Christina Animashaun/Vox

What I learned
about weight
loss from
spending a day
inside a
metabolic
chamber
One of science’s best tools for
understanding obesity is
debunking myths about
metabolism.
By Julia Belluz @juliaoftoronto julia.belluz@voxmedia.com Sep 4, 2018, 10:20am
EDT

Photographs and graphics by Christina Animashaun

When scientists offer mice or rats a spread of junk food, they

consistently find that only some overeat and puff out into
little rodent blimps, while others maintain a normal body size.

A similar thing happens in people. In the US, and around the

world, we are now overwhelmed with highly palatable, cheap
calories. This has helped obesity rates soar on average. But
not everyone overeats and becomes overweight, and not
everyone who becomes overweight or obese develops illnesses
like diabetes or heart disease. This individual variation — why
we have different responses to extra calories and weight — is
one of the greatest mysteries of modern medicine.

The best place to find answers is an 11-by-11.5-foot room in

suburban Washington, DC. This summer, I spent a day there,
one of fewer than 100 patients who will do so this year.

The National Institutes of Health Clinical Center’s airtight

“metabolic chamber” is furnished only with an exercise bike, a
toilet, and a bed. For 23 hours in June, I was sealed in the
chamber, while nurses monitored me constantly through a
plexiglass window and video camera in the ceiling.

Like a prisoner in solitary confinement, I ate meals delivered

through a small, air-locked opening in the wall. Since
researchers were measuring every calorie I used, any leftover
scrap had to be sent back through the wall and recorded. A
heart monitor and three accelerometers on my wrist, waist,
and ankle tracked my every heartbeat and movement.
Inside the metabolic chamber at the National Institutes of Health Clinical Center in Bethesda,
Maryland. The chamber has a “clean” airlock portal where subjects receive their meals, and a
“dirty” one where they can pass back any leftovers. | Christina Animashaun/Vox

There are only about 30 metabolic chambers in the world, and

the NIH is home to three. These highly sensitive, multimillion-
dollar scientific instruments are considered the gold standard
for measuring metabolism. They’ve furthered our
understanding of obesity, metabolic syndrome, and diabetes —
diseases that are now among the greatest threats to health
worldwide — by letting researchers carefully track how
individual bodies respond to the calories they’re offered.

My participation, as a normal weight “control” subject in an

obesity phenotyping study, would be used toward this lofty
goal.

But I wasn’t interested in joining the study just for the sake of
science; I had selfish motivations too. As kids, my two brothers
and many of my friends seemed to be able to binge on junk
food without gaining weight. Today, my husband can gulp
down mountains of pasta and remain skinny. I, on the other
hand, have always noticed the scale creeps up quickly when
I’m not careful about my diet. And I’ve harbored a suspicion
that a “slow metabolism” might help explain my lifelong
struggle to control my weight.

Being a self-imposed NIH prisoner was an exciting and rare

opportunity — to see one of the most important scientific tools
in obesity research up close and to finally get some answers on
this long-simmering question about my body.

But my day in the chamber revealed the depths of my

misunderstanding about my metabolism. And that the
obsession with metabolism speed is distracting, destructive,
and based on a myth about obesity and weight management.

Metabolism, explained
If you’ve surveyed the covers of women’s magazines, watched
Dr. Oz’s TV show, or strolled down the supplement aisle at the
grocery store, you might think your metabolism is a single
thing that can be calibrated with “metabolism boosters” like
chili peppers or coffee, or by following special diets.

In reality, metabolism is the thousands of chemical reactions

that turn the energy we eat and drink into fuel in every cell of
the body. These reactions change in response to our
environments and behaviors, and in ways we have little control
over. (Eating certain foods and exercising a little more
generally shifts our metabolic rate only marginally.)

Julia Belluz/Vox
There are three main ways the body uses calories. There’s the
energy needed to keep our hearts, brains, and every cell of our
body working, known as the basal metabolism. There’s the
energy used to break down food, known as the thermic effect
of food. And there’s the energy burned off during physical
activity — like walking around, fidgeting, or exercising.

The basal metabolic rate accounts for the largest amount of

the total calories a person burns each day (65 to 80 percent
for most adults). Physical activity, on the other hand, accounts
for a much smaller portion — 10 to 30 percent for most people
— despite what many people believe. And digesting food
accounts for about 10 percent.

