Thursday, April 26, 2012

The Biggest Loser Destroys Participants' Metabolisms

[This is an updated and edited version of a post originally published in February 2011. I'm updating it as the original post referred simply to a poster presentation but yesterday the full article was published ahead of print in the Journal of Clinical Endocrinology and Metabolism]

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 theoretically 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 than 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, along with an almost certainly severe degree of stress, peer pressure and dietary restriction given the team and competitive nature of the show (where the team who loses the least weight has a member voted off, and where the last man or woman standing wins $250,000).

So is the weight lost on the Biggest Loser, a show now formally endorsed by the First Lady as an inspiration to the nation, healthy? Does the huge amount of exercise protect contestants against the show doing marked damage to their metabolisms?

The answer to both of those questions certainly appears to be, "No".

In an article published yesterday ahead of print, Darcy Johannsen and friends studied the impact 7 months of Biggest Loser weight loss had on the resting and total energy expenditures of 16 participants. They used all the latest gadgets to do so including indirect calorimetry and doubly labeled water. So what happened? By week 6 participants had lost 13% of their body weight and by week 30, 39%. More importantly by week 6 participants metabolisms had slowed by 244 more calories per day than would have been expected simply as a function of their weight loss and by week 30, by 504 more.

That's basically a meal's worth of calories a day that Biggest Loser contestants no longer burn as a direct consequence of their involvement. How do you think you'd do at maintaining your weight if you ate an extra meal a day?

But maybe that's typical. After all, metabolic adaptations are a known consequence to weight loss - couldn't that be all we're seeing here? I guess it's too bad there's no control group the study could have used for comparison.

Actually there kind of is. Bariatric surgery patients lose massive amounts of weight in a hurry as well, and they generally do so without the inane extremes of lifestyle endorsed by the Biggest Loser. If there were a study on the impact bariatric surgery losses had on resting and total energy expenditure, that would certainly offer some insight as to the healthfulness of Biggest Loser's weight loss program.

Good news! There is such a study. Published in 2003 in the American Journal of Clinical Nutrition researchers looked at the impact bariatric surgical losses had on the resting and total energy expenditures of 30 men and women whose pre-operative average BMIs of 50 were within 1 point of the Biggest Loser contestants' averages of 49, and who lost a Biggest Loser style average of 117.5lbs. And guess what? While resting energy expenditure indeed was shown to slow, it didn't slow down in excess of what would be expected by weight loss alone. In other words? Looking at these two studies, Biggest Loser style weight loss destroys metabolisms dramatically more than does bariatric surgery and does so in huge excess of what would be expected simply as a consequence of losing weight (though I suppose to be fair, the study on the surgical patients was done at 14 +/- 2 months, while the Biggest Losers' was at 7 - perhaps the Losers' metabolisms will improve with time)

That's a rather ironic finding given that one of the Biggest Loser study's authors, Biggest Loser's TV doctor Dr. Robert Huizenga, regularly trash talks bariatric surgery on the show as a terrifically unhealthy way to lose weight. Metabolically speaking, it would seem to me that his own study would suggest bariatric surgical weight loss is far healthier to a body's metabolism than is Biggest Loser style loss.

The study concludes,
"Unfortunately, fat free mass preservation did not prevent the slowing of metabolic rate during active weight loss, which may predispose to weight regain unless the participants maintain high levels of physical activity or significant caloric restriction"
Gee, ya think? "May"?

Here's how I'd spell it out. While some contestants of the Biggest Loser will 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 are doomed by the show itself to regain their weight, as the lifestyles promoted by the reality television show The Biggest Loser are only "realistic" to 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. A few years later 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 and metabolically dangerous approach to weight management, and in the process, stacked his deck entirely against him.

[UPDATE: Received a thoughtful email from obesity researcher Dr. Jennifer Kuk who wondered whether or not the Biggest Loser subjects had their energy expenditures measured in the week or days leading up to the finale. If so, she feels (and I'd agree) that given the competition they might have all been severely under eating so as to increase their chances of winning, and that it therefore might have been their temporary under feeding that led to their abysmal energy expenditure results.]

Darcy L. Johannsen, Nicolas D. Knuth, Robert Huizenga, Jennifer C. Rood, Eric Ravussin, & Kevin D. Hall (2012). Metabolic Slowing with Massive Weight Loss despite Preservation of Fat-Free Mass The Journal of Clinical Endocrinology and Metabolism : 10.1210/jc.2012-1444

Das SK, Roberts SB, McCrory MA, Hsu LK, Shikora SA, Kehayias JJ, Dallal GE, & Saltzman E (2003). Long-term changes in energy expenditure and body composition after massive weight loss induced by gastric bypass surgery. The American journal of clinical nutrition, 78 (1), 22-30 PMID: 12816767

51 comments:

  1. Though I think the Biggest Loser is inspiring to so many people -- I do not like, nor watch, the show. I think it is very unrealistic and gives viewers a false sense of what weight loss is REALLY about.

