It's not about willpower
May 2, 2016 10:50 AM   Subscribe

What happens when the winners of reality show The Biggest Loser go home? Researchers followed a set of contestants for 6 years and came to a disheartening conclusion: losing weight lowers your metabolism (possibly permanently) and increases the hormones that make you hungrier. (SLNYT)
Dr. Ludwig said that simply cutting calories was not the answer... “For most people, the combination of incessant hunger and slowing metabolism is a recipe for weight regain — explaining why so few individuals can maintain weight loss for more than a few months.”
posted by snickerdoodle (156 comments total)
 
I read that story this morning.

It makes me so sad and angry on behalf of those contestants. What a nightmare, to have worked so hard, to believe they won, and now to be back where they started.

(And of course this study won't help much to keep people from fat-shaming. Because that's easier than having some compassion, and so many of us want to live in a Just World.)
posted by suelac at 10:52 AM on May 2, 2016 [21 favorites]


What happens when the winners of reality show The Biggest Loser go home?

They fail to maintain the habits of an isolated, high-pressure environment.
I've been reading notorious jerk Lyle McDonald's Body Recompsition.

more discussion at reddit's r/fitness and hacker news
posted by the man of twists and turns at 10:55 AM on May 2, 2016 [3 favorites]


I'm somewhat confused. Doesn't it make sense that someone that weight 150 lbs has a lower caloric requirement for maintenance than someone that weighs 300lbs?

I'm also still somewhat confused that the idea that you can go on a drastic, temporary change in diet/activity levels to force a major change in body composition, and somehow that change will be permanent. You have to adopt a completely new lifestyle. Forever. That's the only way it can work.

Making unhealthy choices in eating and activity level having lasting damage/repercussions also makes sense.

A TV show does not need to confirm any of this. It was the TV show that sold you on this illusion in the first place. The TV show is part of the problem.


Stop watching the TV show.
posted by alex_skazat at 10:57 AM on May 2, 2016 [21 favorites]


It makes me so sad and angry on behalf of those contestants. What a nightmare, to have worked so hard, to believe they won, and now to be back where they started.

That is life in a nutshell. Success, fame, fortune always need work to sustain itself, and the. You burn out on the hamster wheel. We never quite perfected staying successful in our endeavours as we like that Happily Ever After. The End. approach to things, but realistic it is not.

I am sympathetic, yet not surprised in the least.
posted by Alexandra Kitty at 10:58 AM on May 2, 2016


I did a quick skim of the article, but couldn't find anything addressing strength training and increased muscle mass's effect on metabolism- there's been a much greater emphasis on that as a method of weight control (as opposed to strenuous cardio workouts) in the last decade-ish; might this be further evidence in support of that approach?
posted by Merzbau at 10:58 AM on May 2, 2016 [5 favorites]


Doesn't it make sense that someone that weight 150 lbs has a lower caloric requirement for maintenance than someone that weighs 300lbs?
That's not what the research says, though. It says that six years after a 300-pound person loses 150 pounds, they still need many fewer calories than someone who has always weighed 150 pounds. Their bodies are still fighting to get back up to 300 pounds.
posted by ArbitraryAndCapricious at 10:59 AM on May 2, 2016 [76 favorites]


It says that six years after a 300-pound person loses 150 pounds, they still need many fewer calories than someone who has always weighed 150 pounds. Their bodies are still fighting to get back up to 300 pounds.

Also, your level of activity has to do with this as well. When I'm marathon training, I literally take in thousands upon thousands of calories just to maintain my energy and weight.
posted by roomthreeseventeen at 11:01 AM on May 2, 2016 [1 favorite]


I'm somewhat confused. Doesn't it make sense that someone that weight 150 lbs has a lower caloric requirement for maintenance than someone that weighs 300lbs?

The article repeatedly says that the calorie requirements are lower than would be expected for a person of their current weight, not lower than at their higher weight.

Welp, it's time for another thread where folks can be all "yeah, those researchers at NIH are a bunch of ignoramuses, didn't they know about keto and strength training and not buying junk food?" No matter how much science you throw at a thing, everyone wants to be all "why not do this simple thing to solve your weight problem".
posted by Frowner at 11:01 AM on May 2, 2016 [152 favorites]


I feel so terrible for these individuals. That's a lot to go through, and the emotional and mental strain this will induce, ugh...
posted by Fizz at 11:02 AM on May 2, 2016 [3 favorites]


The body is a raging asshole that wants us to be fat.
posted by Emperor SnooKloze at 11:05 AM on May 2, 2016 [4 favorites]


this show is really really awful. i used to watch it all the time because i struggle with self worth and body image. it's not just the extreme diet/exercise change, the way that show breaks down its contestants and then uses manipulation to make them think they're getting so much better - the way they take away and restore dignity - even without the science backing up that this is a really terrible program, this show is utter trash.
posted by nadawi at 11:06 AM on May 2, 2016 [17 favorites]


Yeah, I remember Charlie Brooker once said he thought The Biggest Loser was contradicting its own message by making weight loss seem really, really hard, as if the only way you can do it is to subject yourself to a boot camp and get ordered around by asshole trainers. Of course, weight loss is hard under any circumstances, but the only way it has a chance of sticking is if you change your habits in small, sustainable ways over time. Somehow it manages to be even more reactionary than crash diets or the go-to-the-gym New Years' resolutions.

All reality shows have these Redemption Story™ things where the participants have to be portrayed in simplistic terms so that viewers can have a “hook” for remembering who is who. But it seems especially cruel to apply that framework in a way that makes people feel ashamed for being fat, as if they're harming society or something.
posted by savetheclocktower at 11:06 AM on May 2, 2016 [6 favorites]


As an avid fan of Fit to Fat to Fit (a very different weight loss show where trainers gain substantial amounts of weight (25-35% of their bodyweight) in order to lose it quickly with their extremely overweight clients - id be FASCINATED to see comparative data showing changes over time in these other metrics for the contestants. If some of the theories pointed to by this data held out, the trainers might be doing measurable and substantial long term damage to their bodies even over incredibly short time spans (the weight gain and loss periods covered by F2F2F are each 4 months long).

Id say reactions to this article go one of two directions: confirmation that the diet and exercise schemes promoted by shows like the biggest loser are unsustainable (not that exciting) and evidence that massively important and partially understood biological processes are every bit as important as external stimuli like diet and weight loss (and i know its not popular to love our chemical overlords, but id sure be tempted to get in on that hunger-hormone study).
posted by Exceptional_Hubris at 11:07 AM on May 2, 2016 [2 favorites]


The body is a raging asshole that wants us to be fat.
That's one way to look at it. Another is that the body is a wonderful organism that evolved to keep us from starving to death. Because for almost all of human history, that was much more likely to happen than getting fat.
posted by ArbitraryAndCapricious at 11:07 AM on May 2, 2016 [53 favorites]


I've yo-yo dieted a couple of times in my life, and every time, I end up heavier than before I started, so none of this surprises me. It doesn't matter if I do some rapid weight-loss fad diet thing or lose weight slowly over a period of years -- it eventually comes back with a vengeance.

I've given up on really trying to lose weight for two reasons: it's clearly self-defeating, and it makes me stupid. When I'm running a calorie deficit, rather than burn off some of my ass, my body seems to stop sending energy to my brain.
posted by jacquilynne at 11:08 AM on May 2, 2016 [3 favorites]


Maybe we should all just stop eating and let nature take its course
posted by The Whelk at 11:09 AM on May 2, 2016 [6 favorites]


It's fascinated me how I can be really diligent and proactive and lose, say, 50-60 lbs, when I drastically change my diet and exercise, etc. But with a little slide back into being anything less than a constant full-time hardass on myself, my body manages to eventually regulate very precisely back to a specific weight - like, to the precise decimal, even. It really does seem like my body is working overtime to get me back to what it feels is homeostasis and equilibrium, as if it has sensed a major life-threatening crisis and all resources have to be diverted to this.
posted by naju at 11:10 AM on May 2, 2016 [13 favorites]


Another is that the body is a wonderful organism that evolved to keep us from starving to death. Because for almost all of human history, that was much more likely to happen than getting fat.

The body is also a wonderful organism that evolved to help us fly into a violent rage at times of peril so we can kill whatever has spooked us. The body is a magnificent and complex but some of the shit that got us this far is a pretty mixed bag as far as outcomes in a post-primitive-battle-for-survival context, unfortunately.
posted by cortex at 11:10 AM on May 2, 2016 [26 favorites]


Because for almost all of human history, that was much more likely to happen than getting fat.

Probably none of us, even in the West, have to go back more than three or four generations to find relatives who died of/had their health significantly affected by malnutrition or starvation. The body knows what it's doing. It doesn't care if you die of 60 of heart disease--by then you'll have reproduced anyway. It cares if you starve at 20.

So maybe in a few hundred years, humans will have adjusted to a food-rich environment and these adaptations will be much more minimal.
posted by praemunire at 11:11 AM on May 2, 2016 [8 favorites]


As I've mentioned elsewhere here, I lost a bunch of weight in my teens and went from fat to stocky. I kept it all off by dint of obsession and stress for about seven years and then it crept back on. Now I'm about where I started. I don't seem to get much fatter, but it's difficult to get meaningfully thinner. I'm a lot healthier now because I started exercising a lot when I went on the diet, but that's about it.

Seriously, unless you have tried to do the "eat very little every single day so that you are never, ever not raveningly hungry" thing, you don't know how hard it is. I used to lie awake too hungry to sleep and think about what I'd eat the next time I had a "cheat" day. And the only reason I could maintain the concentration I needed to stay on that diet was because I was a miserable social outcast with no friends, so I had nothing to do but school, exercise and Not Eating. It just was not sustainable.
posted by Frowner at 11:13 AM on May 2, 2016 [31 favorites]


I'm also still somewhat confused that the idea that you can go on a drastic, temporary change in diet/activity levels to force a major change in body composition, and somehow that change will be permanent.

The idea that they were sold -- that so many people are sold -- is that if they do the drastic, temporary thing to get the weight off, and then change their diet to eat what other people who weigh the same, lower, weight weigh that they will maintain the weight loss.

What this study says -- as so many people know -- is that this isn't correct. What this study says is that even after the weight loss they must eat much less than other people who are the exact same size, just to maintain their weight.

From the article: "Mr. Cahill was one of the worst off. As he regained more than 100 pounds, his metabolism slowed so much that, just to maintain his current weight of 295 pounds, he now has to eat 800 calories a day less than a typical man his size. Anything more turns to fat."

800 calories less. That's a lot, particularly if you're dedicated and have made the necessary changes in your diet to eat a healthy, balanced diet.

And the other point here is that these metabolic changes don't just take place because of the "boot camp" approach to weight loss. They show up in people who lost weight more slowly/sanely as well. Basically, the study says that in order to keep the weight off you have to resign yourself to feeling hungry almost all the time, forever. Now, of course, there may be some people who think this is appropriate penance for people who have the "moral failing" of being fat, but the truth is that it simply isn't any way to live. Unless you've lived this way, you don't really realize what the baseline of your body constantly telling you "You're starving, eat something. You're starving, eat something. YOU'RE STARVING. EAT SOMETHING!!" is really like.
posted by anastasiav at 11:16 AM on May 2, 2016 [73 favorites]


If shame worked, we'd all look like models.

