The Biggest Loser: Are Weight Loss Attempts Doomed?

Melinda M. Manore, PhD, RD, CSSD, FACSMCollege of Public Health and Human Sciences

Oregon State University

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1. Biggest Loser – What did we learn?2. Weight loss/Mgt – What can we

recommend?3. Rethinking how we talk about weight

management.

Today’s Focus

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1. The Biggest Loser: What have we learned?

Bill Germanakos from Biggest Loser

Before After

Kevin Hall, PhDNIDDK

Obesity, 2016

J Clin Endocrinol Metab, 2012

Eric Ravussin, PhDPennington Biomedical Research Center

J Clin Endocrinol Metab, 2012

Question:1. Does a weight loss program of diet restriction and

vigorous exercise preserve FFM and RMR? 2. Does metabolic ‘adaptation” occur to counter

weight loss and contribute to weight regain?

Subjects: Biggest Loser Participants (n=16; M=7; F=9) measured before & after weight loss (0,6,30wk) (33±10y). Methods: Housed in isolated ranch in LA, with 1 contestant voted out every 7-10 d (n=11 at 6wk); 4 stayed for 13 wks. Participants returned home & continued program on their own (30 wk).Exercise: 90min/d supervised (6d/wk, aerobic/strength) + encourage to do another 3 h/d. Min PA=2h/d; Mean PA=3 h/dDiet: 65-70% of baseline energy requirements (1300 kcal/d).

Body Size/En ExpenditureBaseline (n=16) Week 30 (n=16) Change ∆

Anthropometrics (DXA)

Body Wt (kg) 149.2 (38.0) (330lbs) 91.6 (22.9) 57.6 kg (127lbs)

BMI (kg/m2) 49.4 (9.4) 30.4 (6.4) 19.0

Wt Change (%) 39.9 (9.1)

FFM (kg) 75.7(20.2) 65.2(15.5) 10.5 (17.4% Wt Loss)

FM (kg) 73.5 (21.1) 26.4 (13.8) 47.1 (82.6% Wt Loss)

Body Fat (%) 49(5) 28(10) 21%

Energy Expenditure

RMR (kcal/d) 2,679(624) 1,890 (423) -789

Predicted RMR (kcal/d) 2,393 (466)

Metabolic Adapt (kcal/d) -504 (171) (n=14) (7%↓ kcal/kg FFM)

TEE (kcal/d) 3900 (957) 3114 (571) -786 6

∆ Body Size/En ExpenditureBaseline (n=16) Week 30 (n=16) Change ∆

Anthropometrics (DXA)

Body Wt (kg) 149.2 (38.0) (330lbs) 91.6 (22.9) 57.6 kg (127lbs)

BMI (kg/m2) 49.4 (9.4) 30.4 (6.4) 19.0

Wt Change (%) 39.9 (9.1)

FFM (kg) 75.7(20.2) 65.2(15.5) 10.5 (17.4% Wt Loss)

FM (kg) 73.5 (21.1) 26.4 (13.8) 47.1 (82.6% Wt Loss)

Body Fat (%) 49(5) 28(10) 21%

Energy Expenditure (DLW)

RMR (kcal/d) (mea) 2,679(624) 1,890 (423) -789 kcal/d

Predicted RMR (kcal/d) used baseline data 2,393 (466)

Metabolic Adapt (kcal/d) -504 (171) (n=14) (20%↓kcal/kg FFM)

TEE (kcal/d) 3900 (957) 3114 (571) -786 kcal/d 7

Metabolic Changes

Significant Improvements (mean ∆):• Fasting Glucose ↓ 19 mg/dl (20%)• HOMA-IR ↓ 40%*• C-Peptide ↓50%• TAG↓ 64 mg/dl (216%)*• HDL-Chol ↑ 12 mg/dl

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Summary (Baseline-30 wks)

• Despite FFM preservation, high exercise did not prevent the slowing of RMR more than predicted based on weight loss.