    And I've always known inside of me that the majority of the contestants will not keep the weight off once back in their home environment.

    So what you've written is very interesting! (though not surprising to me).

    I also believe that many contestants put the weight back on because of another factor:

    The never get to the core of WHY they were overweight in the first place.

    When you get to be that overweight, it's not about the 'food'. There's a reason(s) why people overeat and/or eat the wrong foods. Sure, there are many factors that go into it -- but by not addressing the underlying issue and getting to the root of the problem -- the show is merely putting a bandaid on a broken leg.

    The old adage of losing weight slowly is best.

    Thanks for your info. Great post, as always!

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    1. oh but deneen, the emotional issues *are* dealt with on the show. the trainers always go on a walk with a contestant or scream at them on the treadmill until the contestant breaks down crying about how they've never felt worthy. All Better! ;)

      I actually saw this episode of Oprah but can't remember if this former contestant spoke about these issues as at least part of the reason for his regain.

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    2. Anonymous12:50 pm

      I'm not sure the whole why comment is all that valid. There was a study in England which was either covered by Dr Freedhof or Dr. Sharma that tracked patients without additional counseling and those with additional counseling. It didn't make any difference.

      I think the real reason folks get obese is as simple is processed food is cheap, tasty and addictive, and some folks are just more prone to the addiction than others, just like alcoholism or drug abuse.

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    3. I agree with the reasoning that easily accessible fast food is a major contributing factor to obesity, along with a very sedentary lifestyle of TV watching and internet surfing is a factor as well (such as watching the Biggest Loser for motivation, rather than exercising).

      But, there is the fact that these patterns and behaviours are passed on through families. I grew up in a family that didn't emphasize physical activity or healthy eating, and grew up battling my weight. It's only as an adult that I've worked toward a healthy balance, and that's not been easy.

      For children, I think it's easy to learn that certain eating styles are "normal." That means re-learning lifestyle choices, which isn't as easy as some people might think.

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    4. Anonymous5:14 pm

      I am 55 years old and have been dealing with weight issues since I was 4 years old. I was the youngest Weight Watcher when I was a girl and lost 50 lbs. at age 11, and I was 4'6" at the time. I'm now 4'11" and weight in at 115 lbs. depending on the day. I now wear size 4 petite. The most I've weighed is 180 lbs - and and wore a size 22 pants for years. I am wondering how many of the others who posted comments have personal experience with large amounts of excessive weight.

      First, the percentage of people who keep the weight off from Biggest Loser should be compared against others programs, I.E. Weight Watchers, Nurtasystems, surgery, etc. At least that would be a fair comparison, whereas this article completely avoids that issue.

      Second, anyone who thinks keeping weight on or off is unrelated to emotional and behavioral issues has never had a major weight issue that is unrelated to putting on lbs. as one gets older. It took me until I was over 50 to finally work out the issues that held my distructive eating habits in place. I have learned to notice when I'm reaching for food in a self-distructive way and stop to deal with my feelings. I've also learned how to love myself, and reward myself without eating. BTW, despite having one of those diets that is uber healthy for over 20 years,(brown grains, lean meats, no sugar, alcohol, blah, blah, I can still found ways to be self-destructive with food! I can binge on rice cakes, honey and peanut butter like nobody's business!

      I now exercise 6 days a week and have a healty relationship with food, but more importantly with myself. I never lost weight rapidly, yet have to keep up my muscle mass and exercise daily in order to keep my metabolism up.

      So, my input is that there are many components involved, and this article is simplistic at best.

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  2. Anonymous7:35 am

    I agree with what you have said above. The exercise and healthy eating on the show are extreme and I cringe at the things the trainers say to participants. I have had patients who have done the "Exercise, exercise, restrict, restrict" and end up right back where they have started. The mental health portion is completely missing from this show, probably because it would not be very entertaining to watch. This can make a big difference! Thank you for sharing this study!

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  3. Thanks for another excellent post. Further proof that a slow and steady approach is more effective in the long run.

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  4. Shame-based approaches like the Biggest Loser to no bring about sustainable change.

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    1. Correction:
      Shame-based approaches like the Biggest Loser do NOT bring about sustainable change.

      Delete
  5. Anonymous9:16 am

    Does this metabolic state remain after the calorific underconsumption ends?
    I suspect like others that there may be a feat/famine approach, with the idea that once one loses the weight, they can return to their high GI sugary and fatty pseudo-foods.

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  6. My favorite weight loss article, "The Low-Fat-Free, Diet-Food-Free Diet" by Emily Greene was published in the "LA Times" on March 13, 2002. http://articles.latimes.com/2002/mar/13/food/fo-52-13 She wrote:

    "I have long suspected that the best way to lose weight was to eat rich food in moderation, not diet food in abundance. During the last 52 weeks, I put that idea to the test. And I lost 52 pounds. To my knowledge, not a single low-fat food passed my lips...For me, the result of this diet was not simply weight loss, not simply fresh delight in rediscovering good, simple things; it was vigor. My eyes are brighter, my skin is better and--to the astonishment of my neighbors--I now bound out of the house in the morning wearing a sweatsuit. Which brings the story to the exercise part. I didn't lose weight just by eating all this good stuff and tossing back Pinot Noir. I lost weight eating good, nourishing food that gave me energy to exercise."

