What the The New York Times misses about The Biggest Loser weight regain

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The New York Times published the following article:

–After ‘The Biggest Loser,’ Their Bodies Fought to Regain Weight

For anyone obese, reading this led one either to Ben and Jerry’s or the bar. It is a depressing read. Words like “frightening,” “stunning,” “radically,” “shocked” seem to appear every paragraph.

The thesis of the article is research has shown, after losing a bunch of weight, the metabolism doesn’t work like would be predicted based on the person’s weight, amount of fat, and amount of muscle. (e.g. have more muscle burn more calories.) We’ve known this for a while, but The Times covering it in the manner they did caused some attention.

Say you were 400 pounds. You lose 200 pounds. Now you’re 200 pounds. But you don’t burn as many calories as would be predicted for a 200 pound person. Because of this, (the theory is) you regain the weight. Obese people have a body that hates them, or something like that, is what the article is getting at. The Biggest Loser is a good avenue (not) to illustrate this because of how much weight people regain, and how obese they were initially.

The study looked at is this one:

–Persistent Metabolic Adaptation 6 Years After “The Biggest Loser” Competition

Containing this daunting quote:

“All but one subject regained some of the weight lost during the competition and five subjects were within 1% of their baseline weight or above.”

Before we get to that though, It needs to be BERATED every single person looked at in this study lost weight. 14 people / contestants were followed. After the 30 week Biggest Loser competition the average weight loss was 128 pounds.

128 pounds!

The way the article is written makes it seem as if it’s impossible for an obese person to lose any weight. And The Biggest Loser isn’t some marvel of science. It’s moving more and eating less. That’s right. Even obese people lose weight doing it.

“While most subjects experienced substantial weight regain in the 6 years since “The Biggest Loser” competition, the mean weight loss was 11.9 +- 16.8% compared with baseline and 57% of the partici- pants maintained at least 10% weight loss.

So while the contestants did regain weight, they still, overall, lost weight. Next:

“In comparison, it has been estimated that 􏰂20% of overweight individuals maintain at least 10% weight loss after 1 year of a weight loss program. Only 37% of the lifestyle intervention arm of the Diabetes Prevention Program maintained at least 7% weight loss after 3 years, and 27% of the intensive lifestyle intervention arm of the Look AHEAD trial maintained 10% weight loss after 8 years.”

Notice how the bolded numbers in the top quote are higher than the bottom quote.

In other words, these people in The Biggest Loser competition -perhaps the most weight challenged people our society has to offer- did better. More of them kept the weight off, and more weight was kept off period. This is in contrast to the take-these-people-out-the-back-and-Old Yeller-them feel The Times gives off.

“Contrary to expectations, the degree of metabolic adaptation at the end of the competition was not associated with weight regain,”

What the article harps on is how the people are six years after the fact. But immediately after the competition the metabolic adaptation did not predict weight regain. The six year follow up did, but that’s different. That’s after all the weight has been regained. Even at six years though the relationship was still only moderate. (The correlation was r = 0.59.) And the level of adaptation after the competition did not correlate with the level of adaptation at the six year mark. This is a murky picture. Not a clear one. Hence:

“The Biggest Loser participants with the greatest weight loss at the end of the competition also experienced the greatest slowing of RMR at that time. Similarly, those who were most successful at maintaining lost weight after 6 years also experienced greater ongoing metabolic slowing. These observations suggest that metabolic adaptation is a proportional, but incomplete, response to contemporaneous efforts to reduce body weight…”

As we’ll see, proportional does not mean significant. Significant is up for interpretation.

–

The research looks at resting metabolic rate as measured by how much oxygen you consume at rest. Consume more oxygen = burn more calories. We probably all have the intuitive sense if you’re bigger -> you breathe more oxygen -> you burn more calories.

Next looked at was total energy expenditure. Resting metabolic rate is how much you burn sitting still where total expenditure is how much are you burning over the course of a day.

Finally, physical activity. Take the total energy expenditure, subtract the resting metabolic rate, and we have our calories burned from physical activity, or how much you burn from doing more than sitting still.

A rebuttal or two to this article and study mention possible measurement error. That’s always worth looking at, with nutrition papers needing it more than any other, but damn if these researchers didn’t do a good job. All variables are measured carefully and rigorously. The authors make sure their equipment from six years previously matches up with their equipment of present day. They even go to the lengths to monitor things two weeks before the study begins. Idea being to make sure the contestants didn’t do anything drastic beforehand, like lose a bunch of weight, which would influence the results.

