Extreme Weight Loss Drops Metabolism - Long Term?
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Let's put another perspective on it. How much did they regain in 6 years? Was it only slightly over 6 kg/year ? That doesn't sound like permanently reduced RMR. It sounds like unsustainable diet program in the first place and loss of muscle fiber. Did they continue the same extreme program after or did they start relapsing to old ways?
Edit: I regained about 6 kg in 6 months. I don't have any RMR to blame...I've already relost 1.5 kg. The point is, the regain they did wasn't very big spread on 6 years.0 -
Sabine_Stroehm wrote: »One really does have to wonder if the speed and aggressiveness of the weight loss factors in.
As well as the psychological factors.
I feel like it has to, that kind of loss in a year or less has got to be completely shocking to your system. the body probably feels like its recovering from a trauma.1 -
Foamroller wrote: »Let's put another perspective on it. How much did they regain in 6 years?
It seems like the BL competitors did better than most. From the paper: 57% of the BL competitors maintained at least a 10% weight loss after 6 years. While according the the National Weight Control Registry ~20% of dieters maintained at least a 10% weight loss. Yes - these are a bit of an apples and oranges comparison but it doesn't seem like BL is all that bad of a weight loss method.Foamroller wrote: »That doesn't sound like permanently reduced RMR.
All BL competitors experienced reduced RMR after 6 years.
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Table 1 is very informative.
A lot of numbers to sift through and think about. Seems to me to be a fairly big loss in BF% (~40% loss at 30 weeks). BW weight loss was also ~40%.
Edited...just saw the FM vs FFM comparison.
It looks like they didn't lose all that much fat-free mass at 30 weeks (Confidence intervals overlap although there isn't much power in a sample of 16 subjects). So the idea that they lost too much muscle doesn't seem to add up.
The big loses were in the FM (fat mass category).
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FFM = fat-free mass (mostly muscle). With weight loss (end of 30 weeks), you'd expect both FM and FFM to decline as it did. But FFM actually went WAY up as a % of body weight, so that's a Good Thing.
RQ went up a bit as they gained weight. Like I said earlier, just another sign that they're eating high-carb and burning more carbs.
The important part is the difference between predicted and measured RMR (adaptation). Kevin Hall models this stuff for a living -- the expectations come from his (pretty good) models. So the surprising finding here is that difference in RMR. That's the data that suggests these subjects have a "broken" metabolism, and it wasn't even fixed by regaining a bunch of weight.
Interestingly, TEE is pretty high -- almost back to baseline. That group stayed very active even after the show.0 -
I thought this article in NYT by Gina Kolata (who I have always found lite on nutrition/exercise science) was really lacking. There was nothing about muscle mass and weight loss, lifting weights vs. aerobic exercise, type of diets (carb heavy vs. carb lite), insulin resistence, etc. My experience with maintenance (sample size of 1) is that if I don't lift weights and exercise most days, and if I go back to eating my binge foods (sugary carby things) I will always gain the weight back. Also sugary carby things triggers my hunger.
Also fast weight loss has never worked for me (always slow is better). I think nutrition/weight loss research is very sucky. I have studied epidemiology/research design in grad school, and most "research" is pretty pathetic when it comes to weight loss.
In her book on Diet & Exercise, Gina Kolata had the same message: might as well give up because you were born to be fat. I just don't buy it. I think we may need to really work hard to find what works for us, and may need a lot of support, but it is doable for most.4 -
But fat free mass is everything in the body except fat, including skin, blood and bones. It's a misconception LBM is only muscle fiber.
Anyway. According to Wikipedia (yeah I know) the most surprising things contributes to higher BMR, including bigger bodies cause more skin demands heat control. They probably lost some skin too, during their weight loss.
https://en.m.wikipedia.org/wiki/Basal_metabolic_rate
Thx for the explanation above. Poor people. Sounds to me they kept exercising madly but couldn't outrun their diet.1 -
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.
Actually one woman - Amanda Arlauskas - lost 87 lbs and after 6 yrs is only up 14 lbs or an average of 2.3 lbs a year. I think psych factors are huge in this as well as very low fat food choices on maintenance which cause satiety issues. We all know the hunger blunting effects of a higher fat diet. They are not getting any of that. So although it is sad that they get to eat less than someone who hasn't lost all that weight it really is all about the cravings/hunger because the one fellow lost weight again with bariatric surgery which only means he cannot eat more food or he will puke. (gross simplification - I know) It doesn't mean he has less cravings, just that he can't act on them.
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In her book on Diet & Exercise, Gina Kolata had the same message: might as well give up because you were born to be fat. I just don't buy it. I think we may need to really work hard to find what works for us, and may need a lot of support, but it is doable for most.
I completely agree that as individuals we need to push through for our health and fitness!!!!
