Making the decision to have bariatric surgery was one of…
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 . 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 .”
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.