have read and understood BMJ policy on
breaths per minute.4 Each of those breaths therefore excretes 33 declaration of interests and have no relevant interests to declare
mg of CO2, of which 8.9 mg is carbon. In a day spent asleep, at
Provenance and peer review: Not commissioned; externally peer
rest, and performing light activities that double the resting
reviewed.
metabolic rate, each for 8 hours, this person exhales 0.74 kg of
CO2 so that 203 g of carbon are lost from the body. For 1 Hirsch J, Farquhar JW, Ahrens EH, Jr, Peterson ML, Stoffel W. Studies of adipose tissue
comparison, 500 g of sucrose (C12H22O11) provides 8400 kJ (2000 in man. A microtechnic for sampling and analysis. Am J Clin Nutr 1960;8:499-511.
kcal) and contains 210 g of carbon. Replacing one hour of rest 2 Hodson L, Skeaff CM, Fielding BA. Fatty acid composition of adipose tissue and blood
in humans and its use as a biomarker of dietary intake. Prog Lipid Res 2008;47:348-80.
with exercise that raises the metabolic rate to seven times that 3 Lifson N, Gordon GB, Visscher MB, Nier AO. The fate of utilized molecular oxygen and
of resting by, for example, jogging, removes an additional 39 the source of the oxygen of respiratory carbon dioxide, studied with the aid of heavy
oxygen. J Biol Chem 1949;180:803-11.
g of carbon from the body, raising the total by about 20% to 4 Ainsworth BE, Haskell WL, Herrmann SD, Meckes N, Bassett DR, Jr, Tudor-Locke C, et
240 g. For comparison, a single 100 g muffin represents about al. 2011 Compendium of physical activities: a second update of codes and MET values.
20% of an average persons total daily energy requirement. Med Sci Sports Exerc 2011;43:1575-81.
Physical activity as a weight loss strategy is, therefore, easily Accepted: 14 November 2014
foiled by relatively small quantities of excess food.
Cite this as: BMJ 2014;349:g7257
Our calculations show that the lungs are the primary excretory
organ for fat. Losing weight requires unlocking the carbon stored This is an Open Access article distributed in accordance with the Creative Commons
Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute,
in fat cells, thus reinforcing that often heard refrain of eat less, remix, adapt, build upon this work non-commercially, and license their derivative works
move more. We recommend these concepts be included in on different terms, provided the original work is properly cited and the use is
secondary school science curriculums and university non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

BMJ 2014;349:g7257 doi: 10.1136/bmj.g7257 (Published 16 December 2014) Page 3 of 3
FEATURE
Figures
Fig 1 Responses of a sample of doctors, dieticians, and personal trainers to the question When somebody loses weight,
where does it go? (Correct answer CO2)
Fig 2 When somebody loses 10 kg of fat (triglyceride), 8.4 kg is exhaled as CO2. The remainder of the 28 kg total of CO2
produced is contributed by inhaled oxygen. Lungs are therefore the primary excretory organ for weight loss. (This calculation
ignores fat that may be excreted as ketone bodies under particular (patho)physiological conditions or minor amounts of
lean body mass, the nitrogen in which may be excreted as urea)

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BMJ 2014;349:g7257 doi: 10.1136/bmj.

g7257 (Published 16 December 2014) Page 1 of 3

CHRISTMAS 2014: GASTROENTEROLOGICAL TRACTS

When somebody loses weight, where does the fat go?

Ruben Meerman researcher, Andrew J Brown professor

Abstract The complete oxidation of a single triglyceride molecule

Correspondence to: R Meerman rubenmeerman@me.com

No commercial reuse: See rights and reprints http://www.bmj.com/permissions Subscribe: http://www.bmj.com/subscribe

No commercial reuse: See rights and reprints http://www.bmj.com/permissions Subscribe: http://www.bmj.com/subscribe

No commercial reuse: See rights and reprints http://www.bmj.com/permissions Subscribe: http://www.bmj.com/subscribe

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