New research showing long term metabolic changes in The Biggest Loser participants which are not observed after gastric bypass

I read a few articles online last week about participants from the TV show The Biggest Loser and how most of them had put all of the weight back on six years after the show. Some academic research had been done with the shows participants and I followed the links through to the article that has been published in the journal Obesity Biology and Integrated Physiology and had a good read, you can find it here.

I think bariatric patients in particular have probably travelled the road of weight loss and regain more times than you can count. I’ve always been good at losing weight. If I restricted food and upped physical activity, sure I’d lose weight but I could never maintain it. It caught my attention because for a lot of us regaining weight we have lost can bring feelings of embarassment and shame and of course that’s the part of the story the media were blowing up.

They set out to measure the resting metabolic rate (RMR) and changes in body composition in The Biggest Loser participants. It has been acknowledged for a while now that weight loss suppresses your RMR and in turn by your metabolism slowing down it’s going to be harder to maintain that weight loss. Your body thinks it may be starving so it gets more efficient at using calories and needs less to run on each day.

They found that at the end of The Biggest Loser the participants RMR’s were greatly reduced confirming their hypothesis that there was a large degree of metabolic adaptation happening in response to the large amount of weight the participants had lost. They thought that this would influence any weight regain that the participants had further down the track.

Six years later they followed with up 14 of the original 16 participants to see where they were at and measure their RMR rates again. After six years most of the participants had regained some of the weight that they had lost during the competition. There was literally one participant that had not regained any weight. I know first hand how devestating, embarassing and ultimately heartbreaking it is to regain weight after going through so much effort to lose such a large amount of weight.

So, at the end of the competition their RMR rates were greatly reduced and this was expected because of the fact they had just lost a large amount of weight and had been on calorie restricted diets for a period of time. Even though most of the participants had regained weight after the competition the researchers found that their RMR rates were still reduced and weren’t statistically any different to what they were at the end of the competition.

Interestingly, they found that the metabolic adaptation that was measured at the end of the competition was not significantly related to the amount of weight any of the participants regained. One of the initial hypothesis of the researchers was that this would be related. Instead they found that metabolic adaptation was significantly related to weight regain and the percentage of weight change that happened during the competition. To add insult to injury the ones who maintained a greater amount of weight loss at the six year point had a greater degree of metabolic slowing.

In laymans terms what that means is the more weight you lose and the longer you manage to maintain a smaller weight, the more your body slows your metabolism to conserve energy expenditure making it continually harder for you to maintain a smaller weight. I have to be completely honest and say this has to be one of the most depressing things I have ever read in my entire life. I always suspected there was more at play than just me falling off the wagon or not having any self control. My eating habits actually were not that bad and the continous upward spiral of my weight seemed to be out of my direct control.

What really got my interest though was this paragraph:

The magnitude of metabolic adaptation increased 6 years after “The Biggest Loser” competition. This was surprising given the relative stability of body weight before the follow-up measurements compared with the substantial negative energy balance at the end of the competition which is known to further suppress RMR [15, 16]. In contrast, a matched group of Roux-en-Y gastric bypass surgery patients who experienced significant metabolic adaptation 6 months after the surgery had no detectable metabolic adaptation after 1 year despite continued weight loss [17]. It is intriguing to speculate that the lack of long-term metabolic adaptation following bariatric surgery may reflect a permanent resetting of the body weight set-point [18].”

A similar thing happens at the six month point after gastric bypass surgery. This makes sense because you are so calorie deficient for a while after surgery that really, what else would you expect. But, and this was music to my ears, One year after gastric bypass surgery there is no detectable metabolic adaptation. Hang on wait, so by having gastric bypass surgery did I just jump this hoop? This finding is really exciting and I hope that it’s more evidence to prove that gastric bypass is one of the most effective ways to treat obesity.

The point they make referencing the fact that the body may reset it’s weight set-point really got my attention and I’m going to try and find more research specifically about this point. They also pointed out that it has been hypothesised in the past that rapid weight loss was thought to increase the risk of weight regain but they didn’t find this to be true in this study. The last sentence of the discussion really highlights the findings they have made,

Therefore, long-term weight loss requires vigilant combat against persistent metabolic adaptation that acts to proportionally counter ongoing efforts to reduce body weight.”

Basically losing the weight, if you can, is the easy part. When you get to the stage of trying to maintain a lower weight your body fights you at every turn. This effect isn’t observed with gastric bypass patients though. I have never been more convinced that I made the right decision for myself in choosing to have gastric bypass surgery. I knew when I decided to have my bypass there were things that gastric bypass did physiologically that doctors couldn’t explain. They were a bit stumped not knowing exactly why it’s so effective long term but it’s research like this that are helping them piece the puzzle together.

