Weight Management in ME/CFS
1 Alazzam et al. 2023 — BMR/RMR Measurement after Spinal Cord Injury
Full Citation:: Alazzam AM, Alrubaye MW, Goldsmith JA, Gorgey AS. Trends in measuring BMR and RMR after spinal cord injury: a comprehensive review. British Journal of Nutrition. 2023;130(10):1684–1698. (Alazzam et al. 2023) DOI:: 10.1017/S0007114523000831 Study Design:: Comprehensive review of metabolic rate measurement methods in SCI Key Findings::
- BMR constitutes 75–80% of total energy expenditure in SCI (vs 60–70% in ambulatory)
- Predictive equations overestimate RMR by 5–32% in SCI
- Indirect calorimetry is the gold standardConclusion:: SCI literature provides the best analog for caloric needs estimation in severely immobile ME/CFS patients. Limitations:: Review; SCI involves neurogenic denervation absent in ME/CFS. Certainty:: 0.70
2 Biolo et al. 2008 — Positive Energy Balance Accelerates Muscle Atrophy in Bed Rest
Full Citation:: Biolo G, Agostini F, Simunic B, et al. Positive energy balance is associated with accelerated muscle atrophy and increased erythrocyte glutathione turnover during 5 wk of bed rest. American Journal of Clinical Nutrition. 2008;88(4):950–958. (Biolo et al. 2008) DOI:: 10.1093/ajcn/88.4.950 Study Design:: Controlled bed rest study; healthy volunteers Sample Size:: n=17 bed rest vs n=8 ambulatory control Key Findings::
- Positive energy balance during 5-week bed rest ACCELERATED muscle atrophy
- Energy balance maintenance was protective against muscle lossConclusion:: Overfeeding bedbound patients may worsen sarcopenic obesity. Energy balance maintenance is critical. Limitations:: Healthy volunteers; short duration; controlled setting. Certainty:: 0.70
3 D’Onghia et al. 2021 — Fibromyalgia and Obesity Meta-Analysis
Full Citation:: D’Onghia M, Ciaffi J, Lisi L, Giunchi D, Malavolta N, Ursini F. Fibromyalgia and obesity: a comprehensive systematic review and meta-analysis. Seminars in Arthritis and Rheumatism. 2021;51(3):608–614. (D’Onghia et al. 2021) DOI:: 10.1016/j.semarthrit.2021.02.007 Study Design:: Systematic review and meta-analysis Sample Size:: 58 studies Key Findings::
- Elevated obesity prevalence in fibromyalgia vs general population
- Obesity worsens FM symptoms; weight loss improves themConclusion:: Weight management is a therapeutic priority in FM; analogous benefits likely in ME/CFS. Limitations:: FM is not ME/CFS; weight loss modalities heterogeneous. Certainty:: 0.75
4 Wilding et al. 2021 — STEP 1: Once-Weekly Semaglutide
Full Citation:: Wilding JPH, Batterham RL, Calanna S, et al. Once-weekly semaglutide in adults with overweight or obesity. New England Journal of Medicine. 2021;384(11):989–1002. (Wilding et al. 2021) DOI:: 10.1056/NEJMoa2032183 Study Design:: Randomized, double-blind, placebo-controlled (STEP 1) Sample Size:: n=1961 Key Findings::
- Semaglutide 2.4 mg: -14.9% body weight vs -2.4% placebo
- ~40% of weight lost from lean mass
- GI adverse events in ~75%Conclusion:: GLP-1 RAs effective for weight but lean mass loss is a major concern in ME/CFS. Limitations:: Excluded chronic illness populations; no ME/CFS patients. Certainty:: 0.90
5 Weijs and Wolfe 2025 — Protein Requirement in Obesity
Full Citation:: Weijs PJM, Wolfe RR. Protein requirement in obesity. Current Opinion in Clinical Nutrition and Metabolic Care. 2025;28(3):231–237. (Weijs and Wolfe 2025) DOI:: 10.1097/MCO.0000000000001087 Study Design:: Expert review Key Findings::
- Protein needs increase to 1.5–2.0 g/kg IBW during caloric restriction
- Higher protein spares lean mass even without resistance exerciseConclusion:: Any weight management in ME/CFS must include protein ≥1.5 g/kg IBW. Limitations:: General obesity; not specific to immobility. Certainty:: 0.65