Weight loss and the Biggest Loser: What you really need to know about the NY Times article

Patients, Facebook friends, and friends of friends contacted me in horror after reading the NY Times article on the Biggest Loser. Weight re-gain is inevitable. Most if not all of it.  And metabolic rate is screwed too. The control you believed you had? Doomed to dissolve. The hope you were given that you'd finally made it to your goal size or weight—or were getting closer—shattered. Overweight, obese, underweight or average size—the feelings knew no size boundaries. Fear. Anxiety. Hopelessness. Panic.

The pain of regain extended well beyond the 14 Biggest Loser contestants studied and their loved ones. It was felt by those of you who shared their struggle and their joy and sought inspiration from this outrageous, extremist show. 

The NY Times summarized the research: by 6 years after the show’s end, all but one participant studied had either regained some weight or gained beyond their starting weight; 4 contestants are now heavier than before they tortured themselves with this unsettling weight loss regime.

I know how you're feeling.

Nearly all have slower metabolisms now than at program’s start—over 600 calories less on average— with the biggest loser, Cahill at a loss of 800 calories burned per day; he now has to eat 800 calories less per day to maintain the same weight compared to at the start of the program. Many reduced their weights enough to improve their health, but the struggle to maintain the loss was constant and painful—physically and psychologically.

Where’s our anger at this abuse?

Four to 6 hours daily exercise was commonplace, with Cahill reporting 7 hours/day while on the show. Two or more hours included intense cardio workouts. And their intake? 1000-1200 calories was not unusual—an outrageous restriction even if the obese individuals were sedentary. That’s right. Just breathing or being at rest they would lose weight at that calorie level given average heights and starting weights. The degree of starvation was shameful and irresponsible. A set up for failure for sure. And did I mention there are now reports by participants of taking stimulants (provided to them by the program) to accelerate the weight loss—like ephedra and Adderall? 

It is simply abusive to lose weight the way they were directed to for the public’s entertainment. The extreme calorie deprivation resulted in a hormonally induced hunger and subsequent binge eating. No doubt, great shame and embarrassment resulted from their regain as they blamed themselves for their “failure”. Unfortunately, people replicate this self-abuse with crazy diets all the time, believing they can just jump-start their weight loss and then sustain it. Wrong, wrong wrong. 

What can you learn from this Biggest Loser study?

Yes, metabolic rate does slow with weight loss. This is not news. You knew it. You knew that when you were dieting and the weight loss you’d hope would continue simply didn’t happen. Your weight would plateau even though you were doing just what you were doing before. Even though you were “being good”. And so you made an adjustment. You’d eat a little less or exercise a little more or use behaviors like purging. And what resulted? More frustration, less “success” with weight loss. 

It may be time to be more realistic.

And for many if not most of you, rebound overeating or binge eating occurred. Because you’re a failure? Surely not! Because it wasn’t sustainable. Because you felt deprived—hungry, unsatisfied, fatigued, unfocused, vulnerable. Because hormone levels fought against you, as leptin levels—which helps us feel satiated—dropped with weight loss.

While the number of study participants—a mere 14 individuals—was small—the results were enormous. All but one regained significant weight. Yet the big news from this piece was the extent of the metabolic rate drop and the duration that it was sustained—observed when last checked 6 years after the end of the show! Now that’s scary.

What does this really mean for you?

While we don’t have all the answers, it appears that the degree of restriction impacts the outcome. Meaning, more rapid loss, more rapid gain. The “biggest loser”, Danny Cahill, had the greatest drop in metabolic rate—down 800 calories/day. He also regained the fastest, based on the NY Times graph accompanying the article. Deny your body and it’s gonna do what it needs to preserve yourself—it’ll try to slow the engine down, to conserve, to save some fuel for another day, to burn fewer calories. Yes, it does appear proportional. More moderate reductions in rate of weight loss, less drop in metabolic rate. 

Is my metabolism ruined forever?