    One of the peculiar things about current weight loss doctrine is this idea that high (percentage-wise) fat intake automatically translates into quick and easy fat gain; that every fat calorie beyond the magical 20 to 35% that passes between the lips increases the likelihood that the body will deposit additional fat on waist and hips. While this idea is not entirely in error, it's important to realize that the body responds to fat intake in the context of total nutrient intake and according to the proportions of the various fatty acid chain lengths ingested.

    For carbohydrate sensitive individuals, response to fat is determined by the amount and quality of carbohydrate ingested. For example, It was reported in research conducted by Peter Kuo et al. that "It was necessary to raise the daily carbohydrate intake to 85-90% of the total daily caloric intake in order to induce hyperglyceridemia in normolipemic subjects." http://www.ajcn.org/content/20/2/116.abstract In other words, normal weight people can indulge in high carbohydrate intake without having to worry about how it affects their blood fats. Not so with the carbohydrate sensitive/insulin resistant folks. For them, replacing carbohydrates of all kinds with saturated fats lowers triglycerides. http://rdfeinman.wordpress.com/2012/02/22/saturated-fat-on-your-plate-or-in-your-blood/

    Which brings us to the fat-phobic nonsense promoted by government, academia, and the food manufacturing industry. It should be obvious by now that a mistake was made. http://jhmas.oxfordjournals.org/content/63/2/139.full In addition to making Americans fat-phobic, the experts mistakenly concluded that omega-6s were heart healthy due to their slight cholesterol-lowering effects. However, the evidence clearly indicates that substituting omega-6 industrial seed oils for saturated (animal) fats deranges appetite. http://www.cannabis-med.org/english/bulletin/ww_en_db_cannabis_artikel.php?id=367

    For carbohydrate sensitive individuals, high carbohydrate snacks containing omega-6s are obesigenic in the extreme!

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  7. Dr. Freedhoff,

    Forgive me if I'm missing something (I don't have a background in the sciences) but both Biggest Loser and bariatric patients have dramatically reduced caloric intake but the BL contestants lose the wt twice as fast and under extreme amounts of physical and mental stress.

    Do those two studies suggest the pop-culture description of 'survival mode' or metabolic slowdown is a stress reaction not simply a reaction to low calorie diets?

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    1. Hi Craig,

      Not necessarily twice as fast. The tests in the surgery group were done at 14 months and actually likely reflect some regain already.

      All that said, and as I noted in the blog post, it is indeed fair to wonder whether or not measurements of the Losers at 14 months, or the surgical patients at 7 months, would prove to be comparable.

      In my experience in my office, where we have had our share of 100lb+ losses and where we measure resting energy expenditures, I've not seen metabolic slowing in excess of that expected by loss virtually ever....but losses here are usually on the order of 1-3lbs weekly.

      Putting my experiences with thousands of REE measurements here together with the data from the studies up above, my bet would be that metabolic adaptations may in part reflect severity of effort. But as a scientist, I'm certainly open to the possibility that I'm wrong and hope one day we'll have more data to consider.

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    2. Thanks for the quick reply! That's interesting. I have read blog articles by fitness competitors that claim their metabolisms were damaged by the rigors of their pre-competition dieting and exercise.

      Often there is a great deal of stress due to the expectations of competition and the deprivation of so many favoured foods. I wonder if the mechanism behind the claimed metabolic damage is similar to that experienced by the BL contestants (assuming the fitness competitors weren't using thyroid medicine or other exogenous aids).

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  8. Great read! I've always wondered if losing so much weight over such a short period of time could have negative effects.

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  9. Bob Johnston11:29 am

    I wholeheartedly agree that the Biggest Loser style of losing weight sets up the participants for failure as it doesn't actually address why they are overweight. Everybody loves to think that people are overweight because they lack will power and are sedentary; I now think these traits (as well as obesity) are actual symptoms of the real cause - a broken metabolism. And their metabolisms are broken because they've been eating the wrong foods all their lives, carbohydrates. With the havoc that heightened insulin levels play over time a body's natural weight (or "set point") gradually shifts up as the body becomes more and more insulin resistant. So sure a person can starve themselves and work out like a fiend for a short period of time but over the long haul it's impossible to sustain unless carbs are removed from the diet, thereby fixing the metabolism and reducing the body's "set point" for weight.

    But as for bariatric surgery I'm not convinced this is a reasonable way to go either. As I mentioned in a comment to an earlier article the recommended diet for bariatric patients changes to one that is low in carbs. Unfortunately the study you cited didn't indicate what these bariatric patients ate but I would imagine the study probably has some confounding variables that are unaccounted for.

