NANCY MAZARIN, MS, RDN, CDN
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BIGGEST LOSER – a misleading report
The grim message from the recent New York Times article is that dieting is futile and re-gain is all but pre-ordained. The authors of the original research didn’t interpret their results that we are doomed to battle our biology or remain fat, which is certainly what the New York Times article implies. The researchers stated that in this subgroup we need to explore other approaches
The artificial environment of “The Biggest Loser” – being followed with cameras 24/7, exercising 9 hours daily and watched by millions for seven months – resulted in extreme weight loss: 8 pounds/week for 34 weeks. By comparison, weight loss after bariatric surgery averages 3 pounds/week which is still considered a rapid rate of loss. The goal rate for a healthy and sustainable loss is an average of ¾ pound /week.
When comparisons were made between contestants and gastric by-pass (RYBP) patient’s, they found considerably more muscle mass was sustained by the contestants, yet their RMR was slower. An anomaly occurred that is not customarily seen in the normal dieting population. The findings, in fact, are consistent with current data that show the response to starvation. This is in contrast to data about the RYGB that shows no slowing of the metabolic rate. Also with the RYBP hunger goes away whereas the lower leptin levels in the Biggest Loser Contestants (BLC) probably leads to more hunger or at least less satiation. What must be considered is that extreme, massive weight loss in so short a time may have created an aberrant metabolism. Changes that occurred in these individuals (e.g. hormonal, metabolic), cannot be extrapolated to individuals losing weight at a slower rate.
The article implied that the decrease in the metabolic rate is the primary cause of contestants weight gain. The drop in metabolic rate (using the numbers they gave us) is not enough to account for the regain, nor is it the only issue, nor does it seem to happen in everyone to the same extent or even at all. In reference to the contestants’ calorie intake, food consumption was not measured. Hunger, cravings, and disordered eating can quickly return. These effects were unquantified.
The study in Obesity that prompted the article in the Times measured contestants RMR 6 years after the end of the competition. They concluded that calorie restriction along with vigorous exercise in the BLC participants resulted in the preservation of fat-free mass (FFM) and greater metabolic adaption compared to RYGB subjects despite comparable weight loss. Metabolic adaptation was related to the degree of energy imbalance and the changes in circulating leptin
Dr. Hall used a mathematical computer model of human metabolism – currently intended for research conducted by scientists and health professionals – to calculate the diet and exercise changes underlying the observed body weight loss. The computer model simulated the results of diet alone and exercise alone to estimate their relative contributions. These simulations suggest that the participants could sustain their weight loss and avoid weight regain by adopting more moderate lifestyle changes – like 20 minutes of daily vigorous exercise and a 20% calorie restriction – than those demonstrated on the television program.
“Dieters are not at the mercy of their bodies, and this is not a subset of the most successful dieters”, stated Dr. David Ludwig, director of the New Balance Foundation Obesity Prevention Center at Boston’s Children’s Hospital. They are abnormal dieters who abused their bodies and minds with restrictive programs that are consistent with deprivation. Food problems remained unresolved and accurate education elusive.
In all my years of practice, I have never worked with an individual who could not lose weight and sustain their optimal weight if they were willing to invest the time and effort needed. The National Weight Control Registry reaffirms that obese individuals can lose weight and sustain the weight loss for many years (average loss of 73 lbs. maintained for more than 5 years). Furthermore, individuals who have undergone bariatric surgery often maintain an optimal weight. Is the regain that is often seen a result of a metabolic abnormality that follows a diet or a significant increase in calories that is a backlash to restriction or a return to customary intake and behaviors? If people continued to eat healthy and exercise, they wouldn’t regain 100 to 200 lbs.
There is no situation where an optimal weight is maintained without effort. With weight loss, reduced caloric need, often coupled with a reduced metabolic rate (previously elevated) is to be expected. The body is smaller so requirements are reduced for feeding and moving. We need to understand that as all of us age, in this obesogenic environment, selectivity with respect to what to eat, when to eat and how much to eat is needed. We all live in a very toxic food environment, and maintaining weight loss is not easy.
As stated by Dr. Griffin Rodgers, the NIDDK Director, “This study reinforces the need for a healthy diet and exercise in our daily lives”. The take home message should have been that you cannot abuse your body with extreme dieting without severe repercussions. It’s time to Stop Dieting. Overweight individuals need to learn how to eat in a healthy, enjoyable and sustainable manner with the goal of attaining and maintaining an optimal weight.
