Tuesday, February 22, 2011

The Biggest Loser destroys participants' metabolisms.

Talk about setting people up for long term struggle.

The term metabolic adaptation is given to the phenomenon whereby when a person loses a certain percentage of weight, their metabolisms slow by greater amounts. This process may be accelerated with more rapid weight loss as a consequence of the rapidly losing body metabolizing calorie burning muscle along with fat to make up for its massive energy deficit.

And as far as rapid non-surgical weight loss goes, there's probably no weight loss program more rapid that of the television show the Biggest Loser where it’s not uncommon for contestants to lose upwards of 150lbs at an averaged pace of nearly 10lbs a week.

Of course what’s different about the Biggest Loser as compared with most other non-televised rapid weight loss programs is the incredibly large amount of exercise concurrently involved.

While I would have hoped that this tremendous amount of exercise would have been protective against a major drop in metabolism, recently reported data states that it doesn’t.

In an abstract presented at the most recent Obesity Society Annual Scientific Assembly, Darcy Johannsen and friends reported that by week 6 participants had lost 13% of their body weight and by week 30, 39%. More interestingly they reported that by week 6 participants metabolisms had slowed by 244 more calories per day than would have been expected by their weight loss and by week 30, by 504 more calories

That's basically a meal's worth of calories a day that Biggest Loser contestants no longer burn as a consequence of their involvement. Effectively that means they're eating an extra meal a day.

How do you think you'd do at maintaining your weight if you ate an extra meal a day?

The authors also reported that the folks with the largest metabolic adaptations (meaning folks whose metabolisms slowed the most) were the folks with the greatest weight losses. The authors then concluded that, “intensive lifestyle interventions” can overcome this phenomenon based on the fact that folks had lost their weight by the end of the show, not based on what happened to them after the cameras stopped rolling.

Sadly I think their conclusion speaks volumes as to the utility of the intervention as well as their own confirmation biases of wanting to believe the show to be good for their contestants. What it suggests to me is that the folks who were the most severe with their diet and exercise efforts lost the most weight but did so at the expense of much greater hits to their metabolisms. Consequently those same folks who lost the most and the fastest, if they want to keep their weight off, are going to have to work at it that much harder.

While some contestants of the Biggest Loser translate their new lifestyles into careers as product spokespeople or fitness trainers and hence have new external motivators to maintain their extreme behaviours, those who don’t I worry are doomed to regain their weight as, “intensive lifestyle interventions” are not the realm of the real world, they’re only the realm of “reality” television and those whose livelihoods and/or fame depend on them.

Case in point? That picture up above, that's Eric Chopin. He was the winner of the third season of the Biggest Loser. He lost just over 200lbs. He was on Oprah to talk about his massive regain. Think Eric dropped the ball? Not me. I think the Biggest Loser provided him with a nonsensical approach to weight management, and in the process, stacked his deck entirely against him.

(Originally this blog identified the person in the photo as Ryan Benson, the season 2 winner who also regained his weight)

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  1. Martin6:01 am

    I don't want to point fingers but the Obesity Society Annual Scientific Assembly are those who serves brownies and sodas on their meetings.

    Anyway. It's interesting information. Do you have any numbers on what their metabolism was? When you gain weight you also increase your metabolism. So the question is, did the numbers come down to a more normal standard or was it reduced to 1000 - 1200 kcal which it seems like when reading this post?

  2. Oi!

    Nothing wrong with the odd brownie =P

    But I am a little bit confused with the numbers as well.
    Say if your 115 kg or so, wouldn't your RMR be about 2500 kcal? So if you lost a bunch of weight shouldn't that drop, so you'd naturally have to eat less?

    Or does the formula change when you do extreme diet/exercise programs?

  3. And what does this mean for WLS patients who lose tremendous amounts of weight quickly? I noticed that you mentioned non-WLS means but does this also affect those who are losing quickly post-WLS as well?