    I've seen animal studies where rats on a low carb diet actually elevate their metabolisms by having a higher body temperature compared to rats on other diets. While I haven't seen a study done on humans I think it's premature to say that bariatric bypass patients maintain their metabolisms due to the surgery rather than eliminating carbs.

    But as a method for lasting weight loss I do agree that Biggest Loser style starvation and increased exercise are a huge setup for failure.

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  10. Anonymous12:19 pm

    This article is a hatchet job using halfass studies to attempt to shine a negative light on The Biggest Loser show. Why was there no mention at all of the good that comes from the weight loss on the show?

    Issues with blood pressure, diabetes and cholesterol disappear for nearly all contestants. The vast majority of contestants keep the weight off. That is FACT. Sure there are a few out of the hundreds of contestants who have had complaints and issues but thats expected. What wasnt expected has been the huge success the weight loss has had fighting these diseases.

    Metabolism issues? Really thats all you have to bash the show with? That straightens out over time as the contestants dont keep up the exercise schedule or calorie restriction they endured on the show yet manage to keep the weight off just fine. Many do gain some weight back as they call a "comfortable" weight to live but nothing near as much as they weighed before joining the show.

    Do some real homework on the subject you are writing about and give the full picture unless of course that was never your intent in the first place.

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    1. Hey Anonymous,

      I think that it is YOU who is missing the point that is being made here. Let me clarify it in easy to follow form for you:

      1. People go on a show such as "The Biggest Loser", and lose weight too rapidly. Along with the rapid weight loss comes some apparent benefits, such as reduction in blood pressure, diabetes symptoms and cholesterol numbers.
      As an aside... you claim that, "The vast majority of contestants keep the weight off. That is FACT." Please post where you are getting this FACT from. Any reports that I have seen show quite the opposite to your unreferenced claim. Either make with the reference or move on to something else. I can certainly provide numerous references. If anyone likes reading pages upon pages of depressing stories of weight re-gain, just let me know. End rant.
      2. After they lose a substantial amount of muscle and create hormonal havoc in the systems, they regain all of the weight lost, and often times more.
      3. Guess what comes back along with the weight?? You guessed it... high blood pressure, diabetes symptoms and raised cholesterol numbers. Can I also add depression to the list?
      4. No problem... just lose the weight again and the health will come back, right? WRONG. This time, the weight will not come off. No amount of starving, exercising or having a trainer screaming in your face will cause weight loss. However, even slight to moderate increases in calories (such as a week in Mexico) will cause rapid weight gain. Welcome to damaged metabolism-ville.
      5. A person such as this (post Biggest Loser), now has changed their body composition. This means that their ratio of body fat to muscle has actually became worse. AKA - they actually will have a higher body fat ratio than before they started.
      6. Check out the results of the Minnesota Starvation Experiment.
      http://en.wikipedia.org/wiki/Minnesota_Starvation_Experiment
      From these results you will see that weight re-gain is only the TIP of the iceberg in terms of what can happen when you starve weight off. Mental, emotional and physical problems. For the rest of your life. Good times.

      It's obvious that you enjoy the show, and that's fine. As long as you don't allow yourself to be ignorant of the facts that happen behind the scenes and after the current season's contestants have returned home to their real lives.

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    2. Anonymous6:33 pm

      I agree with you.

      Delete
  11. Every so often, I look at the "where are they now" Biggest Loser posts that appear periodically. In Every Single One of them, the only people who have maintained their weight loss are those that have devoted themselves to weight maintenance, usually by becoming fitness instructors or motivational speakers, or by spending 2-4 hours PER DAY in the gym.

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  12. Anonymous1:21 pm

    It seems reasonable to me that your metabolism would slow after you have lost massive amounts of weight simply because you weigh less. If you ever calculate your daily calorie needs, a huge factor is your bodyweight. If you weigh 350 lbs your body needs way more calories just to maintain your current weight than you would need if you weighed 200 lbs.

    I used an online calculator to look at somebody my same age, sex, and height, and exercising 3x week. If I weighed 350 lbs I would need 3560 calories/day to maintain my weight, but if I weighed 250 lbs I would only need 2935 calories/day to maintain my weight. There's your 500 calories/day right there. These calorie calculators may not be entirely accurate but I think they give you a good estimate for what you should try to consume.

    I find it hard to believe that the people on the show couldn't maintain their weight loss success after the show is done by eating a healthy diet and exercising moderately. It takes willpower to limit junk food and I suspect that this is something that most of these people lack.

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    1. Anonymous10:07 pm

      Reading the article again might be of some help to you. The point that it was making is that contestants who have been on The Biggest Loser have their metabolism drop more than you would expect from their weight loss alone. That 500 calories you're mentioning for 'standard' weight loss, apparently becomes more like 1000 calories for people who have been on the program.