The degree and duration of metabolic drop reported in the Biggest Loser research is simply not seen in other studies—a drop of 3-5% is more common. And most studies show that this drop reverses with increased food intake. 

Living with anorexia? 

Fear not—you have not permanently messed things up. The famous Minnesota Starvation Experiment demonstrated what those who treat eating disorders know from practice—that metabolic rate rapidly increases with re-feeding. (But continue to starve yourself and yes, your metabolic rate will be suppressed.) It requires a lot more calories than we’d expect for underfed individuals to restore weight. Ask any parent who is helping to renourish their child with anorexia. 

So please don’t be too quick to assume your fate. How do we know metabolic rate increases in this population? In addition to the Starvation Experiment and inpatient studies using indirect calorimetry—a  measure of resting metabolic rate or calories burned at rest, we also can see it indirectly—from increases in heart rate, body temperature and hormone levels.

I don’t have anorexia. I just diet to lose weight.  What does this mean for me?

“Just dieting” still lowers metabolic rate. If you are as extreme as the contestants, you may need to acknowledge your fate. If you are expecting rapid loss to be maintainable, think again. Torturing your body with hours of exercise each day as many of them did (or any amount, quite frankly, that leaves you starving) and/or restricting your eating and denying your hunger will fail you. 

Banning these? Time to change your approach
 to weight management.

Feeling deprived by omitting foods that satisfy you will lead you nowhere. Besides the reduced metabolic rate, the resulting deprivation leads to binge eating. And binge eating contributes to significant excess in calories and weight regain. Hopelessness follows, leads to the “what the heck effect” and eating recklessly. It all adds up to significant weight regain. And with chronic restricting, there’s also a loss of muscle mass which further reduces metabolic rate.

So now what?

Using more sensible, less extreme, more behavioral approaches to take charge of eating may seem less sexy, but has my vote. An 8 year study on lifestyle change resulted in long term weight loss (in 73% of overweight participants)— but not to the degree you might be hoping for. A 5-10% drop in weight was maintainable without losing sanity, and improved health. 

While the Biggest Loser participants tortured themselves dropping huge amounts of weight, and suffered as it rapidly increased, those with practical lifestyle changes lost less to start and after some initial regain, stabilized for years, suggesting better long term outcomes. The Biggest Losers? The study ended at 6 years, but based on the charts most seem to be likely to continue their weight gain trend.

So what can you do?

• Accept more realistic weight goals.  Modest paced weight loss (assuming weight loss is truly needed) may be most sustainable. 
• A 5-10% weight loss is enough to have a signifiant impact on your health—on blood pressure, blood sugar blood, cholesterol, fitness level and overall well being. 
• Focus on fitness goals. Regardless of your weight, find ways to move more, setting realistic goals.
• Address the quality of your intake for health. Include plenty of whole foods including grains, fruits, vegetables, nuts and lean protein sources—as well as fatty fish. But allow room for other foods you enjoy—yes, that includes cupcakes.
• Work on your eating behaviors, as I’ve addressed throughout this blog (see posts labeled mindful eating and binge eating)
• Cover your ears when your doctor says you must drop to the average BMI if you haven’t seen that place in decades, or ever. Clearly more harm than good will be done.
• Oh, and stop blaming yourself. Take charge of what you can control without physical or mental distress. And take some steps to love yourself as you are.

Thanks for reading. And sorry it's taken so long for a blogpost. Please take the time to share your thoughts--and share this piece with others.

Here’s to a Speedy Recovery? Not So Fast!

Alan came in yesterday and he put it right out there. “I was really disappointed with our visit last month.”, he shared. “I expected to lose more that the 6 pounds given all the work I had done”. More than a pound per week achieved through his modest dietary changes and his move from a sedentary activity level wasn’t enough. Sure he was feeling better—sleeping better, less heartburn, more energy—but still the weight loss wasn’t enough.

Thinking this portion should satisfy? Maybe not!

