Extreme Weight Loss Drops Metabolism - Long Term?
KnitOrMiss
Posts: 10,103 Member
http://www.nytimes.com/2016/05/02/health/biggest-loser-weight-loss.html
I just read this article, and the long term reduced metabolisms are terrifying. It makes me wonder if my dropping 50 pounds in 3 months (at least 90% of the weight loss was in 3 months, though I officially measured it as 6 months due to weigh ins) stalled about my metabolism's burn that much, as I keep having the repeat creep trying to get me back to 300+ pounds, despite the fact that that weight loss was back in 2012. I've maintained my losses within a range for these last almost 4 years, and if I let even the tiniest thing slide, I'm back on the gain scale again.
As long as I'm sticking strictly with plan, the calories don't seem to matter as much, but they do still matter. How frustrating! Is there any way that anyone knows of to defeat this? Proactively preferably? Because I sure don't want to get anywhere close to a healthy weight and have to fight harder to maintain my losses than I did to lose them in the first place. That's sure a way to trigger insanity!
I just read this article, and the long term reduced metabolisms are terrifying. It makes me wonder if my dropping 50 pounds in 3 months (at least 90% of the weight loss was in 3 months, though I officially measured it as 6 months due to weigh ins) stalled about my metabolism's burn that much, as I keep having the repeat creep trying to get me back to 300+ pounds, despite the fact that that weight loss was back in 2012. I've maintained my losses within a range for these last almost 4 years, and if I let even the tiniest thing slide, I'm back on the gain scale again.
As long as I'm sticking strictly with plan, the calories don't seem to matter as much, but they do still matter. How frustrating! Is there any way that anyone knows of to defeat this? Proactively preferably? Because I sure don't want to get anywhere close to a healthy weight and have to fight harder to maintain my losses than I did to lose them in the first place. That's sure a way to trigger insanity!
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I just read this too! The authors talk a lot about leptin and how important it is in feeling satiated. I wonder if there is a way to increase leptin levels and thereby decrease hunger? Although for myself the best way to naturally decrease cravings is to adhere to keto and not allow any carb creep.3
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Sadly, I haven't found one go to thing that decreases my hunger. Some days I'm naturally less hungry, other days cravings take over my brain. I know that I really need to get my gut biome tested, but it's so far down the road... Then add messes like this to the mix, and it's one of those things where I honestly just don't see how we can fight biology without being properly equipped.2
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I just read that. It's scary! My weight loss/gain has all been within a 30-lb range (20-lb for much of my adult life) and even that has been difficult. I have been discouraged by how much yoyoing I've done. i have maintained my lower weight for 1-2 or maybe 3 years at a time but then for various reasons I end up gaining again.
I had prediabetes when I was 10 lbs from the top of that range though, even though I actually did exercise and eat a relatively healthy diet then (compared to the SAD). My dad and his mom were both thin diabetics and I have their build (tall, long-limbed, small bone structure but disproportionately big belly). I feel like my body does better/I feel healthier at the bottom of this range but I did start to wonder as my weight loss slowed to a halt even at 1350 cals/day if my metabolism was really slowing down, too. I have a feeling maintenance for me now might be only about 1500-1600 cals/day, even at 5'7".0 -
This is why I've been hanging out here during maintenance. I always assumed I'd be fighting the fight described in the article.
After 9 months or so, all I can say is "no problem!"
Yes, every depleted fat cell means less leptin. There's no way around that.
But my discovery is that it's ALL about appetite regulation. Low carb helps keep my appetite in check, even during maintenance.
It's still an open question on how that works and how long it works. It may have a lot to do with "whole food" rather than "low carb" per se.11 -
I think the real issue (DISCLAIMER - didnt read the article at all) is that "fast" weight loss is usually largely muscle loss. Muscle is extremely influential on your BMR. If you protect your muscle while losing (i.e. eat enough protein, do some weight bearing type exercises to engage your muscles), you can minimize the impact.
For example, I went from 190 to 140 with no exercise over less than 6 months (WLS). My arms and shoulders looked anorexic, but my midsection was still very much overweight - I lost a lot of muscle. All my hard to burn fat was around my trunk area. And I looked like I melted - Muscle gives your body its shape. I was the definition of "skinny fat" and I looked pretty bad. I looked EXACTLY the same as I did at 190 just a smaller version of my fat self. My shape was almost identical or possibly worse than when heavy.