  4. Martin - wrote this post a while ago and got sick of waiting for publication. If my memory serves, metabolisms for men ended up in the 1800 calorie range.

    Sinead - indeed, as you lose weight you do burn fewer calories, but what these researchers reported was that the decrease in metabolism with these contestants was markedly greater than would have been expected purely as a consequence of their weight loss.

    Jennie - yes, this likely does apply to surgical weight loss as well, though the difference being folks with surgical weight loss have anatomical advantages that in turn they can work to help deal with this adaptation.

  5. Do you remember if by "metabolisms" they were talking TDEE or just RMR? I blogged on a depressing study that demonstrated that skeletal muscle becomes more efficient with weight loss, requiring less energy to do the same work. It would make sense that this adaptation to perceived famine would be greater, the more rapidly one's fat stores are depleted.

    Back in my 30's I did a sprint tri and got to my lowest adult weight that summer. I was burning a lot of calories. After the race, as weather got cold ..... boom. Regain.

    So I think TBL contestants are set up for a double whammy with the reduced metabolism and high activity level to maintain some energy expenditure. They WILL need to either eat even less or continue the ridiculous exercise amounts or will regain.

    Dansinger reported in a recent interview that about 1/3rd of TBL contestants maintain their losses, 1/3rd gain about half back but that's still a good loss, and 1/3rd gain it all back. As things go, that's not too bad.

  6. I believe it was RMR CarbSane.

    I'd also be willing to wager, the 1/3 who keep it off are the 1/3 who manage to translate their loss into a career. Product spokespeople, trainers, etc. You're right though, regardless of the why, that 1/3 keep their weight off is great.

  7. Are you suggesting that this metabolic disadvantage is permanent?

    These results don't surprise me. It thought this idea was already well established, that the energy deficit required to lose weight will slow the metabolism. If I were comparing the RMR of a person who has always weighed 200 lbs against the RMR of a 200 lb man who reached that weight today after losing 100 lbs in the last six months, I would have expected the dieter's RMR to be lower.

    Is anyone measuring the dieter's RMR at 200 lbs a year later to see if it has normalized and is the same, or close to, the non-dieter's RMR?

    To me, that's the important question.

  8. Valerie - whether or not their adapatations are permanent or not is a great question which I believe has yet to have a great study with a great answer.

  9. so, how do they go about fixing it??

  10. What did he say about his weight gain on Oprah? I think it's far more likely he fell back into bad habits. Most people can be really strict for a month or two (especially when you're isolated on a weight loss reality show), but adopting a permanent lifestyle change is much harder.

    Maybe a metabolic slowdown played into this, but to regain that much weight, I imagine he started reverting to the same lifestyle he had before the show.

  11. The biggest loser participants are seeing many doctors and many of them have had Lap Band. The exercise is just for show, it's not meaningful or purposeful in any way other to demean and discourage. The trainers are actors. There can be no real conclusions about weight management gleaned from a TV show.

  12. @Valerie & Yoni: Unfortunately I think Yoni's right, the long term follow-up study of this nature has not been done. I've come across a number of studies on the "formerly obese", but quite often they are as little as one month into maintenance!

    Anecdotally, I do think it comes back a bit in the long run as I seem to be able to eat more these days and I've been within +/- 2-3 lbs of what I consider my "real weight" for more than a year and weight stable/slow losses well over 2 years now. Much of 2009 I had to work at keeping the weight off. Much of 2010 especially in the past 6 months or so, it got easier.

    If you need to lose a lot of weight, plan to spend at least as long doing the same things to stay smaller as got you there. I think it's a myth that you establish a deficit, lose to goal and can then increase intake. No. You can't. Chances are when you get to goal your losses have been leveling off for a while. IOW, you're in caloric balance!

  13. Anonymous3:37 pm

    What about athletes who stop training and gain weight?