I never watched this show mostly because I could never a. enjoy someone else's suffering or b. put myself in their shoes (I would have strangled a trainer on day 3, tops). It's always been a uniquely terrible show, a circus in the ancient Roman sense. They might as well have the contestants be chased by lions.
posted by emjaybee at 11:17 AM on May 2, 2016 [10 favorites]


I travel a lot. I have noticed that people who live in countries where their food is not artificially "enhanced" with extra sugar, salt, preservatives and antibiotics + do not spend half their day in a car driving, do not tend to be overweight. America is doing it wrong. Also, this show is an abomination.
posted by pjsky at 11:19 AM on May 2, 2016 [3 favorites]


I meant to add: I really hope we can get some decent science out of this so that we can understand the mechanisms of metabolism better and be able to help people get to a healthier place regardless of where they're starting from (lots of thin people aren't as healthy as you think, either). It would be nice if in that process we stopped shaming people for their appearance, too, of course.
posted by emjaybee at 11:21 AM on May 2, 2016 [9 favorites]


This makes me feel really angry on behalf of the BL contestants. Were they even warned that this would happen??

worse than you even think - when i was still watching the show they'd show up at prior contestants houses and shame them for gaining back the weight, seemingly to reinforce that you have to stay 100% dedicated to their plan or be subject to humiliation forever.
posted by nadawi at 11:21 AM on May 2, 2016 [3 favorites]


Nothing in that article mentions muscle mass. Of course, if you crash-diet in such a manner as they do on TBL, you lose a bunch of muscle along with the fat. Since muscle burns far more calories than fat (50 calories per pound for muscle, vs. 9 calories per pound for fat), it is obviously a lot healthier to minimize muscle loss during a "cut" (that is, a diet intended to lower body fat percentage). You do that by eating a lot of protein, strength-training, and maintaining a REASONABLE caloric deficit, like 250-500 calories a day.

If you don't do that, let's say you lose 100 lbs of fat and 15 lbs of muscle. If you don't put that 15 lbs of muscle back on, then your metabolism is going to drop by 15 * 50, or 750 calories a day. Which is exactly what that article is talking about, isn't it?

For somebody who's morbidly obese, sure, a medically supervised low-calorie diet might be okay because it's more critical to get to a non-critical weight quickly--but once you get there, a slow .5 to 1-lb loss per week is going to make you a lot less hungry, tired, and bonk-prone. The Biggest Loser obviously pays no attention to that at all, they want the shock value of the results from a radical diet.

Anyway, millions of people lose weight, keep it off and recomposition their percentage of lean body mass. It's not rocket science. Building muscle isn't a fast process (about 4 lbs a year if you're consistent), but it isn't difficult to do, and it does increase your metabolism accordingly.

I think that article is really irresponsible, in that it strongly suggests that if you lose weight, you'll just be starving and destined to pack it all back on for the rest of your life. That is NOT true. All that article is going to do is convince obese people that they're screwed either way, and discourage those who *do* want to lose weight.
posted by Autumnheart at 11:23 AM on May 2, 2016 [14 favorites]


...wait, it's not rocket science?? well that explains why i'm so fat. i've been reading books about propulsion and thrust just assuming the pounds would melt off.
posted by nadawi at 11:26 AM on May 2, 2016 [90 favorites]


Diet and nutrition is one of the biggest areas of science where even people who consider themselves to be rational start off with a conclusion that they want to be true and cherry pick evidence that supports that conclusion to give it the veneer of empirical validation.

We've ended up in a situation where it's just about impossible to obtain accurate information on how to lose weight because everyone is pushing an agenda, whether it's economic or just because we want to see the obese as weak-willed lazy slobs who just need to get on the treadmill for six hours a day and starve themselves.

Just to give a quick example, try to find an article that recommends diet soda or low calorie fast food for weight loss. Since those are things that go against the narrative that the only way to be healthy is to eliminate all convenience foods and cook everything for yourself, people will latch on to the flimsiest research and treat it as ironclad evidence that stuff like diet soda is exactly as bad as drinking the full sugared variant. (Not that I'm saying the research is invalid, just that it's given undue weight because it supports what the diet puritans want to believe, and therefore "sounds right".)
posted by zixyer at 11:27 AM on May 2, 2016 [13 favorites]


Anyway, millions of people lose weight, keep it off and recomposition their percentage of lean body mass. It's not rocket science.

It doesn't work like that, though. Not everyone is scientifically capable of keeping weight off.
posted by roomthreeseventeen at 11:27 AM on May 2, 2016 [8 favorites]


I wonder if the way they lost the weight has any impact on these results. Would a long term diet and exercise plan that loses the weight over a couple of years, instead of a crash-diet that loses it in a few months, not freak your body out and let you maintain the same metabolism?
posted by It's Never Lurgi at 11:29 AM on May 2, 2016


God I really hope scientists and medical researchers read internet comments from anonymous people so that they can learn which critical areas of research they just totally didn't think about
posted by beerperson at 11:29 AM on May 2, 2016 [99 favorites]


I had to quickly change my diet/exercise habits for a reason unrelated to weight and it made me much more empathetic to people who have to do that, because like alex_skazat said, you have to do it forever. And it sucks. I would much rather sit on the couch and eat chips, but if I want to achieve [thing] then I have to do this. Forever.

I can totally understand the temptation to think "OK, I've done the thing! Yay me! I can relax now" and the crushing disappointment when you find out that not only can you not relax, you have to do more than the next person.
posted by AFABulous at 11:30 AM on May 2, 2016 [7 favorites]


Nothing in that article mentions muscle mass.

Are we really doing "these [NIH researchers and metabolism experts] didn't think about weight training"?
posted by naju at 11:37 AM on May 2, 2016 [39 favorites]


> Anyway, millions of people lose weight, keep it off and recomposition their percentage of lean body mass. It's not rocket science. Building muscle isn't a fast process (about 4 lbs a year if you're consistent), but it isn't difficult to do, and it does increase your metabolism accordingly.

Give me a moment to think up a more articulate response than “uggggggghhh”:

Instead of deducing (I did these things and I lost weight → weight loss must not be hard in general), work backwards: start with the large numbers of people who want to lose weight and have tried very hard to do so. If weight loss is as simple as you say, then either these people have profound psychological failings that lead them to ignore the obvious solution, or your solution works for you but not for other people.

If we were talking about anything other than weight loss, it would be an obvious red flag if someone came into the thread and said “these scientists are overthinking things — it’s really not that hard to do X.”
posted by savetheclocktower at 11:38 AM on May 2, 2016 [39 favorites]


Anyway, millions of people lose weight, keep it off and recomposition their percentage of lean body mass. It's not rocket science. Building muscle isn't a fast process (about 4 lbs a year if you're consistent), but it isn't difficult to do, and it does increase your metabolism accordingly.

I think that article is really irresponsible, in that it strongly suggests that if you lose weight, you'll just be starving and destined to pack it all back on for the rest of your life. That is NOT true. All that article is going to do is convince obese people that they're screwed either way, and discourage those who *do* want to lose weight.


Welp, here's the scientific article, fresh from peer review! Perhaps you could write a rebuttal, citing your sources, and submit it to the same peer review process.
posted by Existential Dread at 11:38 AM on May 2, 2016 [86 favorites]


muscle burns far more calories than fat (50 calories per pound for muscle, vs. 9 calories per pound for fat)

A pound of fat burns around 2 calories per day, while a pound of muscle burns around 6 calories per day. So, in your example of losing 15lbs of muscle, that would equate to around 90 calories -- less than a tablespoon of oil.
posted by littlegreen at 11:43 AM on May 2, 2016 [18 favorites]


Quote from a scientist:

Dr. Rosenbaum agreed. “The difficulty in keeping weight off reflects biology, not a pathological lack of willpower affecting two-thirds of the U.S.A.,” he said.

Mefi response:

HAVE YOU THOUGHT ABOUT WILLPOWER? I BET WILLPOWER WORKS.
posted by tocts at 11:43 AM on May 2, 2016 [104 favorites]


"It's not rocket science" is particularly funny given that we collectively understand less about human biology than we do about how to make functioning rockets. So yeah, it's not rocket science, it's actually several degrees more complex?
posted by naju at 11:46 AM on May 2, 2016 [79 favorites]


Well, it's gotta be partly the availability of food - I doubt the French or Japanese have any more or less willpower than Americans do, or are fundamentally different on a biological/metabolic level.
posted by AFABulous at 11:47 AM on May 2, 2016 [1 favorite]


I actually think it's fascinating how tenaciously people cling to the willpower narrative. I don't know if it's because they're fat people who want to believe that they can overcome this thing that causes people to oppress them or if they're thin people who want to maintain their sense of themselves as morally superior or what, but it does seem to be really hard to shake some people's belief that you can lose weight permanently if you just try hard enough, despite a lot of evidence that suggests that it's really very difficult to do that.
posted by ArbitraryAndCapricious at 11:47 AM on May 2, 2016 [22 favorites]


Mod note: Yeah, we've been around this block a number of times in the past. Talking about your own personal experiences is totally reasonable, but maybe let's skip the generalized conclusory "here's the actual simple solution to weightloss/maintenance, people just need to try" sort of stuff going forward.
posted by cortex (staff) at 11:48 AM on May 2, 2016 [22 favorites]


Just to head off the whole"but what about the muscle" stuff, some key findings from the article.
Several years ago, we investigated the body composition and RMR changes in 16 people with class III obesity undergoing an intensive diet and exercise intervention as part of “The Biggest Loser” televised weight loss competition (3). 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.
Table 1 notes that on average, at the end of the show the contestants retained only 35.7% of their fat mass, while retaining 85.5% of their fat free mass.

Figure 3 shows an R^2 value of 0.9691(!) for proportion of fat loss to body weight change during the competition (loss) and the six years after (gain).

Regarding resting metabolic rate:
Table 1 shows that the RMR at baseline was 2,607 6 649 kcal/day which fell to 1,996 6 358 kcal/day at the end of the 30-week competition (P 5 0.0004). Despite a significant amount of weight regain 6 years later, the mean RMR was 1,903 6 466 kcal/day, which was not significantly different from the end of the competition (P 5 0.35). Figure 4A shows that RMR was decreased by 610 6 483 kcal/day at the end of the competition (P 5 0.0004) and was 704 6 427 kcal/day below baseline 6 years later (P < 0.0001), which was not significantly different from the end of the competition (P 5 0.35).
posted by Existential Dread at 11:50 AM on May 2, 2016 [24 favorites]


Well, it's gotta be partly the availability of food - I doubt the French or Japanese have any more or less willpower than Americans do, or are fundamentally different on a biological/metabolic level.