At that time, a bout of depression sent me to bed for most of 4 months (i.e. sitting at work all day, straight to bed when I got home). I was eating about 1500-1600 calories at a day at that point. I gained almost exactly one pound every week during that 4 months for a total of 20 pounds. So I was eating 500 calories a day over my maintenance! My BMR must have been 1000, and since i didnt get out of bed I was definitely sedentary.
Then I started weight training. Heavy weights. Deadlifts, etc. I loved it. I quickly lost 30 pounds and totally reshaped my body over the following year or two. I still have some trunk fat, but my arms are curvy and I have a butt again (I guess it didnt occur to me that your butt is a muscle)! BUt was is even more awesome - I weight train for 45 minutes twice a week, and do 10k steps a day most days, and a little hikes here and there... and I maintain on about 2400 calories. If I sit on my butt all day, I can still eat 1800 calories or more and not gain. As long as I keep up the muscle!
So that is my theory on why fast loss is a problem - its not the speed, its the muscle loss that leads to a lower metabolism in general. A 150 pound woman with 20% body fat can eat more than a 150 pound woman with 30% body fat, all else being equal. Muscle increases your BMR. And you dont have to do the really heavy lifting to get there - just progressive body weight will go a long way. "Use it or lose it" is very, very true with muscles.6 -
Muscle loss is definitely part of it. The way I addressed the maintenance issue was to look at SUCCESSFUL long-term maintainers. Ignore the ones who regain.
90% of successful long-term maintainers exercise a LOT. The average was an hour a day.
http://www.nwcr.ws/research/
That will help maintain/increase muscle mass, which not only helps with BMR, but muscle is also a major glucose sink, so it'll help with BG control.6 -
Very interesting. Thanks for sharing!
“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.”
We don't need "agents" (ie new drugs), we need scientists to understand how the human body works and doctors to stop giving advice that is doomed to fail.
::flowerforyou::6 -
BTW, it looks like the study was just published today:
http://onlinelibrary.wiley.com/doi/10.1002/oby.21538/full
The participants rapidly lost massive amounts of weight, primarily from body fat mass (FM) with relative preservation of fat-free mass (FFM), likely due to the intensive exercise training. RMR was substantially reduced at the end of the competition, indicating a large degree of metabolic adaptation.
So much for that theory.
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I read this article too. It is getting a lot of press as it about the Biggest Loser. However, it was a really small sample size.
Nonetheless, this has been shown quite a bit in previous studies - not to mention that maintaining weight loss has a really really low success rate.
I have also seen people noting that reduction in metabolism is likely unique to a program like Biggest Loser with the intense and rapid weight loss.
However, do we know that metabolism is less affected when weight loss is slow? The Lancet study below (large, randomized controlled experiment), found no difference in success of maintaining weight loss with fast or slow programs. Subjects in both treatments tended to regain all of the weight. They didn't measure metabolism though. It will be interesting to learn more about the mechanisms underlying the decline and continued low level of metabolism.
Purcell et. al. 2014. The effect of rate of weight loss on long-term weight management: a randomised controlled trial. The Lancet1 -
Also, the final few paragraphs of the research article featured in the NYT are interesting. They note that while there was a lot of weight regained in the Biggest Loser contestants. They still did better than subjects in most other weight loss programs. They even cite a study that found faster initial weight loss led to greater success in weight maintenance.1
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anthophora wrote: »it was a really small sample size.
16 subjects. All of them regained weight. 11 had a decrease in RMR even after weight gain. 5 of them had an increase in RMR, suggesting the weight gain was appetite driven rather than a metabolic adaptation.
Pretty clear most of them were high carb during the regain. Big increase in insulin, insulin resistance, and blood glucose.
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I think we can all agree that the methodology used on those reality shows are not what we do! See the quote below. They took 'extreme' to a new level. I firmly believe the food choices we eat matters most, and how we care for ourselves via exercise. The method these guys used was not even close to a sustainable plan! There was no way they could keep up with the program, even though their bodies adapted to the extreme levels.