As The Times says:

“The researchers were concerned that the contestants might try to frantically lose weight before coming in, so they shipped equipment to them that would measure their physical activity and weight before their visit, and had the information sent remotely to the N.I.H.”

While a bit pedantic, this is wrong and one place the researchers could have done better. The study monitored body weight before beginning. It did this through using a scale hooked up to the internet, which sent bodyweight data to the researchers for two weeks prior to the study beginning. The study did not monitor physical activity in these two weeks. It did so in the two weeks after the study began, where subjects “were instructed not to change their usual routine.” This is worth addressing because:

Immediately after the competition and at the six year follow up, the authors found zero difference in physical activity. This is odd. It would mean the contestants kept up with the same amount of physical activity during the show for six years afterwards, which is more or less impossible.

“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.”

For SIX YEARS these people kept exercising SEVEN HOURS A DAY??? Clearly this didn’t happen. Maybe the contestants started exercising frantically right around when the study began?

Per above, right after the show and six years later, the contestants are burning 10 calories per kilogram per day. The average weight right after the show is 90 kilograms. Six years later it is 131 kilograms.

• 90 kg * 10 = 900 calories per day
• 131 kg * 10 = 1310 calories per day

These numbers are nowhere near 8,000 to 9,000 like The Times quote above. That’s because calories trackers are misleading.

Second, this would mean the contestants are burning more calories per day from exercise than they were during the show! But this is possible.

We’ll use MyFitnessPal’s calorie calculator because a lot of people are familiar with it.

• After the show people are on average 200 pounds.
  • 200 pound person walking at brisk 4.0 mph, for two hours, will burn 900 calories
• Six years later people are on average 289 pounds.
  • 289 pound person walking at brisk 4.0 mph, for two hours, will burn 1300 calories

The Times makes it seem as if an obese person has to quit their job in order to burn the amount of calories necessary to lose weight. They even profile one of the contestants who did quit his job to exercise. This is lunacy. A two hour brisk walk, for a person 35 years of age like on the show, is something anybody can do. Yeah, maybe if you’re really in deep then it takes a month of getting in shape to do it, but we’re not talking needing seven hours of supervised exercise with a trainer here to do this.

Overall, while we can’t rule out the participants had a blip of exercising frantically (though this is doubtful e.g. they’d likely have to take a couple weeks off of work or something), there is no way these people were exercising the same in regular life as they were on the ranch. Nor would they need to.

-> Again, see this if you’re wondering how they were exercising so crazily on the ranch but not burning way more calories.

Baseline is before the show begins. They’re burning ~2600 calories at rest. After the competition they’re at ~1900 calories. Makes sense as they lost a ton of weight and are in much better shape. Smaller body = burn less calories at rest.

-> The RMR (resting metabolic rate) does go down more than is predicted, but again, at the end of the show this was not associated with weight regain.

Then six years later they’re still burning 1900 calories at rest. This is despite a big gain in weight. To where you’d expect the resting metabolic rate to go up. One might wonder if this had anything to do with the physical activity these people were doing. Where if they kept themselves in a condition something similar to what they were on the show (cardiovascularly, not weight wise), would that impact how many calories they burn at rest? Exercise doesn’t impact resting metabolic rate much though.

We have a likely explanation of something truly negatively impacting metabolism.

-> Negative is subjective. 200 years ago when food wasn’t as a plenty? Poor person who doesn’t have access to food ad libitum? Then this is a metabolism you want.

But no one is contending obese people have, for example, some genetic reason(s) for their condition. That said, again, these people lost a ton of weight. The metabolic adaptation people are focusing on?

On average it was 499, call it 500, calories. This is for people with an average total expenditure of 3429 calories per day. They could eat 3429 kcal to maintain their bodyweight. That means for a non metabolically adapted person they’d be able to eat 3429 + 500 = 3929 calories per day and be at maintenance. But for our metabolically adapted group, they can only ingest 3429 to maintain their weight.

500 calories per day is a decent amount…but so is being able to eat 3429 calories per day! Shit, it’s not like these people need to starve themselves here. 500 / 3929 = 0.127. Our metabolically adapated group has to make up for a 12.7% difference. Whether you eat 4,000 or 3,500 calories a day, you’re probably a lonnnnnng way off from where you should be.