There are a million variables that differ between those countries and the US. That you cherry pick that one as the one it has to be is just another example of diet puritanism. It could be that, but it could be one of the others, too.
posted by Mitrovarr at 11:51 AM on May 2, 2016 [14 favorites]


Disheartening, but not terribly surprising. Hasn't it been out there for a while that this sort of crash dieting can permanently fuck up your metabolism? I could never bring myself to watch The Biggest Loser for that reason; just felt vaguely squeamish watching these poor people being put through the wringer in such an unhealthy, unsustainable manner. Because entertainment!
posted by imnotasquirrel at 11:52 AM on May 2, 2016


> i've been reading books about propulsion and thrust just assuming the pounds would melt off.

Well, not so much melt as "leave your body in a super-sonic laminar flow at about 3500 degrees Kelvin", but you'd still be rid of them. You'd probably need to get new couch cushions too (scorch marks). Too bad it doesn't work that way.
posted by benito.strauss at 11:54 AM on May 2, 2016 [2 favorites]


Do we know that people in Japan or France have an easier time losing weight? This is specifically about losing weight, not about why people get to a particular weight in the first place. I wouldn't be surprised if people in Japan and France had just as hard a time losing weight, but that's not always evident because they have a lower starting weight on average.
posted by ArbitraryAndCapricious at 11:54 AM on May 2, 2016 [16 favorites]


This is big research and hopefully just the tip of the iceberg. For years, medical science has consistently gone with a "calories in-calories out" model for weight gain/loss, but this puts a big wrinkle into that. It's like BMI, in that yes, on a population basis, a random person will lose weight on a 1800 calorie diet, but for any specific person, it's woefully inadequate.

The fact that these people can be up to 800 calories below expected BMR is crazy. What biological/metabolic process can possibly account for that? As they say, the best science doesn't come from "Eureka!", but rather "That's weird..." If humans can have such a low BMR at that weight, why haven't those genes proliferated in times of famine? Is it epigenetic? Are they sacrificing other non-vital metabolic processes? There are so many questions, it's fascinating.
posted by thewumpusisdead at 11:56 AM on May 2, 2016 [19 favorites]


Well, it's gotta be partly the availability of food - I doubt the French or Japanese have any more or less willpower than Americans do, or are fundamentally different on a biological/metabolic level.

Also, this ignores that the US is pretty homogenous for food availability (mostly) and is definitely not homogenous, geographically, for the obesity rate.
posted by Mitrovarr at 11:56 AM on May 2, 2016 [3 favorites]


i don't know anyone who watches the biggest loser for entertainment, even if they think that's it. i think most of the viewers are likely hoping they can learn something new, get some new motivation, find anything at all that will break their inability to lose weight and keep it off. the show is presented in a very 'and you at home, just follow these recipes and get to the gym and you too can be skinny'. a majority of the people i know who watch it or have watched it struggle with weight and body image.
posted by nadawi at 11:57 AM on May 2, 2016 [4 favorites]


Well, it's gotta be partly the availability of food - I doubt the French or Japanese have any more or less willpower than Americans do, or are fundamentally different on a biological/metabolic level.

In France or Japan, childhood obesity is not an issue as huge as it is in the US. Based on this study, people who have been overweight at any point in their lives will require fewer calories in comparison to a person of the same size who was never overweight.
posted by Tarumba at 11:57 AM on May 2, 2016 [3 favorites]


the show is presented in a very 'and you at home, just follow these recipes and get to the gym and you too can be skinny'.

oh, and i forgot the biggest one - 'buy these products'
posted by nadawi at 12:01 PM on May 2, 2016 [4 favorites]


I actually think it's fascinating how tenaciously people cling to the willpower narrative.

Just a corollary of the !!bootstraps!! narrative, isn't it?

nadawi, you're probably right. I think it's more the feeling I get from NBC, that they're in a way exploiting and taking advantage of people desperate to lose weight for the purposes of entertainment (although as you point out that might not be why most people actually watch the show). I just can't help but think that they HAVE to know this is unhealthy and so it kinda pisses me off. I don't know. Is that unfair of me? Am I being too uncharitable?
posted by imnotasquirrel at 12:01 PM on May 2, 2016


oh no! i don't think you're being uncharitable enough! nbc is exploiting these people and damaging them and they're damaging the people at home just looking for a little hope. i was just saying that the people watching the show are not 'oh, enjoyment!' but rather are also being harmed. i know a lot of obese people (myself included) who got triggered right back into our eating disorders from watching the show.
posted by nadawi at 12:06 PM on May 2, 2016 [6 favorites]


There's a new show called Strong, which is kind of like Biggest Loser but with fitness, not weight loss as the focus, and I thought I would enjoy it. But I made it through half of the first episode before I gave up. It turns out that I don't like the format even without the sketchy weight-loss politics. Also, the narrative arc seemed to be that the blond, athletic, "oh, I can't do this, I'm just a mom, I just raise babies" pastor's wife was going to start out the best and continue to be the best and triumph over everyone until she won, and that's sort of not a very compelling arc.
posted by ArbitraryAndCapricious at 12:07 PM on May 2, 2016 [2 favorites]


The article says that this is "new and important." But there have been people researching this and reporting similar results for at least 30 years. I know because I've been reading on the subject for that long. There's been research showing that people who diet, especially people who repeatedly diet for weight loss, end up heavier than they started, as well as other research that undermines the idea that being fat is due to bad habits, moral failings, or lack of willpower.

But reports on this research, even in medical journals, always end with an admonition that this information should not discourage people from trying to lose weight. Because our pathological cultural desire to demonize fat bodies, project everybody's shame about body and food onto them, and then make them disappear is so powerful.

But there are some new and important things about this study. The detailed attention to individuals' metabolisms helps to explain the phenomenon in a scientific and intelligible way. And the end of this article says:
But Dr. Ludwig said that simply cutting calories was not the answer. “There are no doubt exceptional individuals who can ignore primal biological signals and maintain weight loss for the long term by restricting calories,” he said, but he added that “for most people, the combination of incessant hunger and slowing metabolism is a recipe for weight regain — explaining why so few individuals can maintain weight loss for more than a few months.”

Dr. Rosenbaum agreed. “The difficulty in keeping weight off reflects biology, not a pathological lack of willpower affecting two-thirds of the U.S.A.,” he said.
And that is new.
posted by not that girl at 12:14 PM on May 2, 2016 [35 favorites]


I appreciate this article, even though it is horribly sad for me as a lady that once had a reasonable "slightly overweight" body and then got hugely heavier because of some shittily prescribed medication. So now I'm just heavy forever or fucked? If this is true, I think the way doctors put you on weight increasing drugs is criminally irresponsible.
posted by corb at 12:15 PM on May 2, 2016 [13 favorites]


I appreciate this article, even though it is horribly sad for me as a lady that once had a reasonable "slightly overweight" body and then got hugely heavier because of some shittily prescribed medication. So now I'm just heavy forever or fucked? If this is true, I think the way doctors put you on weight increasing drugs is criminally irresponsible.

A friend of mine wrote about this just the other day. She was put on anti-psych meds at 19 to stave off serious suicidal thoughts. And while the drugs saved her life, she gained 100 pounds in less than six months, most of which she has never been able to take off. She has tried decreasing her psych meds recently, in order to try and lose some of the weight for health reasons, but the entire situation is a precarious balance of mental and physical proportions.
posted by roomthreeseventeen at 12:19 PM on May 2, 2016 [7 favorites]


I almost wrote this in my last comment:
I have not read this thread, and I won't, because I know that people will be coming in here to repeat some stuff about calories in/calories out; and how they lost 40 pounds just by giving up cream in their coffee; and how the problem is that people are ignorant about what's in the food they eat; or the problem is that people eat for emotional reasons because they are mentally ill; or that "common sense says..." that losing weight is relatively straightforward and simple. I don't need to hear that shit again. But I am so sure that these people have been in here, ignoring scientific evidence, that if someone reads this thread and lets me know that I am wrong, I swear on my sacred honor that I will send $250 each to a charity chosen by each active mod, and $100 each to charities chosen by retired mods.
I lost my nerve, because as confident as felt, I don't have the money to back that bet. I shouldn't have worried:

Anyway, millions of people lose weight, keep it off and recomposition their percentage of lean body mass. It's not rocket science. Building muscle isn't a fast process (about 4 lbs a year if you're consistent), but it isn't difficult to do, and it does increase your metabolism accordingly.

I think that article is really irresponsible, in that it strongly suggests that if you lose weight, you'll just be starving and destined to pack it all back on for the rest of your life. That is NOT true. All that article is going to do is convince obese people that they're screwed either way, and discourage those who *do* want to lose weight.


Today, I am grateful for things which can be counted on. The sun came up, the planet is still spinning, and it's cloudy here in Michigan. And certain kinds of information-resistant empathy-deficient persons will always show up exactly where they're not needed to share their special mix of "common sense" and "wisdom."
posted by not that girl at 12:24 PM on May 2, 2016 [57 favorites]


These results really don't make sense, as far as I can tell. I'm not saying they're wrong, but we're definitely missing something huge (I've often thought this regarding nutrition).

Ignore the weight gain/loss aspect of it for a moment and think about the implications that people can metabolically survive on 700 fewer kcal/day than they do. If starvation is the historic state, why on earth would never-overweight people be burning nearly 1/3 more calories than what are actually needed to survive? Evolutionarily speaking, it makes zero sense - the higher metabolism folks would be weeded out by mass starvation in lean times.

The paper implies that there is some sort of metabolic regulation going on, such that the same person can potentially maintain homeostasis on different numbers of calories. But that doesn't really answer the original question - there must be some sort of massive advantage to utilizing the extra calories or the downregulation system would have disappeared long ago. Rough analogy - if you had a car that could run equally well and identically and need either 2 gallons to go 10 miles or only one gallon to go 10 miles, there is zero reason why you would ever put it in the fuel hungry mode. If the states are otherwise identical, it's entirely pointless that it even exists.

The answer must be that the metabolic states of low caloric burn and high caloric burn are not identical at all. There must be a major advantage of the body burning those extra calories when times aren't lean. But what does the body do with those 700 calories? They don't disappear into a black hole - those calories are used for something, and that something must be pretty important. The brain uses something like 50% of our intake - does it allow the brain to work better somehow? Does the extra energy get used for extra bodily repair functions? What is the body depriving itself of when it down-regulates metabolic activity?

The worrying implication to me is that weight loss is not just futile but actively dangerous in a way we don't understand. Those extra calories have to be important in some fashion and there must be significant tradeoffs to the body not using them, and we have no idea what those tradeoffs are.
posted by zug at 12:27 PM on May 2, 2016 [41 favorites]


I wonder if it's easier temperature regulation. I've yoyo-ed a few times over the years and I find myself colder than the average person. I mean I only ever really feel comfortable when the mercury rises over 30C.

And for an organism that can sweat it might be genetically advantageous to get rid of excess heat rather than risk hypothermia.
posted by Mitheral at 12:34 PM on May 2, 2016 [6 favorites]


Because the body needs many nutrients besides calories, I can see how it would be biologically useful to be able to burn off or expel excess calories to ensure that enough vitamins and such are coming in, especially if you had a monotonous diet.

