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.

Why I’m worrying about Vyvanse and Binge Eating Disorder

Seeming quick fixes can be so tempting.

This week’s inbox held the following message from an old patient:

“I was watching Good Morning America and they had Monica Seles on, admitting she's suffered from binge eating disorder (BED). They announced a medication they are now using to treat BED, Vyvanse, also used for ADHD. I looked it up and side effects include weight loss. Have you ever recommended this drug for BED? Do you feel it is effective for BED? Can people with BED take this med to lose weight? Do they think if you have BED you must be overweight and this medication can cause weight loss? Which would perhaps (in their minds) solve the bingeing?

That small ED voice that lurks deep from within is screaming 'get me that drug! Get me that drug!' so I can lose weight. WTH?!"

I’m glad she was brave enough to share what she was wondering, as I’m sure she’s not alone in her curiosity. Aren’t you wondering what this means for you?

Let's start by clarifying a few things about binge eating disorder. Most notable about BED is the recurring episodes of binge eating, feeling out of control while binging, and feeling guilt and shame afterward. People of all sizes live with BED, and the experience of a binge may vary. You might eat large amounts of one item—such as a whole package of cookies—or large amounts from a combination of foods. For some, even eating a single bite beyond what they intended may feel like a binge.

There's a way off the roller coaster--appropriately
named the Cyclone.

The common features among sufferers, though, is the guilt, shame and lack of control accompanying the eating. According to the Binge Eating Disorder Association,  "Binge Eating Disorder (BED) is the most common eating disorder in the United States. An estimated 3.5% of women, 2% of men, and 30% to 40% of those seeking weight loss treatments can be clinically diagnosed with binge eating disorder. The disorder impacts people of all races, levels of education and income — including adults, children and adolescents."

Given the shame associated with BED, however, there are likely many more living with the condition than we know.

Medication to the rescue?

Two recent studies were done using Vyvanse—a stimulant used to treat ADHD—for the treatment of moderate to severe binge eating disorder. They were well-done studies— randomized, double-blind and placebo-controlled—with promising outcomes. 

In one study, participants who binged three or more times per week were treated with either a placebo—a dummy pill—or 30, 50 or 70 mgs/day. Researchers saw a significantly better response to the 50 and 70 mgs/day doses compared to placebo in a study of over 250 subjects with a roughly equal number of controls. Improvements included reduction in binge frequency/week, a higher percent of subjects binge free for 4 weeks, and a change from baseline in the Yale-Brown Obsessive Compulsive Scale Modified for Binge Eating—compared to placebo treatment.

Notable, however were a couple of other outcomes. The placebo group also improved, by 21.3 percent (versus 42% in the 50 mgs/day and 50% in the 70 mgs/day treated groups). Meaning, the belief that taking something could help your binge eating was enough to improve binge frequency.

And then there were the side effects. More than 5% of those treated with Vyvanse reported symptoms including “dry mouth, insomnia, headache, decreased appetite, nausea, irritability, heart rate increased, anxiety, feeling jittery, constipation, hyperhidrosis [excessive sweating].” Twelve patients (5%) on Vyvanse reported treatment-related adverse events that led them to stop the study; 5 patients in the placebo-treated group had such negative effects. 

And then there’s this: “CNS stimulants (amphetamines and methylphenidate-containing products) have a high potential for abuse and dependence.” 

If you struggle with Binge Eating Disorder and are tempted by the positive research results, consider the following before you request a prescription. While medications might improve binge eating, so does addressing some underlying eating patterns and thoughts—without the risks of medication. In fact, since the placebo also improved binge frequency by over 21%, it suggests that the power of believing you could change—with some help—is quite strong with BED.

Yes, there's hope without meds for BED!

Need I say more? http://www.annetaintor.com/

Do any of the following scenarios apply to you? If so, medications for BED may be unnecessary.