I am glad this is coming out however. Kolata isn't pushing a way to lose weight but is simply reporting what really is the evidence. This what I appreciate about science journalists.
People always have this notion that those that regain their weight did so because they were lazy or lacked will power. It is much more complex than that. Hopefully this will prompt more development and thinking about long-term health.
I hope there are more tests to actually see what works. This is tough as longitudinal studies are really difficult.
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I've posted this before:
http://www.tuitnutrition.com/2016/03/constitutional-obesity-and-resistance.html
It's basically a theory that our fat destiny is predetermined by the fat cells we grow as kids. Fat cells (almost) never die, and they're always bugging us to refill them if we deplete them.
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Kolata isn't reporting on "evidence" she is reporting on a few individuals -- and without really even giving the facts. What is their muscle mass, what is their exercise regimen, and what are they eating (carbs, sugar, one of them chips)? What kind of social/psychological support are they getting. This is not science just a typical news headline, "selling the newpaper" without really getting at the facts. And who are the controls? Those who lost weight slowly? Those who lift weights? Those who stayed away from their binge foods? Those who eat low carb? We don't even know who the "controls" could be since we don't know what this handful of people are doing. And how about the person who didn't gain much weight? What did she do differently. I think Kolata does a disservice by her "you were born that way" approach to this issue. By the way she is a tiny little thing, and thinks she was born that way (and who knows) but she has exercised fiendishly according to her news articles over the years, and eats in a very intentional way.2
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Am I the only one that actually thinks that WAS quite a lot of FFM to lose? Why is it any surprise their RMR is so low with so much FFM loss?
I must just not be reading this right because it seems like a lot to me.
I know they aren't very accurate, but my scale has shown an increase in my muscle mass even with my minuscule amount of exercise over the last year. I went from trending around 24% in June to 28% currently. With BF around 41% to about 32% now. Even knowing it's not super accurate, I think it's safe to say that I haven't made backward progress.
I mean, I realize I've lost some muscle but the percentage in relation to my current weight has improved.
I would rather see these numbers in this format myself. It makes more sense to me that way.1 -
Sunny_Bunny_ wrote: »Am I the only one that actually thinks that WAS quite a lot of FFM to lose? Why is it any surprise their RMR is so low with so much FFM loss?
FFM went from 50% at baseline to 71% at the end of the show. After 6 years, it went down to 53%.
RMR was predicted based on their particular tissue composition. It was WAY below the predicted value.
Even after regain, RMR was still in the toilet.
Pretty much the definition of "broken."0 -
Sunny_Bunny_ wrote: »Am I the only one that actually thinks that WAS quite a lot of FFM to lose? Why is it any surprise their RMR is so low with so much FFM loss?
FFM went from 50% at baseline to 71% at the end of the show. After 6 years, it went down to 53%.
RMR was predicted based on their particular tissue composition. It was WAY below the predicted value.
Even after regain, RMR was still in the toilet.
Pretty much the definition of "broken."
Ok. I just needed the percentages I guess to "get it". Lol
So they were pretty much right back to the same FFM they started at, even if they were still not as heavy as when they started.
Seems to me it's possible it's about the choice of exercise then? If they kept up muscle catabolizing exercise habits on lower calorie diets trying to maintain their weight, they just kept on spending metabolically valuable muscle for 6 full years! Right?1 -
Kolata isn't reporting on "evidence" she is reporting on a few individuals -- and without really even giving the facts. What is their muscle mass, what is their exercise regimen, and what are they eating (carbs, sugar, one of them chips)? What kind of social/psychological support are they getting. This is not science just a typical news headline, "selling the newpaper" without really getting at the facts. And who are the controls? Those who lost weight slowly? Those who lift weights? Those who stayed away from their binge foods? Those who eat low carb? We don't even know who the "controls" could be since we don't know what this handful of people are doing. And how about the person who didn't gain much weight? What did she do differently. I think Kolata does a disservice by her "you were born that way" approach to this issue. By the way she is a tiny little thing, and thinks she was born that way (and who knows) but she has exercised fiendishly according to her news articles over the years, and eats in a very intentional way.
I guess we will have to disagree on this one. The evidence is overwhelming that the vast majority of people (about 80%) regain nearly all of the weight they have lost. That is a fact. I am not sure where her facts were wrong. Maybe she excluded some stuff you wanted and I would love to see what research has been done on some of your excellent questions.
There are other studies that have looked at some of that. For example, speed of weight loss doesn't seem to affect whether weight is controlled (Purcell et. al. 2014. The effect of rate of weight loss on long-term weight management: a randomised controlled trial. The Lancet). I don't know the literature well enough to comment on the others. That being said, I will take the research approach over diet gurus and anecdotes.