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  13. I think this points to an important observation: calorie restriction per se does not lower the body fat "setpoint", while bariatric surgery does. Rudy Leibel and Jules Hirsch showed in some very careful experiments that metabolic rate is disproportionately reduced with fat loss by CR, and that the process is dependent on a reduced leptin signal. Leptin replacement reverses it:

    http://www.jci.org/articles/view/25977

    People who undergo Roux en Y surgery don't see that kind of response. Rather than crave energy-dense food and feel hungry all the time like people do with CR, they feel less hungry and less tempted by energy-dense food. Their brain reward regions are not hyperactivated by food images like those of people who went through CR. Researchers are currently trying to understand how gastric bypass alters energy homeostasis mechanisms.

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    1. thanks for that, it answers my questions (and my horribly gross over-simplification of the differences between the BL and gastric bypass subjects).

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  14. Laura Walker2:05 pm

    It may be extreme but nowadays people want something fast and easy. At least these people are giving it a shot, and although some of your findings are correct and maybe even valid your entire article proves what America is defined as today....No one ever wants to take responsibility, we always want to find someone else to blame. Obviously the show is extreme,, its television, obviously you must keep up with intense workouts, and if you don't Obviously you will gain the weight back up....but that is up to the individual, its not a time to start blaming a show for your weight gain. My husband works out every single day to be in the shape that he is in, and yes it is required for him to stay in top shape because of his job it should come to no surprise that if you don't work out and eat healthy you are not going to get the right results. I think the show is still inspiring for those that are over weight, and people don't have to go to the extremes the show does, but at least they they that weight loss is possible even without surgery. This article attacks something that shouldn't even be relevant, and it only puts people back where they were at, blaming others, not really looking at themselves, and saying..."see why even try to exercise in the first place." Lets focus on the real issue, and that is we need to eat more healthy and exercise period.

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    1. Good points Laura. We do live in an "instant society". But consider this... I am a Nutritionist and weight loss coach. You would not believe how many times I have clients INSIST that they can lose 8 to 12 pounds per week and remain happy and healthy while doing it. And, they believe this weight loss will be permanent.

      Usually this client is a woman who is only a small amount over weight, and maybe needs to lose only 10 to 15 pounds. However, in her mind, she is obese, and wants to lose 50 pounds. A skewed body image caused by the fashion/fitness industry? Most likely. But, men are not immune either.

      These clients will almost always cite 'The Biggest Loser' as "proof" that this sort of weight loss in realistic, achievable, permanent and healthy. So, do I blame the "The Biggest Loser" for misinforming and misleading people and causing them to undertake an unhealthy lifestyle that will likely cause them future damage??

      Absolutely, I do.

      TBL makes money not only off the show, but sells everything from clothes and workout music CD's to supplements, DVD's and books... The diet industry are corporate diet predators, preying on the hopes, dreams and deepest desires of every overweight and obese person worlwide. IMHO, the diet industry ranks almost right up there with "Monsatan" (aka, Monsanto) in pure evil. Almost.

      Surprisingly, a lot of my clients who fall for the hype are well educated, professional people. I am always somewhat mystified when an RN, lawyer or engineer comes up with a concept from the show, and has accepted it as fact... no matter how non-sensical it is. To quote Tom Naughton, "people need to start using their functioning brains" and start searching for their own facts. But, as Laura touches on in her post, people don't want to take that sort of responsibility, instead choosing to remain apathetic about their own well being.

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    2. Anonymous9:07 am

      There is nothing fast or easy about weight loss surgery. All of the various procedures carry risks and require life-long changes for long-term success. The difference between WLS and TBL is that surgery offers the option for realistic life changes where TBL leaves contestants with destroyed metabolisms and no support.

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  15. Anonymous2:59 pm

    I share some of the same confusion as above. As I lower my body weight, I need less calories. I don't have a background in nutrition or medicine, so I don't understand how this concept translates into a lower (or ruined) metabolism. Isn't the body simply functioning the way it was intended to - by needing less calories for a smaller body mass? I suspect I've over-simplified the concepts, but hey - I'm a forester. Talk to me about trees! Carol

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    1. Anonymous4:53 pm

      Carol I am a dietitian you are right with weight loss you will need less calories but the results of this study concluded in these people that they needed even less calories then would have been expected with the weight loss. He quoted:
      " More importantly by week 6 participants metabolisms had slowed by 244 more calories per day than would have been expected simply as a function of their weight loss and by week 30, by 504 more.