There are several predictors of how fast or slow a person’s

metabolic rate will be. These include the amount of lean
muscle and fat tissue in the body, age, and genetics. Women
tend to burn fewer calories than men. Having a higher
metabolic rate means your body uses food for fuel (instead of
storing it as fat) more quickly. But you can still gain weight if
you consume more calories than your body needs.
Counterintuitively, heavier people generally have higher
metabolic rates than skinny folks to meet the fuel demands of
their larger bodies.

These processes, essential to any living organism, are

complex, and scientists had been working to unravel them for
centuries before the obesity crisis hit.
An engraving of Santorio Sanctorius, a 17th-century doctor and scientist, sitting in his “static
weighing chair.” | SSPL/Getty Images

In the early 1600s, Santorio Sanctorius, an Italian doctor and

“founding father of metabolic balance studies,” ran one of the
first controlled experiments of human metabolism. He invented
the “static weighing chair,” a device that allowed him to weigh
himself before and after meals, sleep, toilet breaks, even sex.
He noticed fluctuations in his bodyweight, and concluded these
could be explained by “insensible perspiration.”

One hundred years after that, French chemist Antoine Lavoisier

used a device called an “ice calorimeter” to gauge the energy
burn from animals —like guinea pigs — in cages by watching
how quickly ice or snow around the cages melted. This
research suggested that the heat and gases respired by
animals, including humans, related to the energy they burn.

The “metabolic chamber” I entered evolved from Sanctorius

and Lavoisier’s work. Over the years, researchers probing the
mysteries of the metabolism figured out that the amount of
oxygen we take in, and carbon dioxide we let off, changes
depending on how quickly we’re using calories and the type of
calories we’re using. Measuring these gases in airtight
environments can determine a person’s metabolic rate.

The debunking machine

The metabolic chamber — also known as a whole-room
calorimeter — is the most precise tool available to track this
gas exchange minute by minute.

NIH’s three chambers opened in 2007 to focus on the growing

obesity epidemic. Eighteen researchers now use the rooms to
run about 400 studies every year. And they are part of a
broader “metabolic unit” dedicated to understanding the
weight problems, obesity, and diabetes that currently affect
up to a third of the people on earth.
A hallway leading to the chamber. Through an array of metal pipes spread on the chamber’s
ceiling, researchers capture and measure oxygen consumption and CO2 production.

Studying thousands of subjects in the metabolic unit — the

chambers plus NIH hospital wings for patients with diabetes
and obesity — has helped researchers show how adaptable the
metabolism is, and how it works with our appetite, body
composition, and physical activity levels to adjust the calories
we’re burning at any moment.

For example, by giving people a medication that causes them

to lose (through their urine) an extra 360 calories per day,
they’ve shown that we unknowingly compensate for those
calories lost by eating more.

They’ve found that exposing people to cold temperatures while

they sleep causes them to accumulate more brown fat — fat
tissue whose main function is heat production — and burn
more calories. (These results reversed completely when the
study participants slept in warmer temperatures again,
revealing how dynamic metabolism is.)

In a remarkable study of Biggest Loser reality TV show

participants with obesity, researchers showed that crash
dieting can permanently slow a person’s metabolic rate,
leading them to hang on to the calories they were eating for
longer, though this isn’t true for everybody who loses weight.

The big theme in many of these studies: Our metabolism

silently shifts under new conditions and environments in ways
we’re not usually aware of.

When it comes to diets, the researchers have also debunked

the notion that bodies burn more body fat while on a high-fat
and low-carb ketogenic diet, compared to a higher-carb diet,
despite all the hype.

“We could have found out that if we cut carbs, we’d lose way
more fat because energy expenditure would go up and fat
oxidation would go up,” said Kevin Hall, an obesity researcher
at NIH and an author on many of these studies. “But the body
is really good at adapting to the fuels coming in.” Another
related takeaway: There appears to be no silver bullet diet for
fat loss, at least not yet.

Many basic metabolism mysteries remain. It’s not fully known

why two people with the same size and body composition have
different metabolic rates. They also don’t know why people can
have different metabolic responses to weight gain (where some
people with obesity develop insulin resistance and diabetes, for
example, and others don’t). They don’t know why certain
ethnic groups — African Americans, South Asians — have a
higher risk of developing metabolic disorders like diabetes, and
why people with diabetes have a higher cardiovascular disease
risk.