(This is total speculation in response to zug's observations.)
posted by paper chromatographologist at 12:40 PM on May 2, 2016 [1 favorite]


You can't look at people and tell how they currently eat with any accuracy. That's the part of this research that a lot of people are going to haaaaaaaaaate.
posted by Linda_Holmes at 12:42 PM on May 2, 2016 [30 favorites]


*thoughtful* You know, my work centers around exactly those trade-offs, zug--not in humans, of course, but on how the presence of body fat influences decisions about how mice allocate energy to social behaviors. (Spoiler: mice who can't access any of their body fat behave quite a bit differently than mice who can, with no manipulation of their actual weight and size and no manipulation of their blood sugar levels.) I'd be surprised to find a lack of trade-offs in humans too, but I'd dearly like to know exactly what is getting traded off and why.
posted by sciatrix at 12:48 PM on May 2, 2016 [13 favorites]


Differences in calorie utilization could reflect changes in the gut microbiome. Population changes could cause efficiency variation.
posted by Mitrovarr at 12:50 PM on May 2, 2016 [4 favorites]


Of course, these results were totally intuitive to me--after all, their bodies 'think' they're being constantly starved and that they're in low-resource conditions. Of course it would be trying desperately to hold on to as much metabolic resources as it can in order to get back to whatever the hypothalamus thinks the set point should be for that body. Once you've got your reserves back and you can trust that resources are going to be stably available for a while--and if not, well, better pad those reserves out some!--then you can start thinking about spending your resources more freely on other things again.
posted by sciatrix at 12:51 PM on May 2, 2016 [5 favorites]


This article made a lot of sense based on my own experience of having gained and lost 150+ pounds with long yo-yos, and having seen bariatric surgery do fascinating things for people's endocrine systems.

I remember years ago that one of the "facts" that got bandied about in weight loss literature (of which I've read far more than any life should include) was that you could never "lose" fat cells. You could only gain new ones or shrink the ones you have. If that's true, I could see that working with hormones in fascinating ways that lead to difficulties in keeping weight off.
posted by ldthomps at 12:56 PM on May 2, 2016 [2 favorites]


Differences in calorie utilization could reflect changes in the gut microbiome. Population changes could cause efficiency variation.

If true, would this point towards attempting a microbiome infusion from a leaner person?
posted by ZeusHumms at 12:57 PM on May 2, 2016 [3 favorites]


it would be trying desperately to hold on to as much metabolic resources as it can in order to get back to whatever the hypothalamus thinks the set point should be for that body

That's certainly a possibility (although my intuition says set point theory is far too simplistic), but that still doesn't really address the tradeoff question - what is the body sacrificing by storing instead of burning all those calories? Why burn them in the first place if you don't really need them?
posted by zug at 12:58 PM on May 2, 2016 [1 favorite]


I read the first 161 comments at the New York Times, and it was almost pure fat-shaming.

The comments here are incredibly kinder and more sensible.
posted by Nancy Lebovitz at 1:04 PM on May 2, 2016 [4 favorites]


I fear our societal obsession with weight loss is causing us to go down wrong paths and blinding us to the actual science of nutrition in many ways - I think it's a big part of the reason why even the scientific side of human nutrition as a discipline is such a mess. The obsession with weight loss specifically has eclipsed the basic research on weight in general.

It wouldn't shock me if the answer is out there somewhere unnoticed in a non-human discipline like behavioral ecology and nobody has made the connection yet.
posted by zug at 1:05 PM on May 2, 2016 [8 favorites]


I read the first 161 comments at the New York Times

Taking one for the team. Expect to see an extra kitten in your pay envelope this month.
posted by thelonius at 1:06 PM on May 2, 2016 [26 favorites]


Well, this is depressing. What am I supposed to do now? Benzedrine?
posted by aramaic at 1:07 PM on May 2, 2016 [1 favorite]


Well, this is depressing. What am I supposed to do now? Benzedrine?

Radical self-love.

edit:

And not the cheesy-looking paperback, the real thing, which means rejecting images and ideas about what and who deserves love that do not lead to the answer "Me".
posted by turntraitor at 1:08 PM on May 2, 2016 [12 favorites]


For someone who has struggled with maintaining weight loss this article is depressing to the extreme.

When I was 17 I weighed 300 lbs. Two years later, after one to two hours of daily exercise and severe calorie restriction I weighed 160 lbs. I was able to maintain this weight for about 4 -5 years. Now 10 years later -after many ups and downs- I weigh about 260, which is the closest I've been to my highest weight.

This morning my wife and I signed up for a service that provides three meals a day for a set number of calories each day. I am telling myself right now that the science conveyed in the article seems pretty sound but I am different. I will be able to lose the weight again and keep it off for good.
posted by blairsyprofane at 1:14 PM on May 2, 2016 [3 favorites]


Since there are a lot of people offering hot takes about "but muscle mass!!!" without actually reading the article, I wanted to mention-- one of the most heartbreaking things about the article is how many former contestants went to EXTREME lengths to continue working out and restricting their diets. Hours and hours a day. One guy literally quit his job in order to work out as much as possible-- but as soon as he had to go back to work, the weight started coming back.

These people didn't go on the show, and then go home and never work out again. They kept with the program, to the best of their ability as humans who had real lives. And doing their best (seriously, I am in awe of how dedicated they were) wasn't good enough.

For a lot of people, "just go for a run in the morning and avoid sugar!!!" means NOTHING for their weight. It might be good for their health in other ways, but it is a drop in the bucket compared to what their bodies will do to keep the weight on. I am so, so tired of hearing this advice bandied about, and I really hope this research will help us to turn our attention to the factors making our bodies act this way. Because lack of willpower isn't it.
posted by a fiendish thingy at 1:17 PM on May 2, 2016 [39 favorites]


Kevin Hall and his team are doing some very interesting research these days, and this article is only part of it. But keep in mind that the cited paper focuses on the extreme methods used in The Biggest Loser, and that people using less extreme methods may still see metabolic adaptation, but not to the same degree. From today's Vox article by Julia Belluz:
The study may say more about the failures of the Biggest Loser approach to weight loss than whether we're all doomed if we try to lose weight. In a 2014 study by the same group of researchers, also published in the journal Obesity, Biggest Loser participants were compared to people who underwent gastric bypass surgery for weight loss. This study found that the TV show contestants had five times less circulating leptin in their bodies and a greater degree of metabolic slow down compared with the surgical patients.
Yoni Freedhoff (previously) summarizes his (small, non peer-reviewed) clinical data for patients starting here and ending here:
For those following Biggest Loser story, know that in our office we measure metabolism with indirect calorimetry roughly every 6 months. While definitely not a study, we've measured literally thousands of patients (via indirect calorimetry). We don't see disproportionate metabolic slow downs - though to be fair, the losses aren't as dramatic as show's. My experience though says that non-extreme efforts don't cause the metabolic damage seen in The Biggest Loser.
SO: metabolic adaptation is real. TBL contestants seems to be affected most severely by it. As noted above, just putting on muscle mass won't burn a significant amount of extra calories. If you find an effective way of losing weight, maintaining that loss, or regaining only a small portion of that loss, is not going to be easy because of some degree of metabolic adaptation which may be temporary or permanent. You will almost certainly have to eat less and move more than the alternate universe version of yourself who was always at that new weight.

But this doesn't mean that someone who is heavier and less fit than they want to be should stop giving a shit about good food and exercise. If you can improve your diet in a way that doesn't make you despair, do that. If you can take more exercise than you are right now (allowing for differing levels of time, work obligations, exercise-friendly environments, social and family obligations, physical limits and fitness -- not everyone can take the stairs or "simply walk" for 60-90 minutes a day), do that. You may only lose 5-10% of your current weight, but that small loss alone can have real effects on your health. You may not lose any weight at all -- AND THAT'S OK -- but you'll still be healthier than if you gave up completely. As Freedhoff says, you should aim for then healthiest lifestyle that you can honestly enjoy. And fuck the haters and the fat-shamers.
posted by maudlin at 1:18 PM on May 2, 2016 [36 favorites]


For someone who has struggled with maintaining weight loss this article is depressing to the extreme.

Depressing... for me it might be the opposite - maybe it will lead to me and others finally just accepting our (overweight, but/and relatively healthy) selves instead of an ongoing sisyphean physical-mental struggle against our own biologies.
posted by naju at 1:21 PM on May 2, 2016 [5 favorites]


Oh, and-- I once talked to a tenured professor who is one of the US experts in physical activity and public health, and he told me that there is zero peer reviewed research that proves that muscle burns more calories than fat. It is a thing that people say, but he once attempted to do a literature review on the subject, and he only found studies that disproved it, or found a completely negligible difference that depended entirely on individual physiology.
posted by a fiendish thingy at 1:23 PM on May 2, 2016 [14 favorites]


Zug, about your concern for what those other 700 calories are doing--a few thoughts:

There are plenty of anecdotal examples of the very same person being able to eat high numbers of calories in youth and remain lean--only to be surprised that in adulthood, metabolism changes and that's no longer the case. There are plenty of teen boys and young men who pack it down and stay lean, then hit 40 and, whoops, fat. It's not like this study is the first time that differential is described. It's clear that the metabolic states are different, even within the same individual.

Also, you're assuming that those "extra" calories are being integrated and used. There are lots of scenarios I can imagine where they're just not used. Pass through undigested, consumed by the gut biome, partially digested but some metabolites get excreted. It's certainly not the case that every atom that passes one's lips must enter the bloodstream before excretion. My guess is that there are a bunch of inefficiencies we just haven't had need to find yet.
posted by Sublimity at 1:26 PM on May 2, 2016 [4 favorites]


but that still doesn't really address the tradeoff question - what is the body sacrificing by storing instead of burning all those calories? Why burn them in the first place if you don't really need them?

Judging by the accounts of friends, and a few comments in this thread, mental acuity/mental state and just like the energy and ability to actually think about things. I myself have experienced this when i was super depressed and eating a small enough amount of calories that i was losing weight even though i was just laying on my couch all day. Most of the people i've talked to who lost weight through cutting calories severely brought that one up as well: You feel fucking stupid and loopy.
posted by emptythought at 1:26 PM on May 2, 2016 [9 favorites]


I've recommended this before: On doctor's orders, I switched to a LCHF/keto diet, and I lost 60 pounds in one year with zero exercise and no hunger. This "bourbon and bacon" diet is not for everyone. But it's working for me, amazingly so.
posted by Cool Papa Bell at 1:28 PM on May 2, 2016 [2 favorites]


There must be a major advantage of the body burning those extra calories when times aren't lean. But what does the body do with those 700 calories?

What does the body not do, you mean! In "starvation mode" you have less energy, more lethargy, you spend less time thinking about things and acting on the thoughts you do have. You sleep less, and are sleepy more. You get sick easy and often. You wander away from hobbies and social circles. You're not as quick on the draw, and it's harder to recall things. You get tired and give up more easily on various everyday activities. You can never seem to make any gains in the gym despite going often.

You still feel much healthier, energetic and active than you did when you were obese - you will never feel as healthy, energetic and active as other people your age who were never obese.