      Delete
    2. Anonymous8:05 pm

      Good catch and thanks for pointing that out. I guess the take-home message for the lay person (me!) is slow and steady weight loss is best and maximizes the amount of calories you can eat as you lose weight. Carol

      Delete
  16. There are plenty of studies around at the moment showing that obesity is NOT able to be combatted by a basically sedentary lifestyle and an hour or so every other day in the gym. it can only be combatted with a permanent and dramatic change in the overall lifestyle. To amandaLP - you are correct - most people who have been extremely obese at some stage need to spend much time being active, but not just in the gym, in life generally. obesity does not come merely from eating too much and too often. the eating is one part of a syndrome of behaviours - most of which relate to movement and activity levels. we eat highly processed food, drive cars too and from work, watch dvds and tv, and play seated video games, and use 'labor saving devices' to give us enough time for even more sedentary leisure.
    before contestants hit the show, their metabolisms were ALREADY damaged. how the heck did they get so obese if their bodies and metabolisms were healthy and efficient. the metabolic damage occurs when the insulin response becomes faulty because of overeating (usually high fat or high refined carb intake mixed with inadequate levels of activity); because the fat cells get to that certain level of efficiency and acquire fat at a greater rate than those of a non-obese person; because of years of radical and dramatic yo yo dieting combined with binge eating which effectively teaches the body to lay fat down very rapidly in response to the brutal binge/starve behaviours. it took some of these people MANY years to get as large and as morbidly obese as they were when the show started. that meant that they had likely reached a condition of homeostasis - where their bodies had adapted to the obesity and were working in such a way as to maintain it. our bodies are geared to keep up in homeostasis, so of course these people are going to have to battle to stop themselves from returning to the point at which they once were. if you have been morbidly obese for years, why would you expect that your body will happily accept a dramatic drop in weight without attempting to return it to a familiar state asap - which is why years of vigilance are required in order to maintain those losses and to build a more healthy and efficient metabolism.
    you cannot tell me that they guy in the pic above maintained a rigorous exercise routine and eating plan that he kept adapting as his body composition changed and still ended up obese? most likely he allowed old behaviours back into his life, along with the wrong types and portions of foods for his particular body type.
    if we are naturally inclined, through genetics or years of a sedentary overly nourished lifestyle, to be obese, we are going to have to combat that inclination for life. in much the same way as a person who is genetically predisposed to certain preventable diseases (like type 2 diabetes etc) can avoid these by dramatic lifestyle choices.
    people CAN maintain dramatic weightloss, but in order to do so, they also have to maintain the dramatic life changes made in order to get there.
    you CAN NOT return to old eating and movement habits and expect to stay lean.

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    1. Anonymous9:58 pm

      Ruth,

      You seem to be having a slight problem with understanding the article. Reading it again might help.

      The Biggest Loser contestants were being compared to a group of patients who had gone through weight loss surgery. Both groups started at fairly similar levels of obesity prior to their weight loss.

      The comparison here is purely on the matter of how the manner of their weight loss affected their metabolism afterward.

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    2. Anonymous10:07 pm

      I totally agree with everything Ruth said.
      Rapid weight loss is not good for your body, neither is professional football or boxing. BL is is a dangerous game just like any other competitive sport. BUT the message it sends, that you can get to your goal weight through diet and exercise is a good one.

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    3. Anonymous2:02 am

      I have been overweight since the mid '70's and my highest weight was 340. Over the last 10 years I lost 90 + lbs and have managed to keep it off by total life style change. Those changes included changing my food choices, giving up or limiting fast foods, highly processed foods and eating more raw foods. The biggest change I made was to drinking water instead of sodas. I still have a long way to go but I know that slow and steady will win the race.

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    4. For what it's worth, the day I gave up on dieting and just committed myself to eating healthy foods was the day I started losing weight. I stopped eating grains, refined carbs, and sugar (among other things) and avoid packaged foods like the plague. I've lost 25 so far (slowly, in about 5 months), and have about 60 more to go. I've seen a lot of additional health benefits too. It's not a race. Eat good food, move your body more, get enough sleep, and take steps to reduce stress. You'll get there.

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  17. Hi, thanks for sharing this article. Yes bariatric surgery helps in some patients but I believe that exercising and eating the right diet will help anyone lose weight. Many people fail in this aspect because of lack of consistency.

    Thanks

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  18. It amazes me that people watch the biggest loser and think that it portrays healthy weight loss. But you wouldn't get very good ratings with a show that takes people 2 years to lose their weight. It's only common sense that calorie restrictive diets of this level are going to affect your metabolism, but at the end of the day, even these fat slobs stack all their weight back on after at least they managed to get a couple of years at a normal weight. They wouldn't have got that without the show. And blaming the show for their weight regain is a massive cop out, they only have themselves to blame. You don't pile on 100 pounds eating lean grilled meat and salads

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    1. Anonymous10:01 pm

      Neil, reading the article again might be of some help to you. It was comparing the approach used on the show and the consequences that it has for metabolism after weight loss with people who have undergone weight loss surgery.

      Scientists who study obesity and weight loss have a legitimate interest in different methods that are available, and how those methods impact the likelihood that a patient will be able to keep the weight off. In this case, it appears that the approach used on the show tends to leave the contestants in a metabolic state where weight maintenance is more difficult than it needs to be.