I wish I could say this was an atypical occurrence. Rather, many a patient, and a parent, present painfully honest about their dissatisfaction. Not with me, I’ll add, but with themselves, their child, their spouse. Really, they struggle to make sense of the reality of changing behaviors with their vision of what should be.

And if you’re like them, it’s not your fault for struggling with this. Ever watch The Biggest Loser? Those who get thrown off the show for not losing fast enough lost 7 or so pounds—in only one week! How about those Jenny Craig and other diet program ads—the ones with those alluring before and after photos with the oh-so-tiny-print revealing for legal reasons, that “results are not typical”? (For the record, losing rapidly will ultimately result in rapid weight increase, preoccupation with food and weight and a host of other consequences).

Perhaps you’re dealing with an eating disorder. These past 2 weeks I’ve watched as my patient’s insurance company repeatedly rejected her pleas for treatment. Alison long struggled with anorexia and bulimia and after much work on the part of her providers (myself included) had agreed to enter a program. I thought that was the hard part. But then the tables turned and she became the one who had to fight for coverage for appropriate care; in the eyes of the insurer, 15 or 20 years entrenched in her eating disorder should surely be remedied in a couple of weeks in a program! Even her providers at the treatment center—no doubt influenced by the regulations and coverage struggles they’ve come to accept—seemed to take that stand, despite her recent slip when left on her own.

You just might encounter some obstacles.

Your difficulties in recovery may be influenced by your unrealistic expectations of the process of recovery or of changing behavior. Like Alan, you may take a “why bother?” approach and throw caution to the wind, sabotaging your progress because you sense you’ve already failed.

Sarah’s parents recently emailed me concerning their anorexic teenage daughter whom I’ve been working with. “She’s been making a point of going out more for dinners and she’d stopped keeping a food record”. Potentially cause for alarm? Maybe. But in Sarah’s case it was anything but. She had make remarkable progress with weight restoration over the preceding months and had been forthcoming about her difficulties—when they occurred. The dinners out? Now that she was more comfortable eating in restaurants and having others prepare her food she was stepping out; it was not an attempt to avoid parental mealtime supervision. And the lack of record keeping? Sarah was working on moving toward more intuitive eating at this point, and we had agreed to move from the daily food logs and exchange list accountability. I am not faulting involved parents in the least. But sometimes change is a good thing, as in Sarah’s case.

Some families expect recovery to be like ER treatment—you come in in a crisis, you get emergency treatment, like surgery or a new medication and you’re discharged to home and fixed. Unfortunately, eating disorder recovery is nothing like this.

So what to do when you live in a world filled with outrageous messages and your unrealistic timeframe for change is far from attainable? Focus on the immediate benefits of the positive changes you’re making, versus dwelling on the disappointments and frustrations. Consider not just the shoulds, as in “I know I’m supposed to be eating better, so that’s good” or “I know that this will help me down the road to prevent heart disease”. 

Don't expect to feel so positive all the time!

Consider the benefits many of my patients shared this week:

• my energy level is so much better

• I’m thinking more clearly

• I’m less preoccupied with what, when, how much to eat and I’ve stopped counting calories!

• my worst fears haven’t come true, in spite of my resistance to making the changes

• it’s getting easier to do the tasks I initially struggled with

• I’m seeing the impact of my role modeling on my young kids

• I was able to have a scoop of ice cream and trust that it would be there if I wanted more later!

• I baked and ate what I baked for the first time in years! (from Food to Eat, I’ll add!)

I also saw improved blood sugars in diabetics—with less than Biggest Loser amounts of weight loss, and I heard from both patients and families about improved mood and decreased irritability.

I realize that the positives, like those described above, may also occur side by side some negative experiences. For those starting to eat more as instructed, the physical sensations can be challenging. And anxiety, for many, is a real challenge and may need to be tackled with support from your therapist and MD. I don’t want to paint an unrealistic rosy picture, suggesting that all you need to do is adjust your thinking!

We’d all like a speedy recovery, as the expression goes. But in order to move there, we just might need to adjust our expectations.

Remember Patience?

Your thoughts?