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@Sunny_Bunny_ , yeah, a good comparison is Keys' famous Minnesota Starvation Study. It wasn't really "starvation." It was high-carb and low-calorie. Pretty much the same results. Everybody ate like crazy, regained most or all of the lost weight. Fat comes back more quickly than muscle.1
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Kevin Hall interviewed on CNN:
http://www.cnn.com/videos/tv/2016/05/02/biggest-loser-show-weight-gain-post-show-lead-hall.cnn
"evidence on fixing this problem is very limited"
"something is special about bariatric surgery"
"if we can better understand what's special about surgery, maybe we can help people keep weight off longer"0 -
How would Fung's idea that those fasting do not experince a slowed metabolism fit into this? Total bunk?
Fung wrote about it today!
https://intensivedietarymanagement.com/the-biggest-loser-diet/
I do not follow his logic at all. He essentially says bariatric surgery patients don't have this problem, therefore fasting doesn't have this problem, because bariatric surgery is just like intermittent fasting (as opposed to calorie restriction).
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Me too. I find that when I go off LC and eat carbier foods, I bloat up and start to crave more... not a good thing.This is why I've been hanging out here during maintenance. ...
But my discovery is that it's ALL about appetite regulation. Low carb helps keep my appetite in check, even during maintenance.
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In reading this thread and understanding what Dr. Fung is saying, maybe it's important to read about his refrigerator/freezer analogy. https://intensivedietarymanagement.com/obesity-solving-the-two-compartment-problem/
I've experienced a big difference between eating lowered calories (whether SAD or LCHF) 3x day and eating the same number of calories (or less) while intermittent fasting. Weight loss, satiety and energy have all improved. I think my body likes dipping into the freezer. I guess time will tell whether it resets my metabolism to a normal level as Dr. Fung says it will. I hope he's right.3 -
Leptin
As a person who has lost a large chunk of weight in a healthy manner (Paleo) and still gained most of it back, I plan to focus on Leptin and minimizing Leptin resistance. For me, the weight regain was all about the incredibly strong urges to binge.
It is my only take away from that article because I have no idea if my metabolism has slowed. Here's hoping that that effect was a result of the extreme plan used on the Biggest Loser.
The good news is that healing Leptin Resistance goes hand in hand with lchf. Why heal Leptin Resistance? Leptin hormone is released by body fat. Less Fat = less Leptin, so being sensitive is important.
"Leptin (from Greek λεπτός leptos, "thin"), the "satiety hormone",[a] is a hormone made by adipose cells that helps to regulate energy balance by inhibiting hunger. Leptin is opposed by the actions of the hormone ghrelin, the "hunger hormone". Both hormones act on receptors in the arcuate nucleus of the hypothalamus to regulate appetite to achieve energy homeostasis.[2] In obesity, a decreased sensitivity to leptin occurs, resulting in an inability to detect satiety despite high energy stores." Wikipedia
Most Leptin protocols recommend a high protein breakfast (30-50 grams), 4-5 hrs between meals with no snacks, a low carb menu. I will link some good articles below.
http://wellnessmama.com/5356/fix-your-leptin/
http://www.wellnessresources.com/leptindiet/leptindiet_home.php
https://www.jackkruse.com/easy-start-guide/
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I do not follow his logic at all. He essentially says bariatric surgery patients don't have this problem, therefore fasting doesn't have this problem, because bariatric surgery is just like intermittent fasting (as opposed to calorie restriction).
I agree that was a tough blog post to read through. He notes that bariatric surgery is the 'bigger badass brother of IF". I saw no logic in this at all and he doesn't provide any.
Also, I was annoyed when he wrote: "So why did all those Biggest Loser contestants gain all their weight back after 6 months?" (emphasis mine). This simply isn't true. Most did not gain all of the weight back. As noted in the paper, 57% of the BL subjects maintained at least a 10% weight loss after 6 years. The number for other dieters is closer to 20% of subjects maintain at least a 10% weight loss for a similar time period. There is too much emphasis on the notion that the BL diet is horrible when in reality all diets are in the long term.
I think IF is great and am doing it now. The data for the health benefits are growing. It will be interesting to see how long-term studies measure up. I don't know of any and last I saw was a quote by David Ludwig that these types of studies haven't yet been done. I would imagine that they in the process now with researchers like Varaday and others.
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@wabmester and @antophora. I agree that was not his finest moment in writing. Although I'm generally a fan of Fung, I really don't like blanket statements and oversimplification dressing as general conclusions. We are humans after all and we all do mistakes here and there.0
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wheatlessgirl66 wrote: »In reading this thread and understanding what Dr. Fung is saying, maybe it's important to read about his refrigerator/freezer analogy. https://intensivedietarymanagement.com/obesity-solving-the-two-compartment-problem/
I've experienced a big difference between eating lowered calories (whether SAD or LCHF) 3x day and eating the same number of calories (or less) while intermittent fasting. Weight loss, satiety and energy have all improved. I think my body likes dipping into the freezer. I guess time will tell whether it resets my metabolism to a normal level as Dr. Fung says it will. I hope he's right.