Years ago I dropped 140 pounds quickly via a gastric bypass surgery. Presto! Weight gone. But I learned nothing. I created no new habits. I didn't know anything about nutrition. My exercise was good, I worked out on weekends (hiking with the hubby mostly) but not much during the week. Sure, I ate less quantity of crappy foods, but I never gave up processed or refined foods for example. And as soon as I could eat more, I did. BECAUSE my body craved it, and the surgery is only a short term fix and it never was meant to solve the full scope of issues. Once I could I ate all day long, just in smaller meals. I was always hungry, even with a stomach the size of an egg. I always had food on me to fix blood sugar swings. Mentally, I would panic if I thought I would be in a situation where I couldn't eat for even 4 hours. I did keep up my weekend exercising though, hubby and I did a lot of hiking on the weekends, which I think helped a lot. So it took 13 years, but I gained back 100 pounds. I would say 40 of those pounds came on the last 3 years, after I gave up hiking on the weekends and become more sedentary. Now I am focusing on not repeating the mistakes I made. I focus on the food quality and not just the food quantity, and I have dropped nearly 75 pounds in 7 months. I eat 1400-1800 calories per day on average, some days more. I don't panic over not having food around anymore. I walk/exercise daily now, but don't push myself crazy. Just walk. 30-90 minutes per day, just to move. DAILY. I also started hiking again on the weekend, ride bikes occasionally, but my exercise is focused on walking every day. This is a sustainable plan, something I could stick with. I don't push myself into extreme measures, because that is not sustainable. Time will tell, but I have no doubt this is the best 'diet' plan I have ever been on in my life.Before the show began, the contestants underwent medical tests to be sure they could endure the rigorous schedule that lay ahead. And rigorous it was. Sequestered on the “Biggest Loser” ranch with the other contestants, Mr. Cahill exercised seven hours a day, burning 8,000 to 9,000 calories according to a calorie tracker the show gave him. He took electrolyte tablets to help replace the salts he lost through sweating, consuming many fewer calories than before.
Eventually, he and the others were sent home for four months to try to keep losing weight on their own.
Mr. Cahill set a goal of a 3,500-caloric deficit per day. The idea was to lose a pound a day. He quit his job as a land surveyor to do it.
His routine went like this: Wake up at 5 a.m. and run on a treadmill for 45 minutes. Have breakfast — typically one egg and two egg whites, half a grapefruit and a piece of sprouted grain toast. Run on the treadmill for another 45 minutes. Rest for 40 minutes; bike ride nine miles to a gym. Work out for two and a half hours. Shower, ride home, eat lunch — typically a grilled skinless chicken breast, a cup of broccoli and 10 spears of asparagus. Rest for an hour. Drive to the gym for another round of exercise.
If he had not burned enough calories to hit his goal, he went back to the gym after dinner to work out some more. At times, he found himself running around his neighborhood in the dark until his calorie-burn indicator reset to zero at midnight.7 -
The problem with biggest loser is the goal was to lose. There was no specification of what they needed to lose other than scale weight. So they worked them to their limits constantly and fed them as little as they could get away with. Sure, that forced weight loss. But a good portion of that was muscle. There will never be any benefit in that! There was never any consideration to their long term. They only needed to prove that these fat people simply needed to eat less and move more and they made that exact point to millions of people every year who try to do the same thing on their own, sacrificing their own metabolic health in the process thinking they are doing the right thing.2
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BTW, it looks like the study was just published today:
http://onlinelibrary.wiley.com/doi/10.1002/oby.21538/full
The participants rapidly lost massive amounts of weight, primarily from body fat mass (FM) with relative preservation of fat-free mass (FFM), likely due to the intensive exercise training. RMR was substantially reduced at the end of the competition, indicating a large degree of metabolic adaptation.
So much for that theory.
I wondered about that since they usually exercise so much. Makes sense. So preserving muscle is helpful but not enough by itself.
I am really hoping I will be able to maintain long-term this time (even though my amount of weight lost was far less dramatic; it was about 15% of my body weight) and that eating lower carb will help with the satiety problem. The idea that you have to stay hungry all the time, forever, to maintain is very depressing.1 -
How would Fung's idea that those fasting do not experince a slowed metabolism fit into this? Total bunk?3
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anthophora wrote: »it was a really small sample size.
16 subjects. All of them regained weight. 11 had a decrease in RMR even after weight gain. 5 of them had an increase in RMR, suggesting the weight gain was appetite driven rather than a metabolic adaptation.
Pretty clear most of them were high carb during the regain. Big increase in insulin, insulin resistance, and blood glucose.