If you got this far in my post I really encourage you to go and read the actual journal article that I’ve talked about here. I’m sure my awesome readers are as stunned, excited and feeling as affirmed as I did after reading this so comment below and let’s chat about it, I’m so interested to hear what you think!

 

The Reference for the article I have discussed and quoted is:

Fothergill E, Guo J, Howard L, et al. Persistent metabolic adaptation 6 years after “The Biggest Loser” competition. Obesity (2016) 00, 00-00. doi:10.1002/oby.21538. This article was first published online 02 May 2016.

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There are 12 comments for this article
  1. Danii at 8:03 pm

    Wow! This is incredible! Thank you so much for sharing this article. This is one of the things I have been worried about (I am having a gastric sleeve in one week).

    • Melissa Peaks Author at 8:20 pm

      I’m so glad it was such good timing for you! It’s a really exciting find and I’m going to be interested to see more work done in this area. Good luck for the next couple of weeks, it’s the start of the rest of your life and you have an incredible journey in front of you.

  2. Teresa Yang at 5:06 am

    The further society gets away from thinking “calories in, calories out”, the better! Weight issues are so much more than calories. I’ve been doing a bit of reading the past few years on weight regulation – there are complex hormonal cascades and networks at play, beyond simple caloric balance and mechanical effects, not to mention the involvement of the enteric nervous system.

    The Biggest Loser series is awful. Really, it’s bordering on medical negligence – not just the restriction on food but the mechanical damage done with so much exercise!

    • Melissa Peaks Author at 7:30 am

      Thank you for your great comment Theresa. I couldn’t agree more about the calories in, calories out thing it drives me nuts when people say that. Also the, “I’ve never had any trouble managing my weight.”

  3. Jeremy at 5:54 am

    I have been really fascinated by this article too. I bet the press article about it didn’t mention about the metabolic rates – only the fact that the participants had regained weight.

    It really makes you think about things differently in two major ways I think:

    1. Gives you a lot more sympathy for those that are very overweight and trying to lose it without surgery and that they really both need and deserve a lot of support through this as their body is literally fighting against them.
    2. If this research were more well known (I guess it is still early stages), then it could act as more of a deterrent to future people if they realised the lasting impacts on themselves then – maybe they might make some different decisions early on.

    Anything more you find please share as this is huge and more people need to know about it.

    Thanks!

    • Melissa Peaks Author at 7:34 am

      They did mention there was a link but didn’t really say too much about the detail. I’m really glad to hear it’s changed the way you think about it, the more understanding we can gain as a society to a problem such as obesity that is only getting more and more prevalent, the better.

  4. Jeremy at 5:55 am

    Sorry spotted a mistake. Should say *without surgery not with surgery. Melissa are you able to change it please?

  5. Sarah at 9:35 pm

    Hi Melissa

    Great post …. and reassuring reading about BMI following surgery.

    I’ve just finished a great book which really does dispel the myth that obese people just lack self control. Its called Fat Science by Robyn Toomath (available on Kindle). It covers a lot of ground – from how our bodies are so well designed to manage food shortages, but no real mechanism for coping with over indulge, how eating behaviors have changed over the decades, how genetics play a part, how marketing affects our food choices etc. Basically, everything you need to know about what is contributing to the obesity epidemic, and why diets don’t work. Its all backed up with lots of research. She covers weight-loss drugs and surgery and says “Drugs mostly don’t work. These expensive operations do. But they can never be the solution to the obesity epidemic because the numbers affected are vast.”

    Worth reading if you get a chance.

    Cheers
    Sarah

    • Melissa Peaks Author at 10:24 pm

      Hi Sarah! Yes I’ve seen her book and it’s top of my list to read. I really should get it sitting in my Kindle library so that I can read it when I find the time. She has done some great work and I was glad to see she’s in support of bariatric surgery being one of the best ways to deal with it. Thanks for reading my blog, I appreciate it!

  6. emma at 3:23 pm

    Great post,
    really needed that small summary of the article since ill be doing an essay about it for a uni assignment.

    My only concern is what are the limitations of the study???

    • Melissa Peaks Author at 8:16 pm

      Hi Emma, I’m really glad you found my summary useful. I have quoted the full reference at the bottom of the post and I suggest you check it out to see the limitations of the study if you’re quoting it in a uni essay. Good luck with your assignment!

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