imgresA new study was released on weight loss and maintenance that has been covered on many sites. Researchers from the National Institutes of Health (NIH) evaluated contestants from Season 8 of the TV show the Biggest Loser. They found that 13 of the 14 contestants studied regained some or all of their weight that was lost during the show. All the contestants studied also had slower metabolic rates than expected – basically it took less food than it should to maintain their weight. They also had lower levels of the hormone, leptin, than expected. Low levels of leptin make people feel hungrier.

Basically the body is always trying to get back to its heaviest weight. This is likely an evolutionary advantage. Extra adipose tissue means more storage for a potential famine and if food does become scarce using food more conservatively means a greater odds of survival. Survivors are the ones who pass along their genes. Even though modern life has eliminated famine for many of use, to the brain weight loss doesn’t mean trying to reclaim a healthier weight it still portends death. For such a level of complexity our brains don’t have the greatest user interface where weight loss is concerned. Maybe in a few thousands years that programming will be reversed, but that doesn’t exactly help anyone struggling to lose weight now.

I am not surprised the Biggest Loser contestants regained their weight. Nothing about what they did was sustainable and there was an excessive focus on exercise, which science tells us is not an effective weight loss tool. People have jobs, no one can go to the gym for four hours a day. Some people wonder if maybe they had less weight to lose or did it more gradually maybe their metabolic rate would have rebounded over time, but I’m not so sure.

I first started Weight Watchers when I was 15 years old and while I lost weight many times, I also regained it – often within a few months or even a few weeks of reaching goal. Each time it got harder and harder to lose the weight. And yet here I am now over 5 years from starting my last weight loss journey. As a chronic pain doctor I decided if the brain could be changed to “rewire” pain, maybe I could hack the concept of neuroplasticity and change how I felt about hunger. I think it worked (or rather it has so far) as I have kept those 50 lbs. off for 4 years and 3 months. It is a daily exercise in assessing hunger and tracking calories and weighing and measuring and planning. Oh the planning. And the constant mindful attention to everything.

Even with a gradual weight loss (50 lbs. over 9 months) my metabolic rate is slower than expected, just like the former Biggest Loser contestants. Using the NIH metabolic rate calculator I should be able to eat 2,400-2,500 calories a day to maintain my weight, but I’d gain 1/2 lb. to 1 lb. a week on that. I know because I tried. When I first lost the weight I slowly added in calories – 100 calories per day each week. It turns out to maintain my loss I get 1,800 a day. That’s right, the difference between weight loss and maintenance for me is a couple of glasses of wine OR a slice of cheese pizza.

What is interesting is I have finally reduced the hunger sensations. Sometimes I get an unwelcome blast from the past, but using the mindfulness tools I have developed I’m able to rein them in and typically bring the carnage down to one meal. I was a world champion binge eater, so no one is more surprised at this than me. It took several years of maintenance to get a better control of the hunger, but it happened and that certainly helps a lot. Sometimes I think I should get my leptin level measured because I’m genuinely curious if it is normal or not.

It’s a bummer that I can’t eat 2,400 calories a day. Basically I plan for three slices of cake a year, my birthday, my kids’ birthday (they are twins, so I lucked out with a two for one with their birthday meal), and a third for some unknown event. And yes, I do have a couple of days a month when I eat more than I had planned, but the next day I am back on the plan. It’s hard, but I’d rather be my healthiest weight.

Maybe one day there will be a hormone to block hunger signals so people won’t have to track their calories obsessively or go through the mental and physical routines I do to make sure I am really hungry and not thirsty or stressed or tired, but every single weight loss drug to date has come with unforeseen serious side effects so there’s that.

This new study is small and may not be applicable to everyone as the weight loss routines were extreme and definitely not sustainable, although my n of 1 tells me my metabolic rate has slowed about as much as those who lost weight the Biggest Loser way so I suspect all of us who lose weight are likely going to have to work around our metabolisms.

I think we definitely need more studies about the impact of different weight loss regimens on metabolic rate and hunger hormones, but I do feel we can draw one conclusion – while we may not yet know the best way to lose weight and keep it off it’s pretty clear that it’s not the Biggest Loser way.






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  1. Biological control of weight is one of the most complex of systems. For example, there is not one single target nerve or hormone for decreasing appetite; there are multiple, and the system is quite resilient, with multiple compensatory mechanisms. If one aspect of the system is suppressed, the others ramp up their activity. Further, we have just begun to understand how the body regulates metabolism, and it is proving to be even more complex than we ever conceived.