    These men were never overweight to start with - in fact they have very low body fat. When they stop training (retire or take a break between seasons) they have to be very careful to conciously reduce the amount of food they eat. Apparently their appetite doesn't automatically decrease with the decrease in activity. If they keep eating whatever they feel like, they get fat.

    (While they're in training their main concern is getting enough good food to stay in top shape. I know, I'm the cook!)

    I'm not a scientist - this is just my observation of my husband, sons, their teammates and coaches. They have jokes about who got a big gut after slowing down the workouts. Of course, each one claims it's never going to happen to HIM!!

  14. Anonymous6:14 pm

    Not sure if anyone has pointed this out yet, but the man in the picture with Oprah is not Ryan Benson, that is Eric Chopin, winner of season 3 who regained but came back and lost again.

    Loved this blog and have passed on the information to our lap band support site! Thank you

  15. Anonymous6:20 pm

    the person with Oprah in the picture is NOT Ryan Benson - it is Eric Chopin from season 3

  16. Thanks for the correction folks.

    Wrong Biggest Loser regainer.

    Will correct.

  17. There are a number of studies that show that metabolic adaptations to weight loss lead to a lower RMR than anticipated by a simple mathematical prediction (Alan Aragon and Lyle McDonald have reported extensively on this).

    However, the salient question is whether or not the mode of weight loss or the speed of weight loss has any significant impact on this metabolic adaptation (Yoni's article suggests that the speed of weight loss exacerbates the metabolic slow-down).

    As far as I know, this has not been established. All dieters suffer metabolic slow-down beyond the predictions based solely on weight loss. Whether or not 'fast' dieters suffer more of a slow down...

  18. Small correction: the photo at the top of your blog post shows Erik Chopin, the season-three winner. Chopin lost 214 pounds in his season. Ryan Benson won the first season. AFAIK, he has never been on Oprah, but he did also regain most of his weight and has appeared on a TBL "winners reunion" special this past fall.

  19. Oops--I see someone else made the same correction.

  20. Anonymous8:32 pm

    Makes one wonder, maybe it would be healthier to just be bulimic? Eat, enjoy, vomit.

    It looks like there's no point in trying to lose weight. It's not going to work. It's unhealthy to be fat, and unhealthy to try to lose it, and unhealthy to throw up.

    I once worked with one of Canada's most revered food writers. Who was bulimic. That's the only way it could be done, writer said.

  21. Anonymous12:09 pm

    What does work then? We've heard a lot about what doesn't and why. What should people do?

    I buried a food addict recently. Truly, food mattered more than anything else in this person's life: more than family, career and finally life itself.

    The pain is horrible, for those left behind but especially for the addict's adult children, who are terrified this will happen to them. It is not forgetable, watching their father lose function of his own kidneys, destroy the transplant, and die of cancer from the anti-rejection drugs.

    They are terrified this may happen to them, and indeed, there are signs. Every desperation diet leads to an ultimate greater weight gain. They are all overweight, but not obese.

    So what should they do?


  22. In terms of what to do, if there were a one size fits all answer, there'd be a great many more skinny folks and I would be out a job.

    Sadly there are far too few helpful resources out there.

    Food/healthy eating wise I'm a huge fan of Walt Willett's Eat, Drink and Be Healthy and Marion Nestle's What to Eat.

    "Diet" wise, as I blogged about a few days ago, the Flex Diet book written by James Beckerman has some good suggestions.

    Of course I'd start off everyone with keeping a careful dietary record of what they're eating to understand their choices akin to keeping a budget to determine spending patterns. I encourage people to eat frequent meals and snacks, include a minimum of 300-400 calories per meal and 100-200 calories per snack and I discourage forbidden foods.

    But then there are so many other variables that impact weight. Medical conditions and medications, job requirements, time commitments, travel, learned behaviours, psychology etc. that impact the individual and then the lack of government action that may impact on society as a whole in terms of food advertising, calorie labeling, education in schools.