1. You restrict your calories throughout the day, trying to be “good”. You deny your body the fuel it needs and by later in the day—often late afternoon or at night—you start eating, intending to eat in control. But then it feels like the flood gates open and you just can’t stop. Perhaps you feel like you’ve already blown it, so feeling defeated, you decide to continue to binge. You’re determined to get back on track tomorrow—with restricting. And so the cycle continues.
2. You eat enough calories throughout the day, but your food choices are very limited—including only foods you "should" be eating based on rules you follow; they may be only high protein, or unprocessed or not very palatable. They are foods that you’re okay with, but that don’t necessarily give you much pleasure. Then, when at a friend’s or out to eat and you eat something to appear ‘normal’ or because you really want it, you have serious regret. Later you continue eating because you’ve already "ruined it", but are determined to get back to your very restrictive, healthy food choices.
3. You truly get enough to eat—enough calories and enough of foods you really enjoy. But most of your eating is quite mindless—you eat standing up in the kitchen, while multitasking—while driving, on the computer or on the phone. So you never truly feel satisfied. And it’s worse when food is kept in sight.
4. You eat enough, you get what you want to eat, AND you pay attention to eat mindfully. But when stress if high, or you struggle with an emotion that’s hard to sit with, your knee-jerk reaction is to reach for food for comfort or to numb out. You may even be completely aware of what you’re doing, but the pull is so strong, because in the short run, it helps. But later, you are left with regret.

If any of the above statements apply, then working with an eating disorder dietitian—together with a therapist can really help. Cognitive Behavioral Therapy (CBT) is a valuable, well-studied treatment for BED, and you can purchase self-help workbooks specifically for this condition as well. 

Learn to normalize  your eating!

Yes, binge eating can be resolved without medication. But it requires dropping the diet and rigidity around eating. Really, dieting simply isn't helping.

For those with ADHD who also binge eat, the medication may be helpful to manage impulsivity—which can lead to binge eating. Delayed gratification—redirecting and waiting to notice fullness—can be too challenging, as is moving away from multitasking.

But using Vyvanse is not without consequences. Decreased appetite may sound appealing but if you don’t know when you’re hungry, it's hard to trust when and how much to eat — making intuitive eating impossible. It may contribute to inadequate intake and food restriction—something those struggling with binge eating may already struggle with. 

Do we need to swap one problem with another?

Further, will doctors inappropriately start prescribing Vyvanse for those who are overweight but not living with moderate to severe BED? Will prescribing seem like the medical quick fix, while failing to address restrictive eating, or deprivation or over-exercising that truly need treatment? 

So, dear readers, please don’t be tempted. But don’t give up hope. Seek out providers that work with binge eating disorder patients because it is in your hands to change.

Other related links you might find helpful:

http://dropitandeat.blogspot.com/2013/05/name-calling-has-its-place-bed-is-now.html

http://dropitandeat.blogspot.com/2013/03/weight-loss-and-recoverycan-they.html

http://dropitandeat.blogspot.com/2013/04/intuitive-eating-is-not-for-youmaybe.html

http://dropitandeat.blogspot.com/2013/03/heres-to-speedy-recovery-maybe-not.html

http://dropitandeat.blogspot.com/2013/04/eating-disorder-recovery-reflections.html

http://dropitandeat.blogspot.com/2012/08/do-or-do-not-there-is-no-try-think.html



http://dropitandeat.blogspot.com/2012/07/forgetting-to-remember-key-obstacle-to.html

You? An eating disorder? Breaking the silence on binge eating disorder and OSFED.

I'm not posting this to brag nor, I'll add, to solicit more emails. 

We can't tell just looking at you who's living with an eating disorder.

And I certainly don't want those of you who are not in such a great place to feel worse about your apparent lack of recovery; I'm aware that's how some of you may think. Perhaps you, too, have come a long way on your journey toward recovery, in ways you rarely stop to acknowledge. (SHOUT OUT: identify what you have done well with today!)

Rather, I write because of what could have happened to Leah. And about what usually happens, to those with Binge Eating Disorder and other eating disorders. So please read on!

"I hope you are doing well and a Happy Belated Birthday!  I just read your latest blog post and it made me quite happy and blessed for our time together.I am happy and proud to say that I am doing great and haven't used food to deal with my emotions.  I am still in therapy and it is a big help but I have really come to the other side with my eating disorder.  I have my moments here and there but ultimately I consider my self in recovery.  I completely think a different way about food and to me that is huge.  I have an amazing relationship with food again and for that I thank you and all of your help.  It was just a year ago - March 18, 2013 that we had our first Skype session and I was in a pretty dark place and didn't know how I was going to get through it all....and then you came into my life.