There is a lot of economization the human body can make before burning fat to keep you alive, and this same "economy mode" is being used by your body to put fat back before allowing you to be healthy. In an evolutionary perspective, it's the kind of thing that gets you eaten by meaner preds, die of illness or allows you to wind up in a state where you actuallly are starving to death, a very dangerous place to be, which is why people not restoring their depleted stock of bodyfat are using more energy.

In a societal sense, we now have a scientific foundation to build upon.
posted by Slap*Happy at 1:29 PM on May 2, 2016 [2 favorites]




The only way I ever lost weight and kept it off, is to make friends with this chronically hungry state of mind I am in, and the burning inflammation that I keep feeling in various areas of my body. I practice meditation so I can have enough willpower to not claw out my insides, and this is at a particularly low stress point in my life. I eat a high protein, medium fat diet, low carb, tons of fruits and veggies and water and exercise. I've memorized health advice to the point where I am bored and find it redundant.

I can't figure out how anyone could really lose weight in the average American society...it's so toxic. Of course your metabolism and biology doesn't want you to lose all that fat. We really need body and fat positivity and acceptance, and to really fundamentally re-think how we treat people with fat bodies.
posted by yueliang at 1:57 PM on May 2, 2016 [4 favorites]


I can't figure out how anyone could really lose weight in the average American society...

Tentatively raises hand (while ducking :/) .... I did it, maintaining going on six years now. But emphatically NOT by relying on "willpower" (whatever that means) in any shape or form. I'm acutely aware of my many and important limitations in that department :/ I think the whole "willpower" discourse is fundamentally cruel, not to mention misguided, and loathe hearing it whenever it comes up...(I don't want to be that person, with the advice, but I structure things around my vulnerabilities, basically. I don't live in hunger or distress, or feel any kind of deprivation - it's been sustainable for me, practically and psychologically. Not intending to brag... it's just, it's been possible for me, for whatever reasons. Maybe some of them genetic, who knows? Maybe some others can have the same experience, I don't know.)

There's a lot of stuff on metabolism (and I guess anything anyone's ever done on obesity:/) on Dr. Sharma's blog, if anyone is interested and minded to hunt through it. IIRC (don't want to misrepresent, but know that this is fuzzy) Dr. Sharma supports multiple solutions, including weight loss surgery, research on medications to help regulate leptin and related hormones thought to be involved in appetite, and self-acceptance. (Other studies, IIRC, have shown a 10% difference in metabolisms between never-obese and formerly-obese people of the same weight. Not anything this drastic... I do think the approach taken by The Biggest Loser is um, unique in lots of ways. On the (US') National Weight Control Registry, most people report walking for an hour a day, that might be a helpful buffer against regain.)
posted by cotton dress sock at 2:27 PM on May 2, 2016 [4 favorites]


Many years ago I was put on a medication that made me gain 60 pounds in less than 2 years.

When I came off the medication, I lost about 50 of those pounds and have kept them off for more than 10 years.

Metabolic complexities aside, my experience was that when I was overweight it was literally harder to not overeat than it is now at a “normal” weight. It’s not that my willpower got better, and it’s not even that I’m now physically less hungry. Even overweight I was perfectly capable of ignoring my stomach growing until the next meal.

Instead, the challenge of not-overeating got easier. I still have to watch what I eat, but if I want cake and decide that it’s not in my calorie budget today, I can make that decision once or twice and not think about it again. Whereas on that medication I had to make the decision 20 or 25 times a day — it was as if my brain had an alarm constantly telling me to eat that I couldn’t turn off.

I don’t know how common that experience is — maybe it’s specific to certain kinds of medication-induced weight gain. But it wouldn’t surprise me if it were broader.
posted by pocketfullofrye at 2:29 PM on May 2, 2016 [10 favorites]


lchf/keto type diet is how i took my husband's a1c of greater than 14 to 5 in 8 months (and have maintained it close to there for over a year). we could do better at it, and we need to add more physical activity, so not all of this is on the meal plan - but after an initial pretty good drop in weight for both of us, we plateaued 20-40lbs above where we should be. so if we were just looking at it as a diet - a thing to get skinny on - we wouldn't have stuck with it. we're somewhat lucky that every 6 months we get a lab reading proving he is healthier than he was over a year ago. having that proof helps me stick with it too even when i'm not seeing the number on the scale going down.

this isn't to advocate for one type of eating plan over another, just saying that a super focus on thinness keeps people unhealthy by making it the only goal. lots of people deride 'healthy at any size' but it's such an important thing to keep in mind. i may still be fat, and i'll likely be somewhat fat forever, but i am healthier eating pork chops and vegetables than when i eat pasta in huge quantities.
posted by nadawi at 2:33 PM on May 2, 2016 [14 favorites]


@pocketfullofrye, that was the reason for my gain as well, interestingly. Maybe it's a snowflakey kind of gain...
posted by cotton dress sock at 2:36 PM on May 2, 2016


I can't figure out how anyone could really lose weight in the average American society...it's so toxic.

Yeah, you pretty much have to say "Fuck Society" to be yourself and be happy pretty often in America. I just stay accountable to myself. For me willpower is definitely a part of it, it's just not the whole people make it out to be. But I'm a sports fan so I watch dozens of beer and pizza commercials a week, willpower has to come into play for me. There's too much temptation out there.

Luckily, for me when I lose weight my appetite seems to go down, I feel more happy and alert, and my metabolism remains predictable for my current weight. Adding more complexity with how many calories I burn would get pretty confusing and difficult quick. But look, if I get down to my goal weight and need to eat less than someone else that size to maintain that weight well, I guess I'll just try and do it as best I can and stop if I have to. Being accountable to myself doesn't mean beating myself up over something I can't prevent. I just don't want to die decades earlier than I might because I didn't do what was within my power to take care of myself. (Especially since I'm pretty sure scientists are gonna crack immortality pretty soon!)

This study could be vastly overstating what this effect would be like on the general population...BL takes sedentary people and has them exercise like professional athletes and puts them on extreme caloric deficits. The impact on the body is extreme and fast rather than a gradual slow and steady. But, I think an elephant in the room here is we need to be doing more to prevent childhood obesity because it has long term health implications some of which can't be reversed. The problem is very few people in a direct position to help (parents, doctors, schools) seem to know how to do that without fat shaming or passing along misinformation.
posted by Drinky Die at 2:37 PM on May 2, 2016 [3 favorites]


Keto was great while my lifestyle was in harmony with it - I was between jobs and able to prepare all my meals myself, and lost 50 lbs. But when I got a job where coworkers went out for lunch nearly every day and keto options just weren't there most of the time, I put back all 50 lbs very rapidly. That's where I'm at now. It's sustainable until it isn't, I suppose.
posted by naju at 2:38 PM on May 2, 2016 [5 favorites]


oh yeah, i meant to mention that in my post - the only way we were able to drastically change our diet and maintain it there is because i'm a housewife and prepare 90% of the food when we're doing well at keeping to it (and even then, it's sometimes just like, omg how much more veggies can i chop and eggs can i consume??). time, resources, and privilege go hand in hand with topics like food and health.
posted by nadawi at 2:43 PM on May 2, 2016 [10 favorites]


How come fat people have to will themselves to be thin, but thin people don't have to will themselves to stop making stupid, judgmental comments on websites?
posted by klangklangston at 2:50 PM on May 2, 2016 [52 favorites]


"even without the science backing up that this is a really terrible program, this show is utter trash."

I used to work with a guy whose boyfriend is one of the producers of the show. The producer was someone who came out on MTV during whatever their precursor to True Life was, and has this incredible optimism about the power of television to change lives for the better. He insists they provide contestants with longterm support to help them keep the weight off, etc. etc.

I just remember the conversation being incredible awkward because I tend to be skeptical of the ability of unscripted lifestyle competition shows to truly shape their participants' lives for the better, but frankly never watched the show and didn't really have any firm opinions beyond the name sounding kinda mean.

I'm curious now if he has any reaction to the study — my hunch is that like many people confronted with science that questions assumptions that they have invested in (and, in his case, have been paid handsomely for) he'll probably find some way to blame it all on the participants not following through with the program somehow.
posted by klangklangston at 2:55 PM on May 2, 2016 [2 favorites]


As an avid fan of Fit to Fat to Fit (a very different weight loss show where trainers gain substantial amounts of weight (25-35% of their bodyweight) in order to lose it quickly with their extremely overweight clients - id be FASCINATED to see comparative data showing changes over time in these other metrics for the contestants. If some of the theories pointed to by this data held out, the trainers might be doing measurable and substantial long term damage to their bodies even over incredibly short time spans (the weight gain and loss periods covered by F2F2F are each 4 months long).

This is what I really want to know. This science makes intuitive sense to me in the case of the Charlotte pastor profiled in the article, who had been heavy since the third grade. If that's your body's biology, it makes sense that your body would want to maintain it, so that even if you lost a lot of weight, you would soon gain it back while eating a normal diet. However, there are many Biggest Loser contestants who had always been thin, and then were injured or had a personal tragedy that impacted their normal diet and exercise routine, causing them to gain a lot of weight. Do THOSE people still see their bodies trying to gain up to their heaviest weight after a weight loss as well? How early in life does the weight gain have to be to impact a person's metabolism this strongly? Or maybe it's dependent on how much weight you gain, or how long you are heavy?

In other words, are the people on F2F2F making it so their bodies will always want to gain up to that 30% body weight increase, or do their bodies "remember" their original "fit" weight and try to maintain that?
posted by chainsofreedom at 3:05 PM on May 2, 2016 [6 favorites]


Two thoughts:

I've never much liked the idea of TBL, too much yelling and every person is different so why are their weight loss plans the same? I recently watched a kind of crappy miniseries on ABC (I think) called "Which Diet is the Best?" It had five people go on a 12 week weight loss journey with different pop weight loss trainers. It is pretty significantly different to me because there was a fitness challenge every week, along with a requirement to complete a half marathon at the end to be eligible for the prize. The contestant who won had a plan that involved things like swapping grapes for candy or water for soda, and allowing yourself a treat sometimes but doing it out of the house so you aren't tempted to eat a whole cake. I am really interested to see how the contestants are doing now. It seemed like they were losing in a healthy way, but I don't know.

And

I've gained nearly 20 pounds since having my last baby. My husband has been nothing but supportive and appreciative of my body at all stages. But I'm wondering if I can ask him to get snipped in hopes that coming off birth control will help me lose this weight.
posted by Night_owl at 3:15 PM on May 2, 2016 [1 favorite]


benito.strauss: "You'd probably need to get new couch cushions too (scorch marks)"

To be fair, this is not a new phenomenon in my house.
posted by scrump at 3:26 PM on May 2, 2016 [1 favorite]


@DrinkyDie - my view is that the onus is on policy makers & regulators to support an environment promoting risk-reduced weight. i.e. regulation of food industries (manufacturers, producers, restaurants - there is no reason calorie counts for serving sizes have to border on the fraudulent, or that counts shouldn't be made available at the point of purchase. Urban food deserts, why - everyone should have ready and cheap access to foods known so far to at least not promote gain... Re employers - people should have enough time to eat well. Investment in public transport, and safe bike and pedestrian paths, and cheap or free access to safe recreational opportunities should be taken for granted. One can dream, anyway :/ )

I agree with you that we should be cautious about results of research looking at TBL.