I agree with @wheatlessgirl66. I can eat same or more "calories" with better results body composition wise. I think it's crucial to give the body enough time to recuperate and actually spend some of the stored fat. Insisting on eating/snacking means burning the newly ingested calories. (I love snacking )
I posted this video in another thread. But Mark Mattson talks specifically about LEPTIN regulation and how IF/running/sedentary affects satiety in mice. From min 20:48.
From min 25 he talks about BDNF in humans.
https://youtu.be/ZpcVku45hFY
Very fascinating!
I notice I always completely lose hunger when trained really hard. The same happens when IF regularly. What a coincidence
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Any "diet" I've ever attempted (even after bariatric surgery) I regained the weight lost, plus more. The reason was because I reverted to eating the foods that made me morbidly obese to start with! Even with a gastric bypass if you return to eating processed, high carb junk, the hunger signal never turns off. Sure your able to eat less, but remaining sooooo hungry leads one to eat more frequently! Plus, a weigh it loss patient can drink fluids while eating that flush the food right on out of the stomach pouch, and they never feel satisfied! This leads to the ability to binge eat!
Imo these folks likely reverted to eating the foods they "love" (or think they do!), making them hungrier, leading to weight gain! Sure the metabolism is shot, which makes the gaining that much easier! But we know what happens when we allow carb creep to occur!
LCHF has made me able to control the food choices, and feel satisfied like never before! I know I won't revert to eating the same foods again! I do have to fight the old feelings of feeling like since I've done so well that I deserve a food treat mentality too! I'm still working on this, trying to change the thinking to "I deserve to be healthy!", or "I deserve to wear these clothes!"...instead! I believe I will always be a work in progress, and don't really expect a finish line!8 -
Among obesity doctors, there seems to be a consensus that bariatric surgery is the most effective treatment. It has the best record for long-term weight loss. Not 100%, but better than any other known approach.
The holy grail is to understand why it works so well and to replicate those benefits without surgery.
Some clues are slowly coming in:
Physiological adaptations following Roux-en-Y gastric bypass and the identification of targets for bariatric mimetic pharmacotherapy.
Three biological responses linked to changes in gastrointestinal tract structure and function post-RYGB, that are implicated in the clinical efficacy of RYGB and that have actual or potential applications as non-surgical mimetic based approaches are addressed. These are (1) exaggerated post-prandial gut hormone responses; (2) local increases in undiluted bile in the gut lumen and augmented circulating bile acid and FGF19 concentrations and (3) compositional changes in the gut microbiota.
I find this fascinating. It's not the mechanical constriction per se, but it's several physiological adaptations to the surgery that leads to long-term success.0 -
Among obesity doctors, there seems to be a consensus that bariatric surgery is the most effective treatment. It has the best record for long-term weight loss. Not 100%, but better than any other known approach.
The holy grail is to understand why it works so well and to replicate those benefits without surgery.
This is exactly it!
We can make all sorts of assumptions as to why the vast majority (~80%) of people cannot keep the weight off (they don't lift, they don't do LCHF, they do too much cardio, they are lazy, insert any diet guru's advice here, etc. etc. etc.). However, we don't know much yet...so it is still a shot in the dark for how to best maintain. The research community also needs to address how/why RMR seems to get so completely broken after weight loss. A decrease in RMR with an increase in appetite is such a difficult problem.
Losing weight is the easy part - keeping it off is where the real challenge comes in.4 -
Interesting @wabmester! The actual bypass of the small intestine must play a big role in what is described. Could be that food doesn't encounter bile as quickly could account for the changes in intestinal microbiota. Or the malabsorption. Or a combination of both. Will be curious to see what their conclusions are!
It has been proven that some roux n y patients have managed to dilate the opening to the small intestine with overeating making the food eaten slip straight through, never stopping in the stomach pouch, and the person doesn't ever feel satiated! Turning their intestinal tract into just a tube! It can be corrected, but most insurances consider this to be another WLS (weight loss surgery) and won't cover it.
Some WLS patients are able to change their relationship with food once they reach max weight loss, and their ability to maintain weight lost goes up, but they have also added regular exercise from what I have seen. My bariatric surgeon is always telling me to jog (I don't believe my history will allow this though he doesn't even take that into consideration of my situation), so I'm sure he has seen the greatest success with his patients who exercise regularly too!
Will be interested to see if they can find a resolution to the metabolism issues after weight loss! Would be monumental for maintenance!0