I will have to think about this more. I think it is likely that factors other than RMR are involved.
However, I didn't see where in the paper 5 people had an increase in RMR (although I didn't read the paper all that closely). Figure 4 shows that RMR increased for 5 subjects from 30 weeks to 6 years but all were below baseline (all negative numbers on the Y axis). Also, interestingly, they note that the greatest declines in RMR were associated with those subjects that experienced the greatest weight loss. Nonetheless, I agree there is a lot to this story and look forward to seeing what comes out in the future.
I think the relevant issue here is not whether they did or did not regain weight but the degree of weight loss (1 subject did actually keep off weight). Biggest Loser contestants actually did quite well compared to other diet programs.0 -
There are also lots of studies about excessive cardio not being a great idea. But, building muscle-- good idea. Exercising (mostly cardio) for 6 hours a day, not such a good idea. Also, their main food choices were advertised as subway sandwiches. That can't be good for anyone either! LOL.
Plasma leptin levels of elite endurance runners after heavy endurance training.
J Physiol Anthropol Appl Human Sci. 2005 Nov;24(6):573-8.
http://www.ncbi.nlm.nih.gov/pubmed/16377941
People who performed intense cardio suffered from decreased T3 hormone production.
Eur J Appl Physiol. 2003 Jan; 88(4-5):480-4.
http://www.ncbi.nlm.nih.gov/pubmed/12527982
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I was actually not intending to focus on the mechanisms of the program BL follows, but more so on folks who lose quickly or consistently, etc.
Personally, in January 2012, I weighed 298. But that June, I was down to 250. In mid-March I'd shown no measurable losses, but I didn't formally weigh in either. So roughly 5-6 months for 50 pounds lost. I'm sure at least some of that was muscle, though I was far more physically active in those months than I had been in years...
After that, over the next 2 years, I mostly maintained, but hit a slow gain, was back up to 272 in February of 2014. Got down to the 250's again, before regaining over the holidays and starting low carb on 1/15/15 at 262 pounds or so... I got down to 239 by the end of March, hit a wall - presumably at least in part due to workout intensely outdoors with limited water and such for a 4 day period. I have never gotten back to that number, maintaining the rest of 2015 in the 250's, while losing some inches, before going off plan at the holidays and getting back up to 265 or so.
Rebooted mid-January again, and have had a few off plan meals here or there, have slimmed up some inches, dropped back down to the 255 range again. It's just so frustrating. For months at a time, I followed the exact same plan, same carb spread, same foods, same activity levels that I did when I was losing slowly but steadily. And next to nothing doing. We're now to May, and I'm down maybe 5 total pounds in 3.5 months, and back into the next pants size, though not fully...
Then I get into a frustration loop of not seeing real progress for 4-8 weeks, then wanting to face-plant into everything off plan to east the frustration, and end up creating a self-fulfilling prophecy... SIGH I don't have the willpower I need, losing 3 additional hours out of each work day (more sleep, commute) has just left me feeling optionless. I'm trying to figure out my options, my failings, etc., because all of this is just getting old. "Just do it..." has never in my life worked...and usually creates the opposite result of what's intended.0 -
slimzandra wrote: »There are also lots of studies about excessive cardio not being a great idea. But, building muscle-- good idea. Exercising (mostly cardio) for 6 hours a day, not such a good idea. Also, their main food choices were advertised as subway sandwiches. That can't be good for anyone either! LOL.
Agree. However, it doesn't seem as if Biggest Loser is any worse for weight regain than other diet programs. Will be good to see whether low carb diets help maintain weight loss as I don't think LCHF has been tested in this context.0 -
does it say how they measured their current metabolic rate? I can understand that while on the show they would've been highly supervised and tested continually, but how are they checking that now? I admit I didn't read the study but read most of the article. it felt like it skewed toward sounding like they were making excuses for the contestants that regained as if it had nothing to do with the highly unsustainable low calorie, high calorie burn diet they were on, and are no longer following.
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auntstephie321 wrote: »does it say how they measured their current metabolic rate? I can understand that while on the show they would've been highly supervised and tested continually, but how are they checking that now? I admit I didn't read the study but read most of the article. it felt like it skewed toward sounding like they were making excuses for the contestants that regained as if it had nothing to do with the highly unsustainable low calorie, high calorie burn diet they were on, and are no longer following.