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up.

They haven’t even figured out how the brain knows what the
body weighs and, therefore, the mechanism that controls our
metabolic rate.

“If I knew how the brain is aware of how much the body
weighs, and how to regulate how many calories it burned off, I
could change that setting and help an overweight person burn
more calories through an increase in metabolic rate,” NIH
metabolism and brown fat researcher Aaron Cypess told me
over the phone before my stay.
Cypess is using the chambers to work toward that, and figure
out whether there might be a drug that can do what very cold
temperatures do: help people burn more calories. These and
other studies in the chamber are a gold mine for data on the
metabolism’s mysteries — data that could eventually help
uncover cures for obesity and diabetes.

The meaning of metabolism

For my part in the research, I’d undergo a battery of physical
tests — from blood draws to an EKG — and spend a day and
night in the chamber. In addition to watching how much I
moved and what I ate, the scientists would get a reading on
precisely how many calories I burned and what type
(carbohydrates, fat, or protein), every minute of the 23 hours I
called the chamber home. I’d also have my metabolic rate
checked using two other methods (the “metabolic cart” and
“doubly labeled water”; more on these later).

In return, I’d get more granular data about how my body works
than I ever could’ve hoped for. And that made me anxious.

Christina Animashaun/Vox
At age 34 and 5-foot-9, my weight hovers in the 150s, and my
BMI is normal. But even as a child, I was chubby and seemed
to enjoy sugary and fatty foods more than other members of
my family. During my late teens and 20s, I struggled to
manage my weight and was at times overweight — a situation
that worsened at the end of high school. I moved to Italy and
indulged in all the pizza, ice cream, carpaccio, and mozzarella
my little town in Abruzzo had to offer. Like a research mouse, I
puffed out and returned to Canada the following year
depressed about my body. It took several years to really start
the process of slimming down.

I’d long believed these fat years somehow wreaked havoc on

my body. Specifically, I thought they slowed down my
metabolic rate, and that that made me prone to weight gain.
But I was about to learn this idea I’d held on to for so long was
wrong.

How the metabolic chamber actually measures

metabolism
Halfway through my morning in the metabolic chamber, I had
eaten and rested at prescribed intervals, and hit the exercise
bike for 30 minutes. I also meticulously recorded all my
activities in a log — when I was standing and reading, lying
down, on the bike — so that the researchers could compare
how they tracked against my calorie burn.

Just before lunch arrived, Kong Chen, a metabolism

investigator at NIH’s National Institute of Diabetes and
Digestive and Kidney Diseases, turned up on the other side of
my plexiglass window to say hello.

“How are you doing in there?” he asked.

I was surprisingly comfortable in the little room, I told him, and

asked if he could walk me through precisely how the chamber
does the work of measuring the metabolism.

Chen, who has a PhD in biomedical engineering, explained that

the room I was standing in was almost airtight, with a fixed
volume of oxygen and CO2. Through an array of metal pipes
spread across the ceiling, researchers captured and measured
the oxygen I consumed and the CO2 I produced at every
minute.

The reason these gasses matter for metabolism is simple, Chen

said. We get fuel in the form of calories — from carbohydrates,
fat, and protein. But to unlock those calories, the body needs
oxygen. When we breathe in, oxygen interacts with the food
we’ve consumed, breaking down (or oxidizing) chemical bonds
where the calories are stored and releasing them for use by
our cells. The product of the process is CO2.

When air is sucked out of the chamber through the pipes, two
things happen: First, gas analyzers measure everything the
person inside respired, Chen said. Then the gas analyzers send
the values for oxygen consumption and CO2 production to a
computer, where researchers like Chen plug them into
equations to calculate calories burned and what type of fuel
was oxidized.

The amount of CO2 we’re releasing, and the proportions of

CO2 to O2, changes depending on how many calories we’re
using and whether those calories came from carbs, fat, or
protein.