• Metabolic adaptation persisted through weight maintenance, which may increase risk of weight regain unless high level PA maintained and energy restriction remained.

9Alan Smith

Objective:1. Measure long-term changes in RMR & body

composition in participants of “Biggest Loser”.

Subjects: Biggest Loser participants (n=14/16; M=6; F=8) returned to NIH 6y after weight loss. 1 subject maintained wt loss; 5 subjects were with 1% of baseline or above.Methods: For 2 wk prior to 3-d NIH Clinical Ctr stay, remote body weight monitoring occurred (bluetooth; electronic). RMR, TEE (DLW) and body composition (DXA), and hormones & metabolite measurements done.

Kevin Hall

Obesity, 2016

Fothergill et al, 2016

Body Size/En Expend. at 6 yN=14 Baseline

Age=34.9yWeek 30

Age= 35.4y6 y

Age = 41.3y

Anthropometrics (DXA)

Body Wt (kg) 148.9 90.6 131.6 (87% of baseline)

BMI (kg/m2) 49.5 (10.1) 30.2 (6.7) 43.8

FFM (kg) 75.5(21.1) 64.4(15.5) 70.2 (93% baseline)

FM (kg) 73.4 (22.6) 26.2 (13.6) 61.4 (84% baseline)

Body Fat (%) 49(5) 28(9) 44.7 (91% baseline)

Energy Expenditure (DLW)

PA (kcal/kg/d) 5.6±1.8 10.0 ± 4.6 10.1±4.0

RMR (kcal/d) (mea) 2,607(649) 1,996 (358) 1,930 (466)

Predicted RMR (kcal/d) 2,577 (574 2,272 (435) 2,403 (507)

Metabolic Adapt (kcal/d) -275 (205) -499 (207)

TEE (kcal/d) 3804 (957) 3,002 (573) 3,429±581 11

Body Size/En Expend. at 6 yN=14 Baseline

Age=34.9yWeek 30

Age= 35.4y6 y

Age = 41.3y

Anthropometrics (DXA)

Body Wt (kg) 148.9 90.6 131.6 (87% of baseline)

BMI (kg/m2) 49.5 (10.1) 30.2 (6.7) 43.8

FFM (kg) 75.5(21.1) 64.4(15.5) 70.2 (93% baseline)

FM (kg) 73.4 (22.6) 26.2 (13.6) 61.4 (83% baseline)

Body Fat (%) 49(5) 28(9) 44.7 (91% baseline)

Energy Expenditure (DLW)

PA (kcal/kg/d) 5.6±1.8 10.0 ± 4.6 10.1±4.0

RMR (kcal/d) (mea) 2,607(649) 1,996 (358) 1,930 (466)

Predicted RMR (kcal/d) 2,577 (574 2,272 (435) 2,403 (507)

Metabolic Adapt (kcal/d) -275 (205) -499 (207)

TEE (kcal/d) 3804 (957) 3,002 (573) 3,429±581 12

Individual ∆ BW, FFM & FM

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Body Weight Fat Free Mass Fat Mass

Regained FFM

Fat Mass Gains

Individual ∆ RMR & Metabolic Adaptation

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∆ RMR

Who experienced the most metabolic adaptation?

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1. Weight regain was not significantly correlated with metabolic adaptation.

2. Subjects who maintained weight loss at 6 y experienced the greatest metabolic adaptation.

Wt regained from Baseline

Biggest Loser Summary

1. Participants regained 87% of their lost weight in 6 y. UNSUCCESSFUL?

2. 50% of participants maintained at least a 10% weight loss. SUCCESS?

3. Metabolic adaptation was NOT related with weight regain – but with long-term weight loss.

4. Long-term weight loss requires vigilant combat against weight regain.

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Diet + Exercise vs Diet?