I'm sorry if my earlier comment was insensitive. I am not saying "hey look, everyone can do it bc I did", but maybe some can. I'm not sure this research, involving a very small sample of people who participated in an unusually aggressive - arguably punitive - approach to weight loss can or should be generalized beyond that context. There is still a lot to learn.

posted by cotton dress sock at 3:35 PM on May 2, 2016 [2 favorites]


If this article makes you despair and you're looking for something hopeful, look at the bariatric study it mentions. The bariatric patients don't experience the same metabolic collapse that the Biggest Loser participants do. That study suggests that there's at least one way to lose weight that doesn't have this effect. In fact, it might be that the extreme crazy diet and exercise regime and rapid weight loss of The Biggest Loser is a uniquely bad way to lose weight.
posted by chrchr at 4:23 PM on May 2, 2016 [3 favorites]


Yeah, but bariatric surgery has its own issues.
posted by corb at 4:25 PM on May 2, 2016 [1 favorite]


These results really don't make sense, as far as I can tell. I'm not saying they're wrong, but we're definitely missing something huge (I've often thought this regarding nutrition).

Why the Calorie is Broken

I've been meaning to do a post around this article, but life... y'know.

"In one recent study, researchers found that mice fed a high-fat diet between 9am and 5pm gained 28 percent less weight than mice fed the exact same food across a 24-hour period. The researchers suggested that irregular feedings affect the circadian cycle of the liver and the way it metabolizes food, thus influencing overall energy balance."

It's complicated..... on many, many levels..... from your gut flora, to your lifestyle (Swing shift, anyone?), to yes, sometimes your willpower/allouttafucks level.....

I think to suss it all out we'd literally have to raise humans in carefully controlled environments from embryos...... and still we couldn't be sure (Plus it probably wouldn't pass an IRB)
posted by Gyre,Gimble,Wabe, Esq. at 4:28 PM on May 2, 2016 [6 favorites]


Yeah, I'm not suggesting that the bariatric surgery is a great way to go. I have no idea. I'm just saying that The Biggest Loser result is contrasted with at least one other weight loss method that doesn't produce metabolic collapse, which suggests that it's not the weight loss itself that causes this problem. It's something about The Biggest Loser.
posted by chrchr at 4:28 PM on May 2, 2016 [1 favorite]


one other weight loss method that doesn't produce metabolic collapse

I don't think bariatric surgery is a good model, if we want to posit that weight loss doesn't need to cause metabolic collapse. Bariatric surgery literally changes the way you absorb nutrients. It's just as likely that bariatric surgery is blocking the normal response to lower the metabolism that will always occur if reducing calories to the point of causing weight loss.

A slow and steady diet is a lot closer to the Biggest Loser than it is to the radical changes we make to the body during Bariatric Surgery.

After being diagnosed with being fat one too many times, I've taken the following position: I am open to the fact that my weight is causing my medical issues. If you, my doctor, feel that is the only possible cause of my problems, then we should apply to forgo the 6 month waiting period for bariatric surgery. If you feel that my weight does not require surgery yet, then let's stop talking about it.
posted by politikitty at 5:20 PM on May 2, 2016 [6 favorites]


"In one recent study, researchers found that mice fed a high-fat diet between 9am and 5pm gained 28 percent less weight than mice fed the exact same food across a 24-hour period. The researchers suggested that irregular feedings affect the circadian cycle of the liver and the way it metabolizes food, thus influencing overall energy balance."

I worked with a nutritionist when I was on an antidepressant that made me gain hella weight, and he said he'd had a lot of success with patients on anti-psychotics by not necessarily cutting carbs, but spacing them out throughout the day. All carbs all at once meant holding on to more carbs overall. So timing of eating, at least anecdotally, definitely has an effect.

Then I switched my antidepressant and I'm not nearly as willing to inhale the entire pantry when I get home from work now, so that helped a lot. My metabolism is probably shot to hell for good though, something else my nutritionist saw in his previous patients - even years after stopping the drugs they had to keep a steady carb, higher fat diet or they'd gain like crazy.
posted by chainsofreedom at 6:08 PM on May 2, 2016 [1 favorite]


One of the lowkey heartbreaking things about this paper is in the last two paragraphs, which points out that despite the BL contestant pool having even more severe metabolic adaptation than expected, they actually did an even "better" job keeping off weight long-term than the average dieter... and the average amount of weight loss was still "only" around 20kg. That's actually really impressive, and means that as a group, they really were highly motivated and did achieve something kind of extraordinary — and yet they're still treated as if they failed because the external standard they're being judged against is so unrealistic.

The comparison to bariatric surgery is really interesting, because it's a particularly effective (if radical!) treatment for obesity and yet we still don't really understand why. Comparing it to dieting is actually almost apples and oranges, because we know the benefit of gastric bypass is not just because it regulates calorie intake; instead it actually seems to alter signaling in some important ways that just dieting doesn't. In other words, it's not just an extreme permanent diet. But it also seems to affect a lot of things at once (inflammation, bile acids, the microbiome, insulin sensitivity -- notably there was no improvement in insulin sensitivity in the BL cohort at all despite massive weight loss!) so it's sort of hard to parse out which changes are causal/important. As a treatment it obviously is not very scalable but I think some people have hope that we can figure out what's going on in bariatric surgery patients, and then see how to make those same benefits available to the people who want them without them having to endure some kind of huge invasive procedure.

Incidentally the research I'm familiar with suggests that actually big dramatic weight losses are not necessarily any worse or better for you than slow steady weight loss (confirmed in the paper: "Rapid weight loss, such as that experienced by “The Biggest Loser” participants, is sometimes claimed to increase the risk of weight regain, but recent studies have failed to support this idea since weight loss rate per se was not observed to affect long-term weight regain [35, 36].").
posted by en forme de poire at 6:56 PM on May 2, 2016 [9 favorites]


It is kind of amazing that we still know so little about how our bodies use food, despite it being one of the most central aspects of our existence.
posted by Dip Flash at 7:18 PM on May 2, 2016 [10 favorites]


A friend of mine wrote about this just the other day. She was put on anti-psych meds at 19 to stave off serious suicidal thoughts. And while the drugs saved her life, she gained 100 pounds in less than six months, most of which she has never been able to take off. She has tried decreasing her psych meds recently, in order to try and lose some of the weight for health reasons, but the entire situation is a precarious balance of mental and physical proportions.

Yes, unfortunately massive weight gain is a frequent side effect of the New Gen Antipsychotics. I still know lots of people who consider them miracle drugs, though, because the difference between having active psychotic symptoms and not having any symptoms is huge on a personal level (and they tend to work VERY well.) And they actually have much less severe side effects than the old generation of antipsychotics, which caused uncontrollable tremors and a whole host of irreversible symptoms. BUT 100 lbs isn't that unusual in weight gain.

It's one of the reasons I'm pretty passionately against the lobbying by the drug companies to have these drugs prescribed for things like depression. They are serious drugs with serious side-effects, which are generally acceptable in cases of a disease like schizophrenia which tends to be life-threatening if untreated and responds poorly to other alternatives, and moreover gets worse over a lifetime if untreated. But I would only support prescribing them to someone with depression in a genuinely life-or-death-and-we've-tried-everything-else situation.
posted by threeturtles at 7:33 PM on May 2, 2016 [2 favorites]


Was planning to post this, totally unsurprised to find it here already. For the record, I was going to overreach with the title and try "The Once and Future Lipid" or "He's not heavy, he's my future self."

I'm a mid-40s guy who lost weight in my mid-30s, put it all back on and then some, and now am in my second attempt to get it under control. Currently successful but check back in 10 years. I briefly tried tracking calories and exercise and was scratching my head why I didn't already weigh like 140 pounds . . . I assumed the counts where crude estimates or I was hitting the bottle harder than I thought, but "basal metabolism off by several hundred calories" now looks like a good hypothesis.

I knew there are people out there who learned about thermodynamics in high school physics and think that makes them experts on dieting. Here we get this great article, a really compelling extreme case to frame the narrative, and a ton of scientists saying "we knew it was like this sure, but didn't know it was so extreme or lasted so long." It's actually a decent science article, a finding that is *not* shocking and put in context of the body of current research. So I am surprised we're still getting comments assuming there must be another explanation, like not adjusting for weight (which is the whole frigging point) or maybe it doesn't apply to most people (which it does, both based on individual measurements and epidemiologically.)
posted by mark k at 9:05 PM on May 2, 2016 [6 favorites]


Ignore the weight gain/loss aspect of it for a moment and think about the implications that people can metabolically survive on 700 fewer kcal/day than they do. If starvation is the historic state, why on earth would never-overweight people be burning nearly 1/3 more calories than what are actually needed to survive? Evolutionarily speaking, it makes zero sense - the higher metabolism folks would be weeded out by mass starvation in lean times.

This is looking at it wrong--it makes a huge amount of sense.

Anyone who had the ability to down regulate in times of starvation without dying had a huge advantage. Also people who could take advantage of "good times" had an advantage. Presumably there weren't many situations where there was population-wide obesity, so "regulate to the highest set point" didn't have any particular negative pressure. (So when my body is trying to make me fat, it is an evolved trait but not an adaptation.)

In terms of "why don't we all run at 700 calories less," you actually don't need a very strong selective pressure to be there. Even slightly reduced fertility or slightly slower muscle repair or endurance would give you an incentive *not* to run at the lower calorie rate as a default, as long as you could down regulate in lean times. You don't need to imagine strong advantages. (I note this is a just-so story, and the actual truth sounds like an area for research. But low fertility is more encouraging than the idea that my dieting has made me stupider--the brain being another good candidate since it's metabolically expensive tissue.)
posted by mark k at 9:13 PM on May 2, 2016 [3 favorites]


I think you're actually in agreement; zug's point, I think, is that it wouldn't make sense if those 700 kcal/day were just being burned off without any benefits, and so therefore, there are probably underappreciated costs to having an overly low BMR for one's weight.
posted by en forme de poire at 10:00 PM on May 2, 2016 [2 favorites]


I think you're actually in agreement; zug's point, I think, is that it wouldn't make sense if those 700 kcal/day were just being burned off without any benefits, and so therefore, there are probably underappreciated costs to having an overly low BMR for one's weight.

Well, zug used terms like "massive benefits" to running at the lower calorie count and for him the implication weight loss is perhaps "actively dangerous."

And I'm the opposite; I think it's so clear that the main benefit is actual the ability to have flexibility in calorie usage, you don't need to look any further for substantial benefits. You may get barely noticeable benefits for running at "normal" but nevertheless want to make use of the extra calories when they are there?