To build on what Dana wrote....thank you thank you thank you for having the confidence in me when I didn't and for being there as a guide to help me get to this amazing place in my life that I can now say I am truly thankful and happy to live. Thank you!!"

I'm driven to post after an ICED (International Conference on Eating Disorders) session about the lack of treatment for eating disorders, particularly binge eating disorder and EDNOS—Eating Disorders Not Otherwise Specified (now renamed OSFED for Other Specific Feeding or Eating Disorder)—that catch all disorders not meeting the criteria for bulimia, anorexia, and binge eating disorder.

Anorexia and to a lesser extent, bulimia, are more likely to be treated—although admittedly so many more aren't in treatment and need to be. And truly, treatment is typically not long enough or intense enough or multi-faceted enough—my thoughts, not the presenter’s.

But I write about these other conditions, these seemingly lessor eating disorders because their impact is so great; of those with eating disorders, approximately 60% of women and 83% of men have BED/EDNOS combined. And while the need for hospitalization or risk of sudden death might be lower, the impact on quality of life, mood, self-esteem, body image, control over eating is tremendous. And let's not forget GI distress, heartburn, constipation, fatigue, high cholesterol, blood sugar management issues—I could go on.

You? Living with an eating disorder?

No, it's not about size!

Sufferers are rarely identified nor have their eating behaviors addressed, contributing to minimizing their own struggle. I mean, if your doctor doesn't ask the questions why would you volunteer about your struggle? More likely, attention is paid to your BMI or 'weight issue' instead. If your loved ones don't sense your struggle with food, but rather just see your weight as a concern, maybe you're the one with the distortion. If you look good and your weight is more or less fine, what's the big deal? They have no idea how you struggle. And if everyone around you is focused in how fat their thighs are or how much weight they're gaining, then you’re certainly not the one needing treatment, right?

Wrong.

Back to Leah. I received her note coincidently while at the ICED conference, and invited her to stop by, as we had never met in person. She would have surely agreed to meet for lunch—as she had come a long way from relying on froyo as lunch/dinner—but time was tight for me, so chai lattes would have to do. And our meeting got me thinking about her history. She long struggled with dieting and food rules, consuming way too much of her mental energy.  That was the norm in both her family and in her peer group.

But Leah knew that this was no way to live.

As she recalls it, it took a tweet of mine that she came across, which lead her to my blog, and then my website and then my book, food to eat, to move her from knowing to doing, to taking action on making her life around food better. We skyped, and I encouraged therapy as well. And as you can see by her note, she did it.

But what if she didn't stumble upon that tweet? Would she, or you, or your friends take the step and initiate change, to move from being ruled by food? Apparently not. The stigma and shame around binge eating and EDNOS is great,as described by Stephanie Bauer, PhD, a researcher in Heidelberg, Germany, making the barrier to change hard to get over. And I learned in a session by Federico Girosi, PhD, from the University of Western Sydney, Australia, that it's hard for those with eating disorders to consider the long term consequences of their disorder, when the short term risk of seeking treatment seems great.

I'm doing my small part. You can do yours too!

Let me tell you, you are not alone. More of you struggle with binge eating disorder and other eating disorders that don't meet the criteria for anorexia or bulimia but which need to be treated!!! You are no less deserving of being freed from the burden of your disease as the person living with cancer.

Please speak up. Halt the fat talk that you hear in your home and with your friends. Start living now, regardless of your size. Ask yourself if the cost of treatment--your fear of what you might hear and how you might feel--is really greater than the cost of not seeking treatment. Do you want to live your whole life concerned about food labels and the calories you consume? Do you want to spend time at meals preoccupied with food and it's nutritional value, rather than enjoying the company of your loved ones? And do you want to carry this sentiment to your children as well? For Leah, that might've been just the tipping point she need, as she was approaching age 30. It felt like enough was enough.

Yet there was no action until perhaps she felt like somebody got it, that she'd be understood, that the risk of shame and stigma might be lower seeking help from someone whose messages she was already comfortable with.

Or in a blog?

