My Thoughts on The Biggest Loser Study

I’m sure most of you have watched at least one episode of the Biggest Loser tv reality show. It’s extreme in all areas – starting with the participants’ weights, the starvation diets they follow, the ridiculous amounts of exercise they are made to do (sometimes until they vomit), the insults they endure by their trainers AND the amounts of weight they lose (often over 200 pounds). I’ve often wondered if they keep the weight off. Will they have a reunion show like the New York Housewives? The answer is no … because they DON’T keep the weight off. A study came out last week that revealed 13 out of the 14 contestants on the show 6 years ago put back on a significant amount of weight and 4 of them are even heavier today compared to before they went on the show. I’ve been getting numerous emails from my clients in response to the article in the NYT: After the Biggest Loser”, Their Bodies Fought to Regain Weight asking me if weight regain would be their fate. Read on for my thoughts…

Depressing article
This article – and the reaction to it – has exploded over the internet. The majority of Americans (66%) are overweight or obese, so the topic of weight loss always catches our eye. But this story takes the cake. The contestant’s stories were heart breaking to read. I can’t imagine losing 200 pounds by working your butt off (literally) and feeling on top of the world only to have the pounds come creeping back on no matter what you did. The fact the most of the contestants regained the weight was depressing. We’ve all heard that the odds are against you when it comes to keeping the weight off. And it would seem like the extreme circumstances of the show would almost set someone up to fail at maintaining weight. After all, who can maintain this rigid diet/exercise program in the real world? Were permanent behavior changes really made? Did eating disorders evolve? Were the contestants prepared mentally how to handle challenges once the show was over? No one is debating that the extreme nature of the show set the participants up to regain the weight. But what that article pointed out was something many of us weren’t aware … a sneaky little thing called metabolic adaption.

Metabolic adaption
I discussed metabolic adaption a few months ago in my blog post “Why is it so hard to keep weight off?” Here is an excerpt from that post: “The act of losing weight actually slows your metabolism. What kind of cruel joke is this?  Metabolism slows down by
15% after you have lost 10% or more of your body weight. Assuming that you keep the weight off, this slow down persists for 3-5 years. (Note: the Biggest Loser study shows it may last longer than 5 yrs) Crazy! This same response happens in both lean and obese people. But it does not occur if you lose less than 7% of your body weight.  And it isn’t greater if you lose really large amounts of weight (like over 20%) This suggests that the metabolic adaptation to weight loss is triggered by either a very narrow range of weight change or by some hormonal signal, and reaches its maximal adaptive capabilities by 10% of weight loss

Prior research by Drs. Leibel and Rosenbaum in humans had shown that the brain fights fat loss partly by making our bodies, especially our muscles, more efficient at using calories. Loss of 10 percent of body weight will require someone to cut the number of calories eaten daily by 22 percent (this research says 22%. Above research 15%)  A woman who drops from 150 to 135 pounds, for example, needs to eat about 250 calories per day less, or exercise 250 calories per day more, to maintain her new weight compared with a woman whose stable weight is 135. Dr. Rosenbaum says, “Whatever lifestyle changes you make to lose weight must be continued indefinitely beyond the period of weight loss if you want to keep the weight off.”  

And unfortunately, exercise doesn’t save you from metabolic adaption. But exercise will help preserve muscle mass which does help with metabolism in smaller weight losses. 

Other causes of weight regain
While metabolic adaption may play a role in weight regain, there are also  many other causes of weight regain. . But please don’t feel it is hopeless to maintain a weight loss – because many people are able to do it. 

It is possible to keep the weight off
Keeping off a large weight loss is possible! Just ask the 10,000 successful weight loss losers of the National Weight Control Registry to see how they do it. A little more about NWCR members:
-Registry members have lost an average of 66 lbs and kept it off for 5.5 years.
-Weight losses have ranged from 30 to 300 lbs. Duration of successful weight loss has ranged from 1 year to 66 years!
-Some have lost the weight rapidly, while others have lost weight very slowly–over as many as 14 years
-A little over one-half of the sample lost weight through formal programs; the remainder lost weight on their own
(pic is of Susan – my client who lost 50 pounds)

Tips to keep weight off
I have had many clients who are successful in maintaining a weight loss. Below are some of my tips as well as results from the NWCR participants.

1. Select a realistic weight loss goal. The participants of the Biggest Loser lost ~ 40% of their body weight. This is  huge amount! Studies have not shown that losing smaller amounts of weight loss cause metabolic adaption (although the exact % of weight loss that causes it is likely variable)

2. Eat breakfast. Eating breakfast is a characteristic common to successful weight loss maintainers and may be a factor in
their success. 78% of successful maintainers reported regularly eating breakfast every day of the week. 4% reported never eating breakfast.