In one sense it's just a difference of degree and perspective but the alternate perspective is a genuine and serious disagreement (on my side at least). Arguing evolution demands a strong signal with impacts on individual functioning is incorrect; minor population-level effects are more than enough to explain it.
posted by mark k at 10:17 PM on May 2, 2016 [2 favorites]


And I'm the opposite; I think it's so clear that the main benefit is actual the ability to have flexibility in calorie usage, you don't need to look any further for substantial benefits. You may get barely noticeable benefits for running at "normal" but nevertheless want to make use of the extra calories when they are there?

Yeah, I think you've missed my point. What's the point of "flexibility in calorie usage" if that usage doesn't *do* anything? Those extra calories are being used for something, probably something important, and we have no clue what that something is. If you lose weight and you downregulate your basal metabolic rate, what exactly have you downregulated? Brain function? Thermal regulation? What changes has your body made compared to never-overweight people at the same weight as you? We literally have no idea.

It's concerning because if never-overweight people burn X calories and formerly overweight people burn X-600 calories, the implication is that the bodies of formerly overweight people are using fewer calories overall and therefore invoking the aforementioned tradeoffs, which might range in importance from "mildly important" to "life changing" - we really just don't know.

(also, for the record, I'm female)
posted by zug at 11:01 PM on May 2, 2016 [1 favorite]


Well, zug used terms like "massive benefits" to running at the lower calorie count

Also, you have it backwards. There must be benefits to running at the HIGHER calorie count, not the lower. Putting all those extra calories in the body is pretty costly and it bothers me that we have no idea what the benefits are (or from the opposite direction, we have no idea what the costs are of having a lower BMR).
posted by zug at 11:12 PM on May 2, 2016 [2 favorites]


Incidentally the research I'm familiar with suggests that actually big dramatic weight losses are not necessarily any worse or better for you than slow steady weight loss (confirmed in the paper: "Rapid weight loss, such as that experienced by “The Biggest Loser” participants, is sometimes claimed to increase the risk of weight regain, but recent studies have failed to support this idea since weight loss rate per se was not observed to affect long-term weight regain [35, 36].").

Sure, in studies, where (possibly non representative) people are given a diet to follow... Many of the broscientists (some of whom are actual scientists, as well as bros) and long-term maintainers I'm familiar with disagree :/ (E.g., Layne Norton and Eric Helms have talked about and witnessed metabolic adaptation in competitive bodybuilders who lose quickly for shows, and have suggested solutions they've seen work - namely, eating as much as possible for as long as possible, throughout WL.)

(I think taking longer can help for psychological reasons. It takes a lot of trial and error - and time - to tweak principles many feel are helpful [more protein, fat, fiber, usually] to your taste, available time, and budget, and really integrate this way of eating into your life. To, maybe, reeducate your palette, as well as your sense of proportion (i.e. actual portions), which is naturally skewed to favour underestimation. To learn to graciously respond to pressure to eat in a way that doesn't serve weight loss without compromising social and work relationships. To learn to detach from potentially derailing moments, and accept them as either part of life (birthdays happen, and cake is important, for crying out loud) or useful information to apply later (maybe you do need breakfast first thing to be positioned for more restraint at lunch), vs. reasons to beat yourself up. To prepare to shift from goal-focused weight loss to maintenance, a style of life that is going to carry on indefinitely. To give the mental map of your body time to adjust to reality.)

All that is practical knowledge many maintainers have found to be true, and widely share on WL forums. I'm not aware of any studies that look at this group (who are right there, in a naturalistic setting, with nutritional records, right there - which, even if they're not entirely accurate, will be more reflective of what people actually do on their own than what is measured in a tightly constrained study, or via retrospective reports).
posted by cotton dress sock at 12:02 AM on May 3, 2016 [4 favorites]


Most of the advice I see on the forums like that is along the lines of what the studies find.

Vox: At the individual level, some very good research on what works for weight loss comes from the National Weight Control Registry, a study that has parsed the traits, habits, and behaviors of adults who have lost at least 30 and kept it off for a minimum of one year. They currently have more than 10,000 members enrolled in the study, and these folks respond to annual questionnaires about how they've managed to keep their weight down.

The researchers behind the study found that people who have had success losing weight share a few things in common: They weigh themselves at least once a week. They restrict their calorie intake, stay away from high-fat foods, and watch their portion sizes. They also exercise regularly.

But note: These folks use physical activity in addition to calorie counting and other behavioral changes. Every reliable expert I've ever spoken to on weight loss says the most important thing a person can do is to limit calories in a way they like and can sustain, and focus on eating more healthfully.

posted by Drinky Die at 1:10 AM on May 3, 2016


yes, the treatments we have currently for obesity are more severe than we would like, hopefully they will be a medical horror story explained by the culture of shame and fat-hating that prevailed in this part of the 21st C


This graphic is a good place to start to unpick the complexity of the challenge we face in getting to grips with a prevention agenda.

(I speak as someone involved in a back-office capacity with the development of metabolic surgery and someone who supports patients who have chosen this option on a charity basis)

I'm seeing Public Health initiatives here in the UK working really well on a population level but it's very, very slow to charge an aircraft carrier in mid-ocean.

What I hope we see with this study is the evidence that has been very carefully verified by the peer review process to date has known for the best part of a decade and translating that evidence to a critical mass audience by linking it to something many people watch because they desperately want a solution to their pain. there is increasing use of the celebrity phenomenon to address a public health issue. Jane Goody -Cervical Cancer, inherited Breast Ca -Angelina Jolie.....

I also nervously clicked on the thread, as I've mentioned in comments over the last few years on Green and Blue much of the research that has been in the public domain for about 20-30 years about obesity, which demonstrated that it is not about willpower, diet and exercise exclusively.

The nasty responses have made me back off contributing more to these discussions. It didn't stop me, I'm proud of a best answer in 2012 when someone's relative was contemplating bariatric surgery, an area I know a lot about.
I have a post-grad in obesity studies, I was key in setting up an important meeting in 2010 in the UK that unblocked some barriers to progress among the surgical societies here tasked with setting the standards of metabolic surgery in the UK, and I contributed to a significant piece of work to prove that the UK National Health Service would save many millions of pounds annually by investing in metabolic surgery.

" But until that day comes this is a safe, effective therapy for the majority of patients. It saves the health service a lot of money as a piece of work I was enagaged in shows (UK specific) but it also has to deal with an extremely successful Diet Industry that is making billions of dollars of the back of those effectively suffering this chronic and intractable condition and getting away with offering them snakeoil and then blaming them when it doesn't work.'

There is a place for companies such as Weight Watchers, Jenny Craig etc. for people with moderate overweight and along with bariatric surgery they can be very helpful resources for people with obesity, morbid and super morbid obesity. But there is no place for the routine but extremely lucrative scripts for drug therapies as yet. However, they make companies very wealthy so along with societal disgust for the fat, industrial levels of profits from their suffering will continue to ensure that a message is spread that this is a dangerous, drastic surgery that doesn't work."


When I said that metabolic surgery was as safe as Gallbladder removal, and indeed Roux-en-Y bypass is now performed more in the USA than that operation, I 'took the hump' as the Brits say, when someone was particularly nasty to me and I took my ball and went home when what I should have done was patiently, again, posted the link.

Like all of us who are long term contributers here on MF, sometimes it's hubris and sometimes it a simple, "why don't you do a simple Google search, you don't even have to PubMed the fucking thing!" it's an exhaustion born of the microagression that you know is behind the challenge. I contribute on this site via microcompassions, in the past, sometimes daily acts, sometimes costing thousands of dollars, I'm happy to contribute when there is a genuine need. But the kick-back I get when posting while fat and informed is of a similar flavour to the kick-back I sometimes get when posting while female and someone who has experienced sexism (although thanks to many Femite warriors in the Blue and grey that has reduced significantly)...we eventually will move to a situation where the knee-jerk "it is all about willpower and I know cos I did it!" will inhabit the same space as 'not all men....'

Bottom line is that the only treatment available right now to this generation is METABOLIC surgery, not weight loss surgery which is a fortunate byproduct of this intervention in most cases but by no means all, not obesity surgery, although it does treat that intractable long term condition, metabolic surgery. The evidence of remission of Type 2 Diabetes (in the non-celebrity arena we can't call it reversal) alone is so overwhelming that the only way this is not a far more utilised intervention has to be deliberate misinformation on a massive scale.

Alongside this and definitely for the future, interventions to make us move more, even simple office interventions that make exerise easier to do, get, engage in.

To be perfectly honest though, there's as much greed, ego, politics in this field as in any other, and wonderful interventions life Gastric Banding are no longer being offered or supported due to factors, get this, that have little or nothing to do with it's success.
Each time I speak about this, even when I give talks to metabolic surgery support groups around the UK on behalf of the incredibly amazing charity support network www.wlsinfo.org.uk I get the one horror story based on a completely unacceptably adjusted, or never properly adjusted gastric band. It is finicky (very scientific term for individually variant) to get a band properly adjusted but it is safer than the next most frequent intervention and the one which dominates (for largely political and ego reasons) in the USA Roux-en-Y bypass.

Not to mention the frothing at the mouth in the international conferences a few years back when mention was made of the Mini-Gastric-Bypass! Hopefully, the 2014 position statement from the British Metabolic and Obesity Surgery Society, an organisation I've worked closely with in the past, will stop the frothing. it also has the best example of English understatement in a medical paper I've ever read
"
There is now published experience with this procedure of more than 6000 patients,
performed over a period of 16 years, by a number of surgeons from different parts of the
world. Their results, to date, suggest non-inferiority of MGB compared to the gold standard
Roux en Gastric Bypass in terms of mortality, weight loss, comorbidity resolution, and quality
of life
. However, most series have only short follow up""""

I love it, .... 'non-inferiority'

if we tell people in their teens that once you break the weight regulatory mechanisms (around about BMI28-32 depending on so many individual bloody variables...sigh) and stay above that for a period of time you may never regain 'normal' weight regulatory mechanisms and have this distressing and soul-destroying fight for the rest of your life.....it may help.

if we systematically plot our baseline rate on an annual basis, and manage to stick to it, it may help .....[the greatest mindfuck of my adult life is that I can gain 10lbs a year on one apple a day over 1350 (it used to be 1450 but hey, age....)

if we tell people in their 40s and 50s now, that have persistently struggled to achieve a healthy weight that metabolic surgery is as safe as a gall-bladder operation and and if we educate ourselves to refuse the pressures from the billion-dollar diet industry that continue to promote the bariatric horror stories, or even just emphasise the ones that don't do well, ......it may help

as many have mentioned above, you cannot tell what someone eat just by looking at them, you can have willpower up the wazoo and still be fat, the very least I expect from my community after the evidence is collected in this fashion is more compassion in the dialogue. I teared up when I looked at the favorites of the early comment in this thread......to me they are evidence that so many people are suffering with this. Y
posted by Wilder at 1:43 AM on May 3, 2016 [15 favorites]


I just realised i heard an anecdatum of the intersection of feminism and bariatric surgery that most surgeons in the field freely quote but I never had the time to verify.

