Bottom line from the NYT articles and the scientific studies which they cite (quote is from the NYT article After ‘The Biggest Loser,’ Their Bodies Fought to Regain Weight By GINA KOLATA MAY 2, 2016.):
All this [meaning all the evidence cited earlier in the article and scientific studies] does not mean that modest weight loss is hopeless, experts say. Individuals respond differently to diet manipulations — low-carbohydrate or low-calorie diets, for example — and to exercise and weight-loss drugs, among other interventions.
But Dr. Ludwig said that simply cutting calories was not the answer. “There are no doubt exceptional individuals who can ignore primal biological signals and maintain weight loss for the long term by restricting calories,” he said, but he added that “for most people, the combination of incessant hunger and slowing metabolism is a recipe for weight regain — explaining why so few individuals can maintain weight loss for more than a few months.”
Dr. Rosenbaum agreed. “The difficulty in keeping weight off reflects biology, not a pathological lack of willpower affecting two-thirds of the U.S.A.,” he said.
Mr. Cahill [one of the contestants who lost the most weight] knows that now. And with his report from Dr. Hall’s group showing just how much his metabolism had slowed, he stopped blaming himself for his weight gain.
“That shame that was on my shoulders went off,” he said.
The following resources are from the NYT(copies of each of these articles are saved in file on this post as well as the other resources.) :
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One Weight-Loss Approach Fits All? No, Not Even Close, NYT
All that follows is from the above article:
To help people find an effective way to lose weight, obesity medicine specialists say they start by asking if there is an obvious cause for a person’s excess weight, like a drug that can be switched for something else. If not, they suggest patients try one thing after another starting with the least invasive option, and hope something works.
“There are 40 therapies I can throw at a patient,” Dr. Kaplan said. “I will try diets and aerobic exercise and sleep enhancement. I have 15 drugs.”
Dr. Caroline Apovian, director of the nutrition and weight management center at Boston Medical Center, said most people can lose weight but keeping it off is the key. For most, she said, finding something that works “is still trial and error.”
Andrea Gardner, a registered nurse who lives in Weymouth, Mass., is in the midst of that process. She has tried one diet after another, losing weight and gaining it back. She is 5 feet 5 inches tall, and her body, she says, seems to want to settle at a weight of about 185 pounds, which is not acceptable to her.
She continues to work with Dr. Apovian, ever hopeful that this time a diet and, she said, willpower, will do the trick.
But [only] about 15 to 20 percent of patients respond to measures short of surgery, with response defined as a change in their body weight that is maintained without constant hunger or cravings. While people seldom end up thin, their permanent weight loss is a proof of principle, showing that treatments can lower the weight the brain forces a person to maintain. [Emphasis added]
The last resort, for those whose obesity is extreme, is bariatric surgery, which elicits a permanent and substantial weight loss in almost everyone.
Every obesity medicine specialist has seen it happen — someone repeatedly tried and failed to lose weight and keep it off. It turned out they were trying the wrong thing. Here are some people who finally found a weight-loss plan that worked.
After trial and error, here are six stories from people who finally found diets, drugs and other methods that helped them keep the weight off.
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From the New England Journal of Medicine (NEJM)
Comparison of Weight-Loss Diets with Different Compositions of Fat, Protein, and Carbohydrates [PubMed Abstract] [PubMed Full HTML] [Full Text PDF]. Published in final edited form as: N Engl J Med. 2009 February 26; 360(9): 859–873. doi:10.1056/NEJMoa0804748.
Slimmer and Hungrier
Some scientists say weight maintenance has to be treated as an issue separate from weight loss. Only when that challenge is solved, they say, can progress truly be made against obesity.
“There is a lot of basic research we still need to do,” said Dr. Margaret Jackson, who is directing a project at Pfizer. Her group is testing a drug that, in animals at least, acts like leptin, a hormone that controls hunger. With weight loss, leptin levels fall and people become hungry. The idea is to trick the brains of people who have lost weight so they do not become ravenous for lack of leptin.
While many of the contestants kept enough weight off to improve their health and became more physically active, the low weights they strived to keep eluded all but one of them: Erinn Egbert, a full-time caregiver for her mother in Versailles, Ky. And she struggles mightily to keep the pounds off because her metabolism burns 552 fewer calories a day than would be expected for someone her size.
“What people don’t understand is that a treat is like a drug,” said Ms. Egbert, who went from 263 pounds to just under 176 on the show, and now weighs between 152 and 157. “Two treats can turn into a binge over a three-day period. That is what I struggle with.”