    But shouldn’t people try to lose weight, when in fact thinner people are healthier?

    The answer is a squeamish “maybe”. There are people who, if they eat more healthfully and increase their activity level, may lose weight in the long term. And there are often a small percentage of participants in weight loss programs and research studies who keep it off. But we don’t yet know how to identify those for whom these interventions will be long-lasting, so applying them to everyone creates far more harm than good.

  2. Given how terrific your posts on abortion are, I find your posts about obesity profoundly disappointing. There’s never any attention paid to the classism, racism, and misogyny that underlie fatphobia. There’s never any consideration of whether fatphobia might shorten people’s lives through stress. And you seem to think it’s reasonable to spend your days counting calories and being constantly distracted by hunger.

    As someone with an eating disorder, as well as various other neuro/psych diagnoses, I’m with Lindy West – I’d rather have a shorter lifespan or even some limited mobility than to have to live in that hellish mental space ever again.

    1. I’m really sorry that you have an eating disorder. I had a friend who was anorexic so I understand how miserable weight loss and calorie counting can be for some people and what a minefield of negative emotions it can bring up. However, I disagree with your criticisms of this article.

      I’m not sure why you think Dr Gunter thinks it’s reasonable to be distracted by hunger, given that this post focuses on why it’s unreasonable to expect people to go through the rest of their lives with depleted leptin levels (ie excessive hunger) in order to lose weight quickly. She even suggests that The Biggest Loser should be cancelled because it is dooming contestants to a life of unnecessary hunger signals. Maybe you take issue with her assertion that people misinterpret other signals from their body as hunger. But for many people that is true.

      “You seem to think it’s reasonable to spend your days counting calories”

      Actually, that IS reasonable. We live in a time and place (the developed world) of incredible food abundance that our bodies were not prepared for by our evolutionary history. There’s nothing unreasonable about using science and maths to overcome the potentially lethal limitations of our species. Calorie counting is associated with a lot of negativity because people with eating disorders do it to extreme and unhealthy degrees. But if you have a reasonably emotionally healthy attitude to food and body weight, have reasonable goals, and have learned not to beat yourself up every time you go over/ under your limits, it’s a very useful tool. My body will happily consume nothing but a whole pizza for lunch; my calorie counter tells me that’s a whole 1,000 calories so I better eat just half of it or less along with a big portion of salad. Speaking personally, calorie counting helps me to feel in control of what I eat, not a slave to whatever food I see in front of me. Of course it might not be helpful for people with eating disorders but that is because of disordered beliefs around food and weight that need to be addressed first before anything else.

  3. I’ve lost 8lbs in 20 days. I started at 12 stone 12lbs (in Britain we use stones and pounds, sorry) and I’m now 12 stone 4lbs and my goal weight is 11 stone (that’s just 3lbs within my BMI as a 5 foot 6 inches female). I don’t know if this is a healthy weight loss rate or too quick. I wasn’t expecting to lose that much so fast. I was expecting maybe 1-2 lbs per week. At first I was thrilled at having lost 4lbs in just the first ten days, but now I’ve heard about this study and done a little more research, I’m worried it’s too fast and I might be affecting my ability to keep it off.

    By the way I really like your blog Dr Gunter, especially your posts about reproductive rights.

  4. I’ve lost 8lbs in 20 days. I started at 12 stone 12lbs (in Britain we use stones and pounds, sorry) and I’m now 12 stone 4lbs and my goal weight is 11 stone (that’s just 3lbs within my BMI as a 5 foot 6 inches female). I don’t know if this is a healthy weight loss rate or too quick. I wasn’t expecting to lose that much so fast. I was expecting maybe 1-2 lbs per week. At first I was thrilled at having lost 4lbs in just the first ten days, but now I’ve heard about this study and done a little more research, I’m worried it’s too fast and I might be affecting my ability to keep it off.

    By the way I absolutely love your blog Dr Gunter.

  5. Thank you! What a timely post since I’ve just embarked on eating MUCH healthier. It does take constant vigilance AND patience.

    Some how I find that most people think that exercise is what takes weight off (an incorrect thought), and don’t focus on truly eating healthy. I’m not debunking the health merits of physical fitness & exercise — it’s just that the exercise is really more about cardio health and emotional well-being vs. actual weight loss.