The average recommended calories is what?, two thousand?!? 500 calories is five miles worth of walking. That’s a little more than an hour and a half at a leisurely pace. Not seven hours of exercise. It’s a few scoops of peanut butter. Few tablespoons of olive oil. It’s not like we’re talking overcoming gravity here. If you eat 4 or 5 times a day, that’s a few meals plus a couple snacks. We’re talking eliminating a snack or two a day. We’re not talking eliminating dinner.

Yes, it might be harder for so and so to lose weight because of this. Just like it’s harder for so and so to do calculus. Or so and so to be outside more than 20 minutes without looking like the sun is tearing their body apart. Welcome to life. We’re not all the same. Some of us need to work a bit harder than others at certain things. But “frightening,” “stunning,” “radically,” “shocked” are not necessary here. 128 pounds were lost!

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The real reason these people gained the weight back:

“Unfortunately, many contestants are unable to find or afford adequate ongoing support with exercise doctors, psychologists, sleep specialists, and trainers — and that’s something we all need to work hard to change”

This gives you an idea of what the contestants have access to on a show like The Biggest Loser. In conjunction with an inordinate amount of money and fame as incentivization. Have we not seen the lengths people will go to for these things? Just watch what happens when people get on the jumbotron.

Here is the money quote:

“But he had started a new career giving motivational speeches as the biggest loser ever, and for the next four years, he managed to keep his weight below 255 pounds by exercising two to three hours a day. But two years ago, he went back to his job as a surveyor, and the pounds started coming back.”

The issue with The Biggest Loser is the issue with 99% of losing weight approaches: they aren’t sustainable. They don’t address root cause. Any of us can be put on a ranch, removed from society, removed from all our normal habits, given trainers, sleep specialists, a carrot of more money than we’ve ever seen, be put around only like minded people, and we’d lose weight. Do that for any behavior, and your behavior will change. But that doesn’t translate when you get back to society, back to your normal job, back to your normal routine.

I’ve seen people who lose weight one week per year…when they go on vacation. Seriously. Like a one week vacation. Come back and it’s obvious the person has lost weight. Within one week back though, bam, weight is back. Environment dictates our behavior in ways we don’t appreciate or want to acknowledge.

Said another way, if we kept these people on the ranch for the past six years, would they have gained the weight back like this? No. Then why are we so concerned with metabolic adaptation?

We should be concerned with this:

“What people don’t understand is that a treat is like a drug,” said Ms. Egbert, who went from 263 pounds to just under 176 on the show, and now weighs between 152 and 157. “Two treats can turn into a binge over a three-day period. That is what I struggle with.”

And this (note below is a different person):

“His slow metabolism is part of the problem, and so are his food cravings. He opens a bag of chips, thinking he will have just a few. “I’d eat five bites. Then I’d black out and eat the whole bag of chips and say, ‘What did I do?’”

Is metabolic adaptation the problem, or is it the fact a person blacks out eating chips? Not when the Old Fashioneds are just too good, but chips. Whatever is causing that is what needs to be worried about.

Personally, I can eat Pringles forever. They don’t make me full, I love salt, anybody who sees me eat them will comment because I start trying to put as many as possible in my mouth at the same time. It’s like my mouth becomes a Dyson vacuum specifically constructed for the Pringle shape. You know what I don’t buy? Pringles. I have them maybe once a year, always at an event. Like a Super Bowl party. Everybody has something, or multiple things like this. Why do I not buy Pringles, why does Ms. Egbert not binge like she used to but black-out-chip-man does, why does someone else not buy Oreos, not buy loaves of bread, but this person still buys chips? Address this and metabolism becomes background noise.

Because when you get off the ranch and come back to your life, whether it’s the frustration of a never getting promoted job, sadness from being lonely, a spouse which buys junk food when you are trying to stop consuming it, living in an area you don’t want to be, living in Texas where you can’t go five feet without seeing a steakhouse, mexican restaurant and fast food place, depression from having no friends, having friends but they’re all obese, the Krispy Kreme which is within walking distance who knows your order before you say it, those things haven’t changed. You can either take the convenient excuse and blame the metabolism you have no control over, which comprises 12.7% of your problem, or you can get to work on the other 87.3%.