  23. Anonymous2:47 pm

    What you've suggested is a start. Not sure of your meaning here:

    /and I discourage forbidden foods./

    Do you mean, not having a list of forbidden foods?

    For the one most at risk, right now an added factor is living in Asia and not having an English nutrition and calorie database of common foods to consult. And being served huge amounts of white rice and being expected to eat every grain or offend. M.

  24. Good post, Yoni. I despise The Biggest Loser program. I understand the contestants sign gag orders, so that we really can't know the long-term impact. A random journalist may "out" someone, but otherwise we're left with the mythology that "they all lived trimly ever after."

    The program's reported maintenance figures of one-third/one-third/one-third are dubious. First of all, one third maintaining loss under what definition? On their own "reunion" program they portrayed people from just one season prior as successful "maintainers" (and some were visibly on a slow slide upward weight-wise). The earlier the season, the fewer contestants were featured, and almost all of them had regained significant weight (but were portrayed as successful maintainers). And, you're right, any who are successful, legitimately (regaining no more than, say, ten percent or so), have probably placed themselves in positions of high visibility and accountability.

    For your disheartened readers (on the verge of considering bulimia), I offer the following: live joyfully, eat healthfully, exercise a lot, and treasure the body that happens. And the first requirement of a joyful life? Don't watch The Biggest Loser! Ack!

  25. Similar results are found in women who do figure contests. By the end of their prep, theya re on such little food and such great amounts of cardio that eventually their bodies just stop burning. There are smarter ways to do it, as these should be lifestyle changes, not get thin quick schemes.

  26. By "no forbidden foods" I mean don't blindly deny yourself foods you enjoy because you feel you're not allowed to eat them.

    Instead it's about eating the smallest amount of those foods that you need to enjoy your life.

    Blind restriction leads many to complete dietary overhaul failure.

  27. Anonymous6:22 pm

    Thanks for the responses.

    I wonder where the low carb diets fit in. I've read that it works well for people with diabetes, and maybe, insulin resistance?

    Why wouldn't they just regain too? But also wonder about the wisdom of adopting such a diet if one is trending or there already with insulin, because wouldn't the kidney be more susceptible?

    I will always wonder if my husband had done low carb would he have turned it around? But that would have had to be about 20 years ago at the latest. I don't recall it being around then. M.

  28. There are success stories for every diet ever invented and certainly many low-carb success stories.

    The secret to success (and it's not much of a secret) is that regardless of the intervention, the only way to keep the weight you lose off is to continue with the intervention you employed to lose it.

  29. Anonymous8:02 pm

    I don't know what the chapters in your book will be, but there is something I've never seen dealt with any where, and wonder if it will be there.

    We began to feel like enablers. Because it was the only time he was with us. The only time he would be happy was when there was food. This was before the worst of the illness. The kids suffered from his disinterest except when we were eating. "Anyone want to go for pizza", would get them abruptly leaving their computer or homework and jumping up eagerly for this would be time with dad. It was so hurtful. Dad would be jocular and fun, and ruff their hair and put an arm around their shoulders. And once the food (massive amounts) was eaten, it was over. Of course for him the eating wasn't over because about 2 hours later he'd start again, but no one would join him. He ate from supper until bed.

    Anyway, I don't want to spill all over here, just someone acknowledge what the families of addicts go through? I've read this about gambling addicts, and alcoholics, but never food addicts. And he would get physically and verbally abusive the few times he tried to diet. When he wasn't sleeping. His tactic was to sleep or eat.

    It's an addiction. The person is an addict. If we wanted to be with him, we knew it had to be about food. Then we would be sick with what was going on.

  30. Regarding the return of the metabolic slowdowns to normal levels, didn't the Minnesota Starvation Study discover that after 9 months or so that all the participant's metabolic systems and energy systems had returned to pre-study levels?

    I've lost 170 lbs and kept that weight off for over six years now. My own experience agrees with the above. My maintenance calories are pretty much exactly what is estimated based on various calorie estimators given my age, height, weight and activity level.