Losing a Key Hormone
Slower metabolisms were not the only reason the contestants regained weight, though. They constantly battled hunger, cravings and binges. The investigators found at least one reason: plummeting levels of leptin. The contestants started out with normal levels of leptin. By the season’s finale, they had almost no leptin at all, which would have made them ravenous all the time. As their weight returned, their leptin levels drifted up again, but only to about half of what they had been when the season began, the researchers found, thus helping to explain their urges to eat.
Leptin is just one of a cluster of hormones that control hunger, and although Dr. Hall and his colleagues did not measure the rest of them, another group of researchers, in a different project, did. In a one-year study funded by Australia’s National Health and Medical Research Council, Dr. Joseph Proietto of the University of Melbourne and his colleagues recruited 50 overweight people who agreed to consume just 550 calories a day for eight or nine weeks. They lost an average of nearly 30 pounds, but over the next year, the pounds started coming back.
Dr. Proietto and his colleagues looked at leptin and four other hormones that satiate people. Levels of most of them fell in their study subjects. They also looked at a hormone that makes people want to eat. Its level rose.
“What was surprising was what a coordinated effect it is,” Dr. Proietto said. “The body puts multiple mechanisms in place to get you back to your weight. The only way to maintain weight loss is to be hungry all the time. We desperately need agents that will suppress hunger and that are safe with long-term use.”
Brain Sets the Calories
Dr. Lee Kaplan, an obesity researcher at Harvard, says the brain sets the number of calories we consume, and it can be easy for people to miss that how much they eat matters less than the fact that their bodies want to hold on to more of those calories.
Dr. Michael Rosenbaum, an obesity researcher at Columbia University who has collaborated with Dr. Hall in previous studies, said the body’s systems for regulating how many calories are consumed and how many are burned are tightly coupled when people are not strenuously trying to lose weight or to maintain a significant weight loss. Still, pounds can insidiously creep on.
“We eat about 900,000 to a million calories a year, and burn them all except those annoying 3,000 to 5,000 calories that result in an average annual weight gain of about one to two pounds,” he said. “These very small differences between intake and output average out to only about 10 to 20 calories per day — less than one Starburst candy — but the cumulative consequences over time can be devastating.”
“It is not clear whether this small imbalance and the resultant weight gain that most of us experience as we age are the consequences of changes in lifestyle, the environment or just the biology of aging,” Dr. Rosenbaum added.
[One Biggest loser contestant said] “‘The Biggest Loser’ did change my life, but not in a way that most would think. It opened my eyes to the fact that obesity is not simply a food addiction. It is a disability of a malfunctioning metabolic system.”
The effects of small imbalances between calories eaten and calories burned are more pronounced when people deliberately lose weight, Dr. Hall said. Yes, there are signals to regain weight, but he wondered how many extra calories people were driven to eat. He found a way to figure that out.
He analyzed data from a clinical trial in which people took a diabetes drug, canagliflozin, that makes them spill 360 calories a day into their urine, or took a placebo. The drug has no known effect on the brain, and the person does not realize those calories are being spilled. Those taking the drug gradually lost weight. But for every five pounds they lost, they were, without realizing it, eating an additional 200 calories a day.
Those extra calories, Dr. Hall said, were a bigger driver of weight regained than the slowing of the metabolism. And, he added, if people fought the urge to eat those calories, they would be hungry. “Unless they continue to fight it constantly, they will regain the weight,” he said.
All this does not mean that modest weight loss is hopeless, experts say. Individuals respond differently to diet manipulations — low-carbohydrate or low-calorie diets, for example — and to exercise and weight-loss drugs, among other interventions.
But Dr. Ludwig said that simply cutting calories was not the answer. “There are no doubt exceptional individuals who can ignore primal biological signals and maintain weight loss for the long term by restricting calories,” he said, but he added that “for most people, the combination of incessant hunger and slowing metabolism is a recipe for weight regain — explaining why so few individuals can maintain weight loss for more than a few months.”
Dr. Rosenbaum agreed. “The difficulty in keeping weight off reflects biology, not a pathological lack of willpower affecting two-thirds of the U.S.A.,” he said.
Mr. Cahill knows that now. And with his report from Dr. Hall’s group showing just how much his metabolism had slowed, he stopped blaming himself for his weight gain.
“That shame that was on my shoulders went off,” he said.