    Thanks for sharing your personal struggle with weight loss, making it real and demonstrating that even health professionals who “supposedly” have more knowledge in the arena of health (often a myth) are challenged by weight loss (and gain) too!

  6. I agree that it takes serious commitment to make big, permanent changes in your lifestyle in order to lose weight and keep it off. For me, though, and certainly counterintuitively, the most “extreme” intervention — intermittent fasting — is also by far the easiest.

    Fasting is not “crash dieting”. It’s gaining more and more scientific support as an effective way to actually keep your metabolism from dropping while losing fat and preserve lean mass, and also repair insulin resistance if you are flirting with diabetes (as many people are without even knowing it).

    A lot of people who haven’t looked at the science (and even some who have, but can’t image doing something so unusual) look at me like I’m crazy when I tell them how easy it is. It’s odd how something that was totally acceptable up until the 20th century evokes such fear today. People are so terrified of missing a single meal. It’s ridiculous.

    More for me I guess, or perhaps I should say ‘less’. 😉

  7. Thank You!!! Just last night I saw this being reported on “World News”. I thought… I want to know more of the why!
    Here it is! Thanks!!! I am on Weight Watchers. 15 pounds away from my goal weight. I am a life long vegetarian and recently was on a Fruits and Vegetable for a month suggested by my surgeon with the intention of not passing another gallstone and blocking the duct before he was able to remove my heavily stoned gallbladder. Had the surgery last week all went well. Having been on the fruits and veggies and researching which of them are healthier for the liver and to thin the bile so hopefully I don’t produce any more.( if that is possible) This experience has made me really pay attention to what I eat. Reading this entry has helped me understand how important conscious eating is to maintain our health and fitness.

  8. I’ve been looking for a well-written and thoughtful take on this study, thanks Jen. I lost 50 lbs and have maintained over three years, using similar techniques: the bulk of my diet is fruits and veggies; I continue to log what I eat periodically to stay on track; I don’t binge. I also work to maintain muscle bulk and tone- a few minutes of core work every day. I swear this helps more than anything to keep my metabolism revved. Any thoughts on this? I’m convinced that we can increase our metabolism to some extent by building up some muscle, not like weightlifting, just regular core work.

    1. When I am home, I walk three miles in hilly terrain almost every day, rapidly, a fairly good work out. I am convinced that it helps, although I know that it doesn’t burn off that many calories. My leg muscles are in fairly good shape. Perhaps the extra muscle burns more calories even when I am not excersizing? I don’t know.

    2. I’ve been wondering this very thing about muscle mass and metabolism after weight loss. I’m thinking of taking up weightlifting again to see what happens.

  9. I also lost a great deal of weight, about 75 pounds. I have kept it off now for about five or six years. It took me perhaps three or four years to lose it. I don’t know if that has something to do with my ability to keep it off.

    I also find that I gain weight very easily, and I have to always be aware of what I eat. I can cheat every now and then. I allow myself one candy bar per month, and I lick the spoon when I prepare my mother-in-law’s dinner. We never eat out. I find that when I do, usually when I am away, I gain weight very quickly. A week away from home for CME usually adds about five pounds. I can lose it fairly readily when I get home. Why, I don’t know.

    I am hungry much of the time, but it usually is bearable. I find that I need some carbs to make it to the next meal. Also, fresh fruit and vegetables don’t seem to have much of an impact on my weight, so I have never put a limit on them.

    My advice to anyone trying to lose weight is that everyone is different. Other people’s advice is not necessarily going to be the best thing for you. Keep trying until you find a system that works for you.

    1. I think we used similar techniques – constant vigilance about intake and weight.

      Like you I almost never eat out. I find if I have > 2 meals away from home a month it makes maintenance that much more challenging.

      I allow myself 75 cals of 70% dark chocolate most nights.

      Thanks for sharing!

    2. Just over a year ago I lost 60 pounds through food tracking, severe calorie restriction, less than 15 g of sugar a day and moderate walking/ hiking for exercise. It was great!
      But to stay at that weight is only possible through food obsession. During weight loss I ate no more than 1250 calories a day. While I was trying to maintain I was hoping I could bump it up to around 1500/1600, but no dice. Eating 1600 a day has led to a 20 pound gain over the last 6 months. A tiny gain a week, but it certainly adds up quickly.

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