  31. Thank you for writing this - everyone needs to see it! I was having this very discussion with a colleague today. Some would say it makes for good TV - I won't watch it - but it is not sending the right message!

  32. I struggled with my weight for a couple of decades; I was either starving or literally exercising my ass off. By today's standards, either one would be an "eating disorder" only I never got really thin; just kept in in check.

    But for the last six years, I've been eating Atkins; and have never felt better, been more healthy... or been thinner.

    Maybe I have a metabolic disorder and have to eat this way to be healthy.

    Or maybe... not.

  33. LOL. I love Oprah in that picture....

    "MMmmmmhmmm....I feel your pain. Trust."

    No one can empathize more than She. I guess even God isn't perfect.

  34. Anonymous2:48 pm

    Yes. It's everyones fault except his.
    *shaking head*

  35. Anonymous11:57 am

    I was under the impression that people who were heavier had higher metabolisms than people who were much smaller. If that is true, then it would make sense that a 400-pound man's metabolism would change if he suddenly went to say, 150 lbs, simply because he has less mass to support...obviously I'm not a doctor, but how does that factor into the equation?

  36. Indeed.

    Thing is the results here were slowing far greater than would have been expected from their weight losses alone.

  37. Yoni, could it be that they are neglecting TEF in their predictions? That could at least count for some of the extra "tanking" of the metabolism. Dr. Dansinger said in his interview with Jimmy Moore that they generally halve the contestants' intakes. So not only does a lighter person with less LBM require less to live on, but they expend less to process that which they consume.

  38. I don't think so CarbSane as measurements of the resting energy expenditures wouldn't be impacted by TEF as REE measurements are done either fasting or at least 4 hours post meal.

  39. Tracy F1:07 am

    I've watched BL for a number of seasons and it seems each season the rate of weight loss is greater than the season before.

    It IS a reality TV show, and that will ultimately be its demise - the need to entertain (and draw viewers and the advertisers that follow) gradually overtakes its original (good) intent.

    The show needs to re-think what it is trying to do for these people. Only professional athletes can devote full time hours to exercise, which is what happens at the ranch. That would be fine if they had professional athlete lives to resume when they leave the ranch, but most will return to average joe lives like mine.

    So they need to be taught HOW TO MAINTAIN THEIR WEIGHT IN AN AVERAGE LIFESTYLE, like an average weighted person does. Eat the calories you need by consuming nutritious foods. Walk to the mailbox. Take the stairs once in a while. Get a dog that needs to be walked.

    Eric (the one on Oprah) was interviewed on BL last season. He openly admitted that he returned to his old lifestyle after the show - the same lifestyle that made him obese the first place. It had nothing to do with his metabolic rate falling - it had everything to do with resuming massive caloric intake, poor nutrition, and all the bad habits he had before.

    So what they need to do is provide graduated prizes.

    One for the end of the season, a second (more valuable) for maintaining their weight loss at the end of the next season, and an even greater prize for maintaining it for one more season. Maybe even a prize for random unannounced weigh ins (like professional athletes with random doping tests, haha)

    Seriously! I'd TOTALLY tune in to see that season after season!

  40. Hi there! I desperately need some help...with exercise. Not motivation, I have tons of that! Not gym membership, have that! Not even buddies, I have those! I walk, I kayak, I started to do yoga, I have worked one on one with a fitness trainer for 6 months. Did I lose weight? No!
    Diet? Mine, is great! I eat healthy! I am realistic, following a gluten free diet, trying to go refine sugar free (reduced by about 80%, and alcohol free. I consume on average 1800 calories a day. My weight is 230 lbs, at 5'5''.
    I did an ultralow calorie weight lose program, right here in Ottawa about 4 years ago and lost 50lbs. Which I kept off for a year be walking 45 minutes a day, and maintaining a 1500 calorie a day diet. Then I got ulcerative colitis...too sick to walk...had to go on a low residue diet...and gained back the 50 lbs over the next year.
    The problem now is that every time I exercise and push myself, even slightly...I end up with head splitting migraines! I have had them since I was 12 and had to learn to live with them, this is nothing new. But it is so frustrating! I know I need to exercise 5 times a week, but the more I exercise the worse I get. I hydrate, I sleep well...I eat a healthy diet. I take supplements! My doctors are clueless! I've had all the bloodtests and scans....and I am "prone to migraines. Period!"
    What is going on? Do you have any suggestions? How can I exercise efficiently enough to lose weight with out setting off migraines (or gut issues)?