They retested at the same center they used while on the show.0 -
auntstephie321 wrote: »it felt like it skewed toward sounding like they were making excuses for the contestants that regained as if it had nothing to do with the highly unsustainable low calorie, high calorie burn diet they were on, and are no longer following.
It could be making excuses but this issue of weight regain is what happens to most everyone who does any diet program. The paper below that highlights the National Weight Control Registry finds that only ~20% of subjects maintain a 10% weight loss after 5 years. Keeping weight off is more than simple will power.
Wing and Phelan. 2005. Long-term weight loss maintenance. Am J Clin Nutr.1 -
Muscle loss is definitely part of it. The way I addressed the maintenance issue was to look at SUCCESSFUL long-term maintainers. Ignore the ones who regain.
90% of successful long-term maintainers exercise a LOT. The average was an hour a day.
http://www.nwcr.ws/research/
That will help maintain/increase muscle mass, which not only helps with BMR, but muscle is also a major glucose sink, so it'll help with BG control.
Extreme exercise is the only thing that has ever allowed me to maintain my large losses. Every time life has gotten in the way of my exercise, all of the weight has come back, and then some. I know now that if I want to lose weight permanently, exercise is not optional. I'm not exercising much now, but I still have a long way to go before I'm anywhere near maintenance and I am currently losing sufficiently. I'm slowly incorporating more fitness into my life, but the more I lose, the more focused I will become on the exercise side of things.
At 19 I lost 50 lbs (220 to 170) and kept it off by walking 2 hours a day. 2 years after the loss, when I started working 3 jobs and stopped walking, I gained it all back and then some (a lot more).
At 24, I was laid off from work and I walked the hills of San Francisco all day, every day for 3 months, literally from one side of the city to the next and lost 80 lbs (280 to 200). For the next 2 years, I exercised my *kitten* off for 10-15 hours a week at the gym and I maintained my loss, though I never lost any more.
At 28 I was diagnosed with cerebral venous thrombosis, the entire venous system of my brain was filled with clots. It took me 2 years to fully heal from that and I no longer had the strength or energy to workout anymore, I made it up to 300 lbs. I was diagnosed as a diabetic at that time and when I was eventually put on insulin, I made it all the way up to 380. I managed to lose 30lbs quickly, but I've spent the last 8 years bouncing between 325 and 350.
So I'm on my third big weight loss journey now, my dream is to get to 140-150, but I'd be very happy to be 180 and fit. I've gone from 340 to 280 since 11th December. My weight stalled a lot in April, but I know stress affects me a lot, hormones suck. I'm back on track now with a goal of at least 100 lbs more.
I know many people here have said that they can eat a lot of calories as long as they keep it LCHF, not me. But then when you look at my history in reflection of the article shared, it may make a little more sense. Like all of those people on Biggest Loser, as soon as I'm no longer exercising at those weight loss levels, all of the weight has come back on. I've always just attributed it to exercise fueling my metabolism and when I stop exercising, my metabolism implodes, but it sounds like there may be more to it.
I'm hopeful (because I have to be, I'm not going to give up on myself again) that with the new tools in my belt now - some behavioral changes, the benefits of low carb appetite suppression and the fact that I can nearly control my diabetes solely with diet - that this time I'll be able to maintain long-term. Being a little older and wiser, I'm prepared to fight for enough time in my life to exercise, no matter what my employer expects of me. And I finally have my husband on my side and he's been such an amazing cheerleader and he's so excited to see me happy and feeling hopeful again.
It's not new news that most dieters regain and many regain more than they lost. We've seen countless studies and articles that attest to that over the years. The whole metabolism issue addressed in this article is certainly disheartening, but to me, knowledge is power. The more I understand my body, the better I can fight for for it.5 -
anthophora wrote: »Figure 4 shows that RMR increased for 5 subjects from 30 weeks to 6 years but all were below baseline (all negative numbers on the Y axis).
Well, 30 weeks is how long they were losing weight. You'd expect a reduction in RMR with weight loss. You wouldn't expect it with a weight regain.
So 11 of the 16 clearly had a "broken" metabolism. That is something to fear.
But 5 of them, almost 1/3 had a pretty normal response -- RMR went up with increased weight, suggesting that it wasn't a "metabolic adaptation" that was driving the gain.