Please share this with your friends, whether they have an eating disorder or not. If they start a conversation about dieting or body image, turn it on it's head. share the messages you're reading here and challenge them to have a better life. Check out our new book drop the diet: guided recipes for overcoming your food rules, a modified version of food to eat, rewritten with chronic dieters and binge eaters in mind—coming VERY soon!

Work on giving yourself permission to eat, and enjoying food, all foods, regardless of their fat or carb content. And seek out the services of providers who specialize in eating disorders to help guide you along the way.

Really it's not too late.

Please share on FB, Twitter, Pinterest, email or in conversation with your community! Thanks for reading. More to come from the ICED conference soon!

Half full? What perspective has to do with recovery

It took me years to grasp this not-so-deep expression.  Rather than focusing on the full vs. empty, I'd get stuck with the half part. So while viewing a cup as half empty suggests looking at what's missing, and seeing it as half full connotes a positive outlook, I simply couldn't see it. The half empty description seemed rather positive to me. I mean, at least it's only 1/2 missing! I'm not sure I ever really contemplated half full—as in "it's just not good enough".

Take a look at the image to the right. What do you see?

And when you look at your body? 

Do you focus on all that's good about it, or get fixated on those parts that disgust you?

When you reflect on your eating yesterday do you highlight where you slipped, or acknowledge what was in place?

When you consider how you've eaten over the past week, do you recognize your mindfulness or your balance? Or can’t you get past where your eating, activity or behaviors were less than stellar?

Oh, and about that image above—did you note the black dot, a blemish of sorts? Or did you notice the full screen of white, of possibility?

Gratitude

Why would you take care of a body you despise—one you view as too fat, or weak, or unattractive? Why adequately nourish it, lovingly stretch it, gently exercise it? And why would you keep pushing for change if you can not appreciate the benefits of your efforts?

What if you woke up every morning with appreciation that you were still breathing, that you had the gift of another day? And what if you noted that, beyond the aches and pains, most systems functioned quite well? I know, I know—this may not be the case for some of you. Persistent tinnitus (that high-pitched ringing in your ears), chronic hip pain, or knee or backaches, problems digesting or sleeping—these are nothing to be thankful for.

A patient of mine just told me about a buddy of his who's an avid hiker. He climbed all 48 4,000 footers in New Hampshire—an impressive feat, I'll tell you, as someone who knows those trails well; they're steep, rugged, filled with loose rock. It's certainly motivating, though, when rewarded with the stunning panoramas when we hit the peaks.

The only thing is, that successful hiker? He's blind, and hikes with a guide dog. Somehow I suspect he doesn't wake up and dwell on his lack of vision.

I really don't know. I am quite fortunate to have a body which functions at 100%, at least for now.

Do we need to experience the threat of loss of function to appreciate that our body works? Must we starve, or fast, to appreciate food? Can't we appreciate the power we have to change our reality, to shift our perspective?

Shift your thoughts

• Perhaps you purged this week, but only once or twice—per week, that is, versus per day.
• Perhaps you exercised, a goal you set for yourself, for 10-15 minutes per session—less than you intended, but more than you had managed to do in the recent months.
• Perhaps you overate, but stopped yourself much sooner than you usually do, preventing an all out binge.
• Perhaps you ate cookies, or cupcakes, but in reasonable portions, and perhaps you allowed yourself to finally taste them and thoroughly enjoy them. Imagine that!
• Perhaps you are beginning to give yourself credit for some positive actions you are taking—just not all the time. 
• Perhaps you can begin by identifying 2-3 positives each day, while getting ready for bed or when getting dressed in the morning.

Your intake, activity, or behaviors may be far from perfect, but perhaps you’re still moving forward. The work may not be done.

Maybe things aren’t so great. But have you lost the ability to create a positive shift, to see the white space?

Perhaps, it’s only half empty.

My gratitude to Rabbi Leslie Gordon and Rabbi Barry Starr for their recent words which inspired this post.

Consider these other posts on this topic:

http://dropitandeat.blogspot.com/2011/06/30-chance-of-rain-70-chance-of-recovery.html

http://dropitandeat.blogspot.com/2011/10/setting-record-straight-shifting-your.html

http://dropitandeat.blogspot.com/2012/01/saying-goodbye-to-your-jeansa-new.html

http://dropitandeat.blogspot.com/2011/07/losing-part-of-your-body-gaining-vision.html