2. Weight Loss – What can we recommend?

PLoS One, 2009

Subjects: M/W (n=48); Age: 38y; BMI=27.8(kg/m2); <2d/wk PADiet: (TEE determined by DLW over 14-d); Wk 1-12 & 22-24 all food provided; Wks13-22 self-selected diets based on targets; 30% FAT; 15% PRO; 55% CHO

• Control (ad libitum diet);• Caloric restriction (CR) (↓ 25% of en); • CR (↓12.5% en) + Ex (↑12.5% en; 5d/wk, 45-55 min/d using HRM) • Low calorie diet (LCD) = 890 kcal/d until lost 15% BW then

maintenanceDuration: 6 monthsData collection body comp (DXA): baseline, 3, 6.

↓25% en

CR = ↓ 25%CR + EX = 12.5% eaLCD = 900 kcal/d

Key point: Weight loss the same with CR (-10.4%↓) and CR + EX (-10%↓).

6 mo

CR+Exercise

Caloric Restriction only

Redman et al PLoS 2009

CR = ↓ 25%CR + EX = 12.5% eaLCD = 900 kcal/d

-240±114 kcal

+ 129±86

Author: “Volumetrics Weight-Control Plan: Feel Full on Fewer Calories” &“The Volumetrics Eating Plan”

Dr. Barbara Rolls, Distinguished ProfessorPenn State University

Low Energy Density (LED) (kcal/g) Diet

Types of Foods:• Whole fruits• Whole Vegetables• High fiber whole grains• Low fat foods (dairy/meat)

Characteristics of Foods• High fiber & water content =

High volume/weight• Less energy (kcal) per weight (g)

of food (kcal/g)• Aid in satiety & promote feeling

of fullness• Low in fat; no sweetened bevSummary: LED diets may result greater losses in BW & reduction in kcals + with no reduction in portion sizes. Rolls et al, 2004

¼ c raisins vs. 1 2/3 c grapes

Results:

Portion Size Effects: -231 kcal/d; 10%↓ kcal

Energy Density Effects: -575 kcal/d; 24%↓ kcals

2006, AJCN.

Examples of very low, low, medium, and high energy dense foods

Very-low(< 0.6 kcal/g)

Low(0.6-1.5 kcal/g)

Medium(1.5-4.0 kcal/g)

High(>4.0 kcal/g)

Most whole fruits, berries

Other fruits: bananas, papayas

Dried fruits: apricots, raisins, apples

Nuts and nut butters

Most whole vegetables

Starchy vegetables: peas, corn, winter squash, baked potato

Whole wheat (WW) breads, bagels, English muffins

Cookies, muffins, pastries; foods with added sugar and fat

Skim milk; low-fat yogurt/dairy

Fat-free cottage cheese

Mozzarella or Swiss cheese

Other cheeses-cheddar, Brie-, mayo, sour cream

Broth based soups Cooked whole grains:(oatmeal, brown rice)

Baked snack foods: pretzels, tortilla chips

Potato chips, regular tortilla chips, pretzels

Legumes, low-fat meats

Eggs, sirloin steak, pork chops

Candy-all types,chocolate 24

Recommendations from ACSM Position Paper for Weight Control for adults (Donnelly et al. MSSE 2009):

Prevent weight gain = 150-250 min/wk (20-35 min/d) Improve weight loss = 150-250 min/wk (20-35 min/d)

+ moderate energy restriction Keep weight off after dieting =>250 min/wk 3-5% ↓ in wt can significant ↓ CHD factors People who lose wt and keep it

off typically exercise at least ~1 1h/day (NWCR data).

Challenges to Weight Mgt

3. Surviving our obesogenic environment?

Weight management is difficult in today’s food/built environment. Identify what you can manipulate & understand

what you cannot change. Identify a weight that is ‘healthy’ and allows you

participate in physical activities. Remember your diet & PA level is the sum total

of the small everyday choices you make!

Thank you! Questions?