3. Activity. 90% of the participants exercise, on average, about 1 hour per day. Walking was the most common form of activity. So there’s no getting around it, staying active is a major part of keeping the weight off. pic credit

4. Consistent self-weighing. How many times have you avoided the scale because you didn’t want to see the “damage” that occurred?  Weeks turn into months and before you know it, your weight is up 10 pounds. 75% of successful maintainers weigh themselves at least once a week. This may help to catch weight gains before it escalates and allow you to make behavior changes to prevent additional weight gain. Study 

5. Consume a low calorie low fat diet. Successful maintainers of weight loss reported continued consumption of a low-calorie and low-fat diet. Women in the registry reported eating an average of 1,306 kcal/day (24.3% of energy from fat); men reported consuming 1,685 kcal (23.5% of energy from fat).  Study

6. It gets easier in time. Once these successful maintainers have maintained a weight loss for 2-5 years, the chances of longer-term success greatly increase.

7. Less variety. Ever hear of the smorgasbord effect? The more food choices you have in front of you, the more you will eat. Successful weight loss maintainers tend consume a diet with limited variety in all food groups, especially foods higher in fat. Restricting variety within all food groups may help with consuming a low-energy diet and maintaining long-term weight loss. This isn’t saying you have to eat a boring diet, just don’t give yourself too many options. pic credit

8. Consistency. If you’re one of those people who frequently indulge on the weekends and they try to make up for it during the week, think again! You are likely setting yourself up for weight regain. Participants who reported a consistent diet across the week were 1.5 times more likely to maintain their weight within 5 pounds over the subsequent year than participants who dieted more strictly on weekdays. Study

9. Less screen time. 62% watch less than 10 hours of TV per week.

10. Very strict over the holidays. The typical person tends to gain a few pounds over the holidays and never lose it. The majority  of successful weight loss maintainers are “extremely strict” in maintaining their usual dietary routine  and exercise routine  over the holiday.  Study 

11. Low carb works too. While the majority of people maintained their weight loss on a low fat diet, ~ 11% of people kept the weight off on a low carb diet. Keep in mind that the results I obtained from this study was from a few years ago. My personal opinion is that the percentage of successful maintainers on low carb diets might be higher than 11% at this point. So bottom line, there is no one diet that works for everyone. Low fat, low carb – find what works for you and most importantly, what you can maintain. Study

12. Nip it in the bud.   Although successful weight losers continued to maintain a large percentage of their weight 
losses over 2 years, recovery from even minor weight regain was uncommon. However, small regains were common, and few persons were able to re-lose weight after any weight regain. So forget the vacation mentality – “I’ll eat more now and make up for it later”.

13. Medical triggers work. While no one wants to have a medical issue, it’s been shown that medical triggers may produce a teachable moment for weight control, resulting in better initial weight loss and long-term maintenance. Nearly 77% of the sample reported that a triggering event had preceded their successful weight loss. Participants with medical triggers reported greater initial weight loss than those with nonmedical triggers or no trigger. Participants with medical triggers also gained less weight over 2 years of follow-up than those with nonmedical triggers or no trigger. An example of a medical trigger is if you’ve been told you have prediabetes/diabetes or high high blood pressure. Losing weight – and keeping it off – can have a dramatic effect on your health. Study   pic credit 

My interview with weight loss experts:
I contacted the weight loss experts at Weill Cornell Medicine Comprehensive Weight Control Center – Katherine H. Saunders, MD, Leon I. Igel, MD, Rekha B. Kumar, MD – for their opinion on maintaining a weight loss.

Do you feel patients can keep weight off?
Yes, it is certainly possible to keep weight off and we have helped many patients maintain significant weight loss; however, the more weight you lose, the harder it is to maintain the weight loss.

At what % body weight loss do you feel metabolic adaption becomes a big issue? 
There is no percentage cutoff, but faster weight loss (resulting in more loss of lean muscle mass) is more problematic.  Slower weight loss (up to 1-2 lbs per week) with concomitant weight resistance (hand weights, yoga, Pilates, etc.) reduces loss of lean muscle.

What is the best piece of advice you would give someone to keep the weight off?
Develop lifestyle changes that you can maintain long-term.  The best diets and exercise regimens are the ones that you enjoy and can stick to.

Bottom line:
You CAN maintain your weight loss. What we’ve  learned from the participants in the NWCR is that good nutrition, physical activity, maintaining a consistent eating pattern across weekdays and weekends and self-monitoring are important for keeping the weight off once it has been lost. No one is saying it’s easy … but you can definitely beat the odds

How are YOU keeping the weight off?