5/16/2016
Obesity in the News:
America’s Biggest Losers

You may have read about a new study published in the scientific journal Obesity and then reported in the New York Times revealing that most of the 16 contestants on season 8 of The Biggest Loser, have regained much, if not all, of the hundreds of pounds they had collectively lost.

The study focused on the reality of what happens after losing weight. The authors of the paper basically found that the body’s metabolism slows down after dieting, making it extremely hard to keep weight off, and that this low metabolic rate persists for years.  “The results stunned researchers. They showed just how hard the body fights back against weight loss.”

Not surprised by the study were researchers at Columbia University, especially Berrie Center Co-Director, Rudy Leibel, the Christopher J. Murphy Memorial Professor of Diabetes Research and his colleague Berrie Center diabetes researcher, Michael Rosenbaum, MD. They had previously shown that the low metabolic rate that occurs following a 10% or greater weight loss is still present 1-6 years following dietary restriction. Dr. Rosenbaum was quoted in the New York Times story:

“We eat about 900,000 to a million calories a year and burn them all except those annoying 3,000 to 5,000 calories that result in an average annual weight gain of about one to two pounds,” he said. “These very small differences between intake and output average out to only about 10 to 20 calories per day — less than one Starburst candy — but the cumulative consequences over time can be devastating.”

On the topic of obesity, both Drs. Leibel and Rosenbaum are authorities (as well as insightful interviewees). Recently, Dr. Rosenbaum had time to talk about the Times story (still trending, with results from the study making their way through other national media) losing and gaining weight and his own research with Dr. Leibel. Here is what he had to say:

In general, what did you think of the Times Story?

It was good in that it presented obesity as a disease that continues to manifest itself in the form of a very low metabolic rate, even after it has supposedly been cured by weight lost. Our studies started in 1980s and at the time, everyone thought that obesity and the difficulty in sustaining weight loss was the result of will power. When we said, ‘that’s not right, people who are obese and people who are lean both seem to make similar metabolic adaptations to sustain weight loss,’ this was met with incredible resistance from the medical community. Greater recognition of obesity as a disease by the NIH, the American Medical Association, and medical providers has helped move our perception of obesity in the right direction.

The lead researcher who is also the head of NIDDKD, part of the NIH, called the results both frightening and amazing. Perpetual dieters called it depressing: What say you?

I would much rather be told that I have a disease that predisposes me to regain the weight I’ve lost, than that I am lazy, slothful and gluttonous. And that applies to the two-thirds of the population who are overweight or obese.

Obesity is a chronic disease that is still present even when it is not evident on the surface. If you have diabetes, and your blood sugar is in wonderful control, you still have diabetes. Obesity is in the same category. You still have to treat obesity after even when excess weight is not evident.

Most people are inadequately informed in advance just how difficult it is keep weight off. In my opinion, they should know that they are going to have to maintain a long-term follow-up.

Is there anything not in the Times that we should know?

The work that Rudy and I have done has taken this farther and shown that this metabolic opposition to sustain weight loss includes not only resting energy expenditure but also changes in skeletal muscle metabolism, endocrine function and feeding behavior, all of which conspire to make you regain the weight you’ve lost.

Does everyone gain back weight after losing it?

15 per cent of the population on average is successful at losing more than 10% of their weight and keeping it off. Even after all the tummy gigglers, exercise programs,  pharmaceuticals and nutraceuticals, this number has not changed significantly over the past 30 years.

The pharmaceutical and weight loss industries in general are recognizing that you have to consider losing weight and keeping weight off as somewhat separate but related problems. Therapies specifically designed to keep weight off by “reversing’ the changes in metabolism and behavior that occurred as a result of weight loss should be forthcoming. In addition, the responses to weight loss vary substantially among individuals. With precision medicine, I hope that we will be better able to look at certain genes or traits as “predictors” of the best therapy to encourage weight loss and discourage weight regain for each person.”

Dr. Rosenbaum is a Professor of Pediatrics and Medicine at Columbia University Medical Center and a diabetes investigator at the Naomi Berrie Diabetes Center. Currently he is developing a multi-disciplinary treatment and clinical research program for children who are obese with a grant from the state of New York.