I view that as not-so-bad news. If 95% regain weight, we have 5% to help guide us.
This study suggests that 68% or so may be doomed, but maybe 32% of us have a path forward. That's better than 5%. 3 -
anthophora wrote: »auntstephie321 wrote: »it felt like it skewed toward sounding like they were making excuses for the contestants that regained as if it had nothing to do with the highly unsustainable low calorie, high calorie burn diet they were on, and are no longer following.
It could be making excuses but this issue of weight regain is what happens to most everyone who does any diet program. The paper below that highlights the National Weight Control Registry finds that only ~20% of subjects maintain a 10% weight loss after 5 years. Keeping weight off is more than simple will power.
Wing and Phelan. 2005. Long-term weight loss maintenance. Am J Clin Nutr.
oh I know I'm very familiar with weight regain, I just know that my regain had everything to do with no longer tracking my food intake and freely munching on whatever I wanted and less to do with any supposed metabolic rate reduction. I'm not saying that their metabolic rate didn't change, I just think there are a lot more factors at play than just that, and the article seems to want to steer people towards worrying about not being able to have any control over whether they regain or not1 -
PaleoInScotland wrote: »
At 24, I was laid off from work and I walked the hills of San Francisco all day, every day for 3 months, literally from one side of the city to the next and lost 80 lbs (280 to 200). For the next 2 years, I exercised my *kitten* off for 10-15 hours a week at the gym and I maintained my loss, though I never lost any more.Muscle loss is definitely part of it. The way I addressed the maintenance issue was to look at SUCCESSFUL long-term maintainers. Ignore the ones who regain.
90% of successful long-term maintainers exercise a LOT. The average was an hour a day.
http://www.nwcr.ws/research/
That will help maintain/increase muscle mass, which not only helps with BMR, but muscle is also a major glucose sink, so it'll help with BG control.
lol that may be a little tmi
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auntstephie321 wrote: »PaleoInScotland wrote: »
At 24, I was laid off from work and I walked the hills of San Francisco all day, every day for 3 months, literally from one side of the city to the next and lost 80 lbs (280 to 200). For the next 2 years, I exercised my *kitten* off for 10-15 hours a week at the gym and I maintained my loss, though I never lost any more.Muscle loss is definitely part of it. The way I addressed the maintenance issue was to look at SUCCESSFUL long-term maintainers. Ignore the ones who regain.
90% of successful long-term maintainers exercise a LOT. The average was an hour a day.
http://www.nwcr.ws/research/
That will help maintain/increase muscle mass, which not only helps with BMR, but muscle is also a major glucose sink, so it'll help with BG control.
lol that may be a little tmi
OMG MFP's censor just made that sound really bad!! That was supposed to be a s s not the replacement word MFP used. I kept seeing *kitten* in people's threads and though it was just some new internet thing people were intentionally doing to self-censor. Geez, I didn't think the three letter word for your behind was a bad word
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Well, 30 weeks is how long they were losing weight. You'd expect a reduction in RMR with weight loss. You wouldn't expect it with a weight regain.
Again, what is so interesting to me is that NONE of the contestants were back at their basal RMR after 6 years. That is astonishing. Also, Fig 5C is a bit scary.But 5 of them, almost 1/3 had a pretty normal response -- RMR went up with increased weight, suggesting that it wasn't a "metabolic adaptation" that was driving the gain.
Sure but we have no idea as to which subjects these were and the degree of weight loss (at least I didn't see it in the paper). It would have been nice if they provided the data. I could probably get it from Figure 5 but I should get back to my real job...I view that as not-so-bad news. If 95% regain weight, we have 5% to help guide us.
I agree with this and I like the approach as each of us has only body to test this. However, we can't ignore the ones who fail. In general, we have to have a control group to see what is actually working and what behaviors are leading to weight control.0 -
auntstephie321 wrote: »I'm not saying that their metabolic rate didn't change, I just think there are a lot more factors at play than just that, and the article seems to want to steer people towards worrying about not being able to have any control over whether they regain or not
Agree. I do hope researchers and nutritionists see this as a major major issue in weight loss programs. In fact, I think it may be the biggest. We need better tools and strategies for this if we want to deal with the obesity epidemic.
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One really does have to wonder if the speed and aggressiveness of the weight loss factors in.
As well as the psychological factors.0