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    2. Seriously Neil, you call overweight people,"Fat Slobs". Would you call a black person the 'N' word. I'd think not. So why is it all right for you to call an overweight person a “Fat Slob” or any other derogatory name. Overweight people get this prejudice type attitude all the time and people like you think it is ok to say. Well it is not. Grow up and find a brain and some compassion.

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  19. Anonymous10:00 pm

    Most are saying the contestants gain their weight back. Where is the PROOF?

    You have like one winner out of 15 that gained their weight back. The majority of total contestants didnt gain their weight back and follow a reasonable exercise and healthy eating plan. Not really sure whats so difficult to understand unless people just want to find fault regardless of the truth.

    As for surgery vs diet/exercise its a no brainer since nobody has ever died on The Biggest Loser...

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    1. Anonymous10:04 pm

      People are saying that some of the contestants regain the weight. No one has said that all of them do.

      The winners of the program are disproportionately likely to make a career out of maintaining their weight following the show, because they can get endorsements etc if they do. For that reason, they're probably not a very good sample group to represent the probability of weight regain among former contestants.

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    2. Anonymous10:27 pm

      I mentioned the winners but also stated the large majority of total contestants have kept their weight off and didnt have to jump through hoops to do it.

      Once the weight is off they simply exercise a lot less and eat more of the healthy food they learned to eat while on the show. If "making a career out of maintaining their weight" means living a healthy lifestyle like we should all be living then yes thats what they do.

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  20. This is a really good topic, I like the BL show and I can see how after losing all that weight if you do not maintained they can easily go back and more. In 2005 I drop over 40lb in one month and kept it of for another 6, but then when I stop eating healthy I regained it plus 40lb. In 2010 almost reaching 300lb I decided to make a change and I had the WLS, now a year and half I have been maintaining 150lb where by BMI is at 22 or so, but I have to say that I'm at a time in my life where I feel so healthy and not tired, and it hasn't been all because of food restriction because I can eat all I want if I want, my only problem with that is that I can regained my weight and some if I don't keep up with my exercise and my new way of eating, I cut all of the process food, fats and all them addicted carbs that kept me regaining every time I made a change in my weight in the pass, but the reall change in my life was coming to the realization that I am food addict and not just a food addict but one who is always hungry and craving for all the wrong stuff, and my journey has only been doable through the strength in my faith and the fact that I stay accountable by being plugged in with the circles that educate me and encourage my life change, in other word I seek to stay involve in support groups online or within my community not make money out of this(not criticism any one that has) but because I am the average Joe that can not afford to rearrange my whole life only around me but also my family work.... It hasn't been easy but it is doable... I don't mock the show and sure thing the surgery path has not been easy, but I am grateful for the life change that this has given me, I hope what ever method people choose that fits them, that they really consider after the light and cameras whether on a show or your family and friends, it will be you and only you that has to deal with maintaining the weight off... this is my story.

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  21. I am writing here as someone who has lost (so far)152 lbs.

    Someone commented above: "I think the real reason folks get obese is as simple is processed food is cheap, tasty and addictive, and some folks are just more prone to the addiction than others, just like alcoholism or drug abuse."

    Yes, serious overeating is often an addiction. But not because "processed food is cheap, tasty and addictive". People who seriously over eat obviously are GETTING something good from the food, or they would not abuse it in spite of all the problems that it causes! One has to carefully see WHAT are the "benefits" of overeating, and find new and healthier ways to meet those needs. [For example, one of my main reasons for overeating was the energy rush it gave me when I was tired. Today I try and get more sleep....., Also coming to terms with certain emotional issues helped me be able to stick with my new way of living....]

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  22. A more efficient metabolism equals a 'destroyed' metabolism...? I dunno...I can see some pretty good evolutionary arguments for arguing the reverse.

    To be sure, a more efficient metabolism makes weight loss harder to maintain...but the moniker 'destroyed' adds a layer of judgement that's just not there in the data.

    Slower does not necessarily imply worse (or better for that matter)...that's a matter for a different set of trials to determine.

    Cheers,
    Harry

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    1. Anonymous11:26 pm

      Ha ha! I agree with Harry. With food prices going up and up, I am glad my metabolism is so slow. i only need about 1400 calories a day thanks to yoyo weightloss from low fat medifast diets and being over 50. I also have the "thrifty gene" which I blame on being a descendant of the surviving starving dust bowl ancestors. Now I am a Primal / Paleo follower and I am never really hungry much anyway, even after an hour of rowing with the 4 man crew.

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  23. “…remember that prolonged dieting (this one [meaning the Atkins diet], low-fat, low-calorie, or a combination) tends to shut down thyroid function. This is usually not a problem with the thyroid gland (therefore blood tests are likely to be normal) but with the liver, which fails to convert T4 into the more active thyroid principle, T3. The diagnosis is made on clinical ground with the presence of fatigue, sluggishness, dry skin, coarse or falling hair, an elevation in cholesterol, or a low body temperature. I ask my patients to take four temperature readings daily before the three meals and near bedtime. If the average of all these temperatures, taken for at least three days, is below 97.8 degrees F (36.5 C), that is usually low enough to point to this form of thyroid problem; lower readings than that are even more convincing.” - Dr. Atkins

    Hypothyroid anybody?