The reason these minute-to-minute measurements are so

important is that they allow the chamber to detect subtle shifts
of energy expenditure — as little as a 1.5 to 2 percent change
over 24 hours — in a way no other tool can. “If you have an
intervention — a drug or diet — that changes a person’s
physiology by a small percentage, we can measure that,” Chen
said proudly.
Kong Chen, a metabolism investigator at NIH’s National Institute of Diabetes and Digestive and
Kidney Diseases, speaking to me before my “metabolic cart” test, in a hospital room outside of
the chamber. | Christina Animashaun/Vox

The next best metabolism measuring method, called doubly

labeled water, involves drinking a sample of water that contains
(or is “labeled with”) forms of the elements deuterium and
oxygen-18. Since they’re not normally found in the body,
researchers can determine a person’s metabolic rate by
tracking how quickly they’re expelled through urine sampling.
But doubly labeled water can only detect a 5 percent change in
metabolic rate over seven to 10 days, more than double what
the metabolic chamber can see.

These tiny changes in calorie burn might sound insignificant,

but over time, they add up. “Ultimately,” Chen said, “it only
takes maybe a 100 calorie-per-day difference between food
intake and energy expenditure over a few years to gain 10
pounds.” So an extra cookie a day can mean the difference
between fitting in your jeans or not.

I asked Chen whether he’d ever used the chamber himself. He

told me he was his own first subject, part of an early validation
study. What did he learn, and did it change his behavior?
“I found myself to be fairly normal in terms of metabolic rate,
which is good and bad I suppose,” he said. “Good because I’m
metabolically normal. But it also means that I’m probably just
as at risk to anyone else to gaining weight if I’m not watching
it. So I’m not one of those people that can eat all they want
and not gain weight.”

After Chen’s visit, the rest of my day in isolation whirred by

with several more rest periods, exercise bursts, and meals. I
went to bed that night thinking about Chen’s results and
wondering what the chamber would reveal about me.

“You’re perfectly normal”

The next morning, I woke up groggy from six hours of light
sleep. I was eager to open the heavy steel door and get into
fresh air.

But the experiment wasn’t over. A “metabolic cart” — which

looked like a computer on rollers connected to a tube and a
plastic hood — arrived to measure my resting energy
expenditure, or metabolic rate when I’m awake but not
physically active, and before eating anything. So I lay in a
hospital bed as a technician fitted the clear domed hood over
my head while the machine captured the CO2 I respired.
A technician measures my resting energy expenditure with a “metabolic cart” right after I
wake up. | Christina Animashaun/Vox

On my way out of the hospital, I said goodbye to Chen and

thanked the nurses who had cared for me. They reminded me
to collect urine samples every day for a week so they’d get a
final measure of my metabolism, using the doubly labeled
water method. I’d also continue wearing the three
accelerometers. Together, this data would give the researchers
a sense of my average daily calorie burn as a “free-living
subject,” outside the hospital.

A few weeks later, I called Kevin Hall to go over my results.

What most surprised me: There was a pretty wide gap between
how healthy I was and how unhealthy I expected I’d be.

“[The results] suggest you’re perfectly normal,” Hall said.

My metabolic rate was what he’d have predicted for someone

my age, height, sex, and weight. In other words, I didn’t have a
“slow metabolism.” I had burned the equivalent of 2,330
calories per day in the chamber, including during sleep, and
most of those calories (more than 1,400) were from my resting
energy expenditure. My biomarkers — my heart rate,
cholesterol levels, blood pressure — were all excellent,
suggesting no heightened disease risk leftover from my
overweight years.

There were other revealing takeaways. Staying awake cost my

body only a few more calories than sleeping, which didn’t
surprise Hall. “We know the sleeping metabolic rate is about 5
percent less than resting metabolic rate when you’re awake,”
he explained.

What’s more, the 405 calories I burned during 90 minutes on

the exercise bike was both less than is advertised in spinning
classes and just 17 percent of the total calories I had used,
validating once again that workouts typically account for a
relatively minor part of total energy expenditure.

Even during sleep, my body was busy. “This goes into the
question of, ‘Does your brain’s energy expenditure go up when
you’re doing a hard math problem compared to when you’re
zoning out watching TV?’ And everyone who has measured that
has said ‘no’ — it’s a fixed amount, and your brain is not
inactive at any point in time,” Hall said.