  41. Fab50 - I'm all about living the healthiest life you can enjoy.

    While certainly being able to exercise more vigorously might improve your health, I'd embrace the fact that you're actually motivated, willing and able to exercise at lower intensities 5x a week.

    That's worlds better than many.

    No, it's not fair, but we've got to play with the decks we're dealt.

    Wish I had the answer that would lead to the migraines disappearing....but given you've been worked up plenty, my guess is they may just be your deck.

  42. OK, not the answer I was hoping for...but such is life! So how do I get the weight off? I don't want to go back on the 900 calorie diet again....as I believe it did screw up my metabolism severly. If I am maintaining my weight at 1800 calories a day, what do I need to do to lose 2lbs a week? Drop to 1100 cal a day? Can I get complete nutrition in 1100 calories a day? And will this low amount screw up my metabolism further? I want to raise my metabolism...how do I do that?

  43. Again, likely this isn't the answer you want.

    Your job is to live the healthiest life you can actually enjoy.

    From a weight perspective that would mean eating the smallest number of calories that left you happily satisfied and exercising as much and as vigorously as you can enjoy.

    Whatever your weight does when you're living the healthiest life you can enjoy is what I refer to as your "best weight".

    Simple truths:

    If you can't happily eat less, you won't eat less.

    If you can't happily exercise more, you won't exercise more.

    Ideal weights, BMIs, etc - they're all useless for goal setting.

  44. Thank you Doctor! I guess its "living Large" for me.

  45. MarMar10:13 pm

    I found this site searching for Biggest Loser studies. I was interested in the psychological developments that result as a consequence of the "beatings". However, all I found were studies on the harm this over excercising does, which has been my contention all along. My husband is a little bit obsessive and he just discovered the show and we have been watching all the seasons on Netflix. Well, he challenged me to jump on that plataform thingy, which I as fool agreed to, although I knew it was dangerous. Well, I lost balance and fell backwards, twisting my ankle so bad that I have been 3 days with it up and am unable to walk and exercise, which is killing me. I wanted a place to tell somebody how dangerous this stuff is, no wonder the contestants get scared of doing certain things and some times refuse to be bullied into doing more than they can. Thank you for the information and space. I have subscribed!

  46. Hi, Dr. Yoni

    I respect both Dr. Sharma, Dr. Jeffrey Friedman and Dr. Stephan Guyenet. All these men have a good grasp of what genuine science shows us so far about obesity. They are all working to understand it better.

    None of them would support" The Biggest Loser". It is the most unscientific crap out there.

    Dr. Sharma said you have to "tug at the rubber band very gently" or it will snap back badly. Dr. Stephan Guyenet has said that any caloric deficit can't be blatantly or deliberately done. The more under the radar, and gentler the better. It also has to be what you enjoy and can sustain for the rest of your life.

    Things such as having that one or two less sodas a day and increasing NEAT a bit can work with the body. At least in those who are not severely obese. Those are examples of not fighting the body.

    Severe obesity, like some contestants have, is a chronic disease state. Their situation is not as easy to remedy as the person who has only 8 pounds to lose. In the future we probably will have drugs whcih target fat cell regulation specifically.

    The unknowns about morbid obesity are vast and monumental. There is also significant uncertainty.

    Take care,