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  24. FACT: a lot of people in the US are OBESE. I stayed there for almost 2 years and was SHOCKED to see how much some of them weigh. It's a nightmare. And the problem is their kids are the same.

    FACT: they get as 'heavy' as they are for eating crap foods and not working out. We do tend to cook at home, here in my country. We rarely eat out and, when we do, we don't go to McDonalds. We do care more about eating right (in my family we're actually baking bread at home and making our own yoghurt).

    FACT: the people on the Biggest Loser LOSE weight and LEARN the recipe for keeping themselves healthy: eat less, work out more.

    Some of them do go from HUGE numbers (I am constantly shocked to see people reach 300 lbs anyway) to some better numbers for themselves. Sure, they drop them too fast, but the recipe is still the same: even if they cannot work out most of the day, as they did on the show, they can still squeeze in some hours (come one, we ALL DO THIS) and be careful with what they're eating. How can we in a small country (with less access to nutritionists and all this jazz) still keep a decent weight on and so many Americans weight as much as 2-3 normal people put together? Because we COOK at home, we eat soups, we eat fruits and vegetables and don't eat all day long at the fast-food joints.

    I personally don't believe in a hugely restrictive lifestyle to be honest. I love my chocolate. I love a good pizza from time to time. Even a decent burger. But I don't eat them daily. I do try to have a healthy calory intake and work out.

    I see many of the contestants are doing wonderful. They still try to work out, they've put on some weight (20-30 lbs the most), they seem to be more careful with their eating habits. It proves IT CAN BE DONE.

    For someone who's struggled all their lives with HUGE weight, keeping it off is very hard. And it's something people need to realize. They have to work extra-hard to maintain their weight. It's not impossible: the proof is in all the people who have lost weight (via the show or just on their own) and are keeping it off.

    Nothing comes easily, but blaming a show for your weight gain is stupid. How come Eric did gain the weight back and many other contestants are doing so well? Ah, I know, it's metabolism. It's the glands. It's the entire world that's not fair.

    We're not idiots, we understand the show is A SHOW. It shows stuff that's sometimes far fetched. We know the contestants try various tricks to lose weight and these tricks (not eating, not drinking) are NOT something to be done on the long run. This is why diets usually don't work: because weight-loss is not something you do today or for 3 months. It's something that means CHANGING your life and keeping it that way.

    I do believe that, with all its imperfections, the show WORKS. It inspires people and it shows that America (and many other countries) does have a HUGE problem (no pun intended). At least for this, we still need the show.

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  25. Anonymous8:19 am

    Did you see the episode where the dietitian went to the kids homes?

    Did you not see all the junk food they had in their cupboards?

    They buy cookies and candies and COOL WHIP!

    Why do they eat? Who cares. It's ANXIETY and an aversion to pain. Exactly like a heroin addict.

    Fat people make bad food choices. That's why they are fat.

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  26. Anonymous5:45 pm

    I watched this show a few times and it's seriously the most inspiring show I have ever watched. The complaint that people lose weight too fast and somehow slow down their metabolism can't be held against the positives in people's lives. HELLO they were like 400 pounds or something. If their metabolisms and bodies had been so efficient - not withstanding the fact that they gained weight because they ate an insane amount of food - they would not have been obese in the first place.
    What you are saying, sounds like common sense to me, and I am no scientist. People who were once hugely overweight will have an easier time gaining weight than someone who was slim their whole lives.

    I have 40 pounds to lose at the age of 34. I gained weight about 6 years ago due to depression (and eating to compensate the bad feelings) and never lost it. I have been on a sensible diet now and I have recently majorly upped my exercise to 2 hours of really hardcore spinning (I have always been quite fit despite the fat gain) and I am sorry yes I am losing faster (4 lb per week) because I need the motivation. People don't realize how hard it is to go on some diet and to see meager, terrible results. Motivation is a huge thing in losing weight and a rapid weight loss is a major motivator. Watching that show made me realize that if someone can lose 150 lb, I can lose 40 lb and get back to 125.

    Here's a reality: people who were once fat simply don't have the bodies of a thin person, it is always harder. It's almost like being an alcoholic, you react differently to food than someone who never has "abused it". It's a reality I will have to deal with once I lose the weight. But it's worth it.

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  27. Anonymous11:59 am

    While I agree that The Biggest Loser is a dangerous example of extreme weight loss, so is bariatric surgery. For some people, it really may be the only solution, but for many others it's not. It's like being on a fad diet for the rest of the patient's life, only straying from that diet can have life-threatening consequences. The BBC released a documentary called "10 Things You Need to Know About Losing Weight", which not only completely changed the way I looked at weight loss as a whole, but I changed how I saw myself as well.

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