Christina Animashaun/Vox

As for the “calories in” part: I consumed about 1,850 calories

(including 18 percent protein, 36 percent fat, and 46 percent
carbs) of the 2,250 calories provided to me. That means I was
in an energy deficit, and if I continued eating that much, I’d
lose weight.
I also found out that I’m bad at estimating my calorie
consumption. During my chamber stay, I told a nutritionist
what I’d eaten the day before and filled in a survey of my food
consumption over the past year. Based on that, she’d
calculated I was eating only 1,500 to 2,000 calories per day. I
thought I was being incredibly thorough and generous in my
accounting, but if this was really all I ate, I’d be thinner than I
am.

The results of these food surveys made me wonder how many

of us blame some aspect of our biology for weight gain when
we’re really just underestimating our calorie intake, forgetting
all the little extras we eat and drink that can add up to pounds
over the years. It seems I had too.

I asked Hall if there were any other potential explanations for

why I felt I gained weight so easily. He told me NIH does other
studies that could answer that. If he had tracked my
metabolism before I had lost weight earlier in life, he’d be able
to detect any slowdown in response to slimming. Or if I
participated in an “overfeeding study” — where I was
deliberately fed more calories than my body required — he
might detect no change in my metabolic rate. There are some
people whose metabolic rate speeds up when they overeat,
using the extra calories as fuel instead of storing them as fat,
and it’s possible I’m not one of them.

But we didn’t have that data, and according to what he could

see, I was in perfect health.

The metabolism myth

I hung up the phone and reflected on the chamber experience
— and my quest to better understand my body.

Spending time at NIH reminded me that our epidemic of weight

problems, in addition to damaging our physical health, has left
in its wake an epidemic of psychological scars — even in those
who, like me, manage to lose weight.

I was genuinely surprised, and somewhat relieved, when

nurses and doctors kept referring to my biomarkers as
“excellent” and to me as “very fit.” Even though I know my
bodyweight is in a healthy range, I still feel like a chubby kid.

And you don’t need a history of weight problems to experience

these feelings of inadequacy. Celebrities and big businesses —
like Goop and Dr. Oz and many of the supplement, wellness,
and exercise companies out there — have minted billions off
stoking our anxieties about our physical shortcomings. If we
only tried a new exercise, bought a new gizmo, or ate a certain
way, they suggest, we’d be slimmer, glowier, healthier.

Yet the truth of the metabolic chamber is that there’s a lot of

variation in how people respond to diets and exercises, and so
far, no single approach has worked to help everybody. That’s
why so much of the one-size-fits-all weight loss advice we’re
steeped in is so frustrating and futile for so many.

The chamber has also shown that while some people have a
“slow metabolism” relative to others their size and age, this
isn’t a major cause of obesity. And despite the focus on
“metabolism boosting” for weight loss, there’s nothing money
can buy that will speed your metabolism up in way that will
lead to substantial slimming.

When I look back at what helped me lose weight, there was

never a magic bullet — a special diet, exercise regimen, or
supplement — that worked. Through plodding trial and error, I
discovered habits and routines I could stick with to help me eat
less and move more.

I don’t keep junk food in the house, I avoid eating out a lot, I
prioritize sleep, and I try to fill my plates with fruits and
vegetables. As for exercise, I build it into my daily life —
walking or biking to work, or during lunch breaks. And I’ve
found mornings and weekends best for dedicated workouts
(yoga, running, swimming, spinning, Pilates, etc.).

These routines are a work in progress, and I know that my

ability to maintain them is strongly tied to my socioeconomic
status and where I live. If I had more personal or financial
stress, or lived in a different neighborhood with a long
commute to work, I’d probably sleep less and eat more. I
certainly wouldn’t be doing Pilates.

Research from the chamber won’t alleviate these

socioeconomic drivers of obesity. But a better understanding
of human physiology and metabolism — with the help of the
chamber — might level the playing field through the discovery
of effective treatments. As Lex Kravitz, an NIH neuroscientist
and obesity researcher, told me, “Even if a slow metabolism
isn’t the reason people become obese, it may still be a place to
intervene for weight loss.” The same goes for the other
common illnesses — diabetes, cardiovascular disease — linked
to extra weight.

More immediately, science from the chamber should debunk

our metabolism myths. It certainly debunked mine.
Christina Animashaun/Vox

For more information about how to join a study at NIH, check

out this link on patient recruitment or contact the NIH Clinical
Center Office of Patient Recruitment at 1-800-411-1222 or
prpl@mail.cc.nih.gov.

Editor: Eliza Barclay

Copy editor: Tanya Pai

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