Roux got his name on the bypass technique invented by his father-in-law, which for surgeons is immortality ....now either it was a wedding gift, or it was a 'thanks for taking her off my hands', in either case it's weird.
posted by Wilder at 1:56 AM on May 3, 2016


http://www.medicaldaily.com/biggest-loser-weight-loss-slow-metabolism-384465
posted by Nancy Lebovitz at 2:00 AM on May 3, 2016


I remember doing a brain dump with the wonderful Alex Blakemore, genetics of obesity researcher at Imperial wondering at the emotional, physical and mental toll of constantly trying to stay under your baseline MR, the constant yo-yo dieting and in particular the social cost in a culture obsessed with youth, beauty and fitness (dressing up a thiness expectation) particularly for women.

as so many of the commenters upthread have mentioned the mental acuity gap while dieting, the thought occurred as it must have to many female researchers in this field.... is this one of the elements to explain the persistent gender pay gap? The fact that dieting to 1,000-1,200 takes real planning and interrupts social and family life quite a lot, add the sheer time and energy required for the sometimes almost cruel levels of exercise to live on even a healthy diet with such a low BMR, is a relatively constant activity among women, more so (although this is changing) than men.

What could we have been doing with this time and energy?, many people on here managing other long term medical conditions will know what I am talking about but they may never have associated it with something we think as 'simple' as keeping to a healthy weight.
posted by Wilder at 2:25 AM on May 3, 2016 [6 favorites]


This thread gives me a headache. I was hoping that more people would respond to the point I made with, rather than talking about how they lost weight: "We really need body and fat positivity and acceptance, and to really fundamentally re-think how we treat people with fat bodies."

I hate this whole willpower bullshit, and am down to upend paradigms related to how we think about weight and bodies and people, ala Wilder. As someone who isn't working in obesity research but is a human being, I would just like more language and dialogue and frameworks for how to start with that, in a way that promotes scientific literacy. The New York Times and Harvard Medical School and blahblah keep regurgitating the same stuff when it comes to emphasizing on losing weight.

I honestly care so little to learn stories of how people lose weight. Personally, I lost 26 lbs, but a lot of it is basically just deciding to not eat and maintaining my insulin resistance and graduating from college and spending a lot of time recovering from trauma and becoming a hermit from the world for 6 months. Do I dare prescribe that for anyone else? Is it even realistic for anyone else who isn't me? Hell no, because I was lucky enough to even be able to LOSE weight. I had no guarantees that it would even work. I know for a fact the whole thermodynamics of calories in/calories out is far more complex, and I think it's close to magic that I even did lose weight. I have friends who can't, and they shouldn't be dehumanized for it.

That doesn't solve the larger problems of society's thinking about fat. What I want to know is how we can fundamentally rethink about this problem, so that 20-35 years from now, we can laugh in shock and incredulity that we thought so basically.

This is for the sake of my loved ones who are so chronically sad when harassed on a nearly daily basis to lose weight. This is for the people who fatshame people, because they themselves are terrified of being stigmatized and being seen less as human due to their weight. This is for the bigots who take on fatshaming as one of the most commonly accepted prejudices today. I swear, if someone tells me to eat less and move more one more time...
posted by yueliang at 4:07 AM on May 3, 2016 [8 favorites]


as so many of the commenters upthread have mentioned the mental acuity gap while dieting, the thought occurred as it must have to many female researchers in this field.... is this one of the elements to explain the persistent gender pay gap? The fact that dieting to 1,000-1,200 takes real planning and interrupts social and family life quite a lot, add the sheer time and energy required for the sometimes almost cruel levels of exercise to live on even a healthy diet with such a low BMR, is a relatively constant activity among women, more so (although this is changing) than men.

This is another way of saying "women are paid less because they are less intelligent", only with an added dollop of "but it isn't their fault, it is because of their diets!"

Please don't do this.
posted by a fiendish thingy at 5:49 AM on May 3, 2016 [4 favorites]


So, what was the one person whose metabolism recovered (see graph in the NYT article) doing? Pauls' metabolism also recovered somewhat, presumably due to gastric bypass surgery. What about the only other line which goes up instead of down on that graph?
posted by gakiko at 5:52 AM on May 3, 2016


[Dieting] takes real planning and interrupts social and family life quite a lot, add the sheer time and energy required for the sometimes almost cruel levels of exercise...

...and the emotional roller-coaster of the "journey" too, as one replaces old habits with new, confronts the dynamics of important relationships, copes with hunger and exercise/injuries among other discomforts, etc. It all certainly adds to cognitive load.
posted by carmicha at 7:00 AM on May 3, 2016 [3 favorites]


The full text is interesting. The measured RMR is lower than the predicted RMR, but it's still 1900 kcal/day. I had expected much less, based on all the talk about starvation mode. There are plenty of middle aged women who have never lost or gained weight who have RMRs that are hundreds of calories less. A typical RMR for a middle aged women of normal weight is about 1200 kcal/day. If they're not particularly active, their total daily energy expenditure is about 1500 kcal/day. Yet, serving sizes still assume that you eat about double that, you don't really ask for half a glass of wine at a bar, etc.

The article also mentions other studies with different results ("Longer-term studies in women found no significant sustained reductions in RMR following weight regain") so it's quite possible that the results here are related to the specific program followed in TBL. It's still interesting of course, but I'm disturbed by the interpretation that I'm reading in so many places that this is the definite study that proves that trying to lose weight is futile.
posted by blub at 8:04 AM on May 3, 2016 [4 favorites]


I just think there has been a total lack of discrimination in looking at important differences between groups of people and different WL methods, and the takeaway message that's gotten through with this is, "it's impossible"... I mean, the article refers to "the human body" - no, the study looked at bodies that have been above a certain BMI for a certain amount of time, and were then put through TBL, specifically.

if we tell people in their teens that once you break the weight regulatory mechanisms (around about BMI28-32 depending on so many individual bloody variables...sigh) and stay above that for a period of time you may never regain 'normal' weight regulatory mechanisms and have this distressing and soul-destroying fight for the rest of your life.....it may help.

Right - so I barely hit a BMI of 30 for a very brief amount of time, in adulthood. Totally possible - probable - that people like me never got hit by that kind of storm. People like me might benefit from well-supported conservative WL methods, like diet and exercise together. Those people are hearing a message that doesn't serve them.

1900 isn't a crazy number in absolute terms, imo. However, asking people with dysregulated metabolisms to cope with intolerable hunger at that intake, without providing some kind of support - whether it's surgery or medication; definitely more kindness is required - is punishing. They need different kinds of answers.

Another thing is that there may be other differences between various experiences of overweight and obesity, and maybe some of those need to be looked at, at the same time. One thing the Adverse Childhood Experiences Study found was that people who'd experienced certain kinds of trauma in childhood were very much more prone to obesity than others. That is important knowledge to have, from both a prevention perspective, and a treatment perspective. If obesity is - for some people - a lifelong coping mechanism, one that yields effects that attract different kinds of trauma, for shit's sake, that is some snowflakey stuff that doctors (and everyone in their medical world) need/s to be mindful of.

And journalists reporting on this, and researchers, need to be careful AF about how they talk about all of it.
posted by cotton dress sock at 9:07 AM on May 3, 2016 [8 favorites]


People like me [...] are hearing a message that doesn't serve them.

So what? You hear that message literally everywhere else.

American life is saturated with the message that if you just eat less and try hard, you can be thin. You are hearing plenty messages that serve you. You are hearing that you finally get to be worthwhile because you lost 20-50 pounds.

Guess what? It doesn't make you worthwhile. It doesn't make you a better person. Your worth is not derived from your weight, and the fact that you need to be in here trumpeting your success says so much about the unhealthy messages that society can't seem to unpack.

The people hurting are not people who successfully lost weight through mechanisms that might have worked, but certainly not in ways that we fully understand. The people who need scientific study and development are not people who can "healthy living" their way into being healthy. It's the people for whom healthy living isn't sufficient. Most people have a strong preference for lifestyle modification over medication and surgery. They're still going to try that first.

You don't need a scientific breakthrough. So why say it's medically irresponsible to focus on the people who do? Why would you demand that researchers take their limited resources and devote them to recognizing and acknowledging you exist?

People don't stay fat because it's socially acceptable. It's moral panic to worry that scientific evidence on the difficulty inherent to weight loss will fuel the obesity epidemic rather than possibly mitigate the vast discrimination we heap on fat people.
posted by politikitty at 10:39 AM on May 3, 2016 [4 favorites]


Sure, in studies, where (possibly non representative) people are given a diet to follow...

IIRC though that's not just from artificial environments: the National Weight Control Registry you referenced has also observed that successful weight-loss maintenance can happen either with a bigger change up front or with small gradual changes, and I don't think they've observed any correlation between initial weight loss and maintenance. And even with a randomized study, the variable we're talking about is weight maintenance, which is measured months after the diet phase (and people aren't typically sequestered while in the diet phase, so it's not ultimately that different from commercial portion control services, except of course that you're under a doc's supervision). It seems to be more about what a given individual prefers; some people might find small changes easier to acclimate to, others might be more motivated by seeing a bigger change up front. Maybe there's other research that shows a difference in resting metabolic rate between people who lost weight quickly vs. slowly, I'm just not aware of it?
posted by en forme de poire at 10:50 AM on May 3, 2016 [2 favorites]


So why say it's medically irresponsible to focus on the people who do?

It's irresponsible to say it applies to *everyone*, because it might *not*, there is not enough knowledge to say based on this sample, and presenting this research as an authoritative, universal, final statement on "how the human body works" seems overconfident. To say the least.

Guess what? It doesn't make you worthwhile. It doesn't make you a better person. Your worth is not derived from your weight, and the fact that you need to be in here trumpeting your success says so much about the unhealthy messages that society can't seem to unpack.

I don't think I'm worth more at this weight than I was at any weight, wtf - please stop with that? Yes, I think it is important to make some distinctions, which is why I'm talking here. Am I "trumpeting" my results, really? I didn't think so... my intention was to say it is possible FOR SOME. It is - for some.

The people hurting are not people who successfully lost weight through mechanisms that might have worked, but certainly not in ways that we fully understand. The people who need scientific study and development are not people who can "healthy living" their way into being healthy.

Agreed - reporting should make those distinctions. Research should find those distinctions.

Why would you demand that researchers take their limited resources and devote them to recognizing and acknowledging you exist?

I'm not. See above.
posted by cotton dress sock at 11:19 AM on May 3, 2016 [4 favorites]


There are plenty of middle aged women who have never lost or gained weight who have RMRs that are hundreds of calories less. A typical RMR for a middle aged women of normal weight is about 1200 kcal/day.

Half of the contestants were guys, the mean age was 35, and the mean weight after weight loss was around 200 lbs, so a middle-aged woman of average weight is a pretty skewed comparison. That's why they compared the RMR to what they would expect given the participant's gender, age, and weight.
posted by en forme de poire at 11:47 AM on May 3, 2016


(Also, do you have a cite for that 1200 kcal/day figure? That seems really low to be a "typical" value based on RMR calculators.)
posted by en forme de poire at 11:57 AM on May 3, 2016 [3 favorites]


From the headline: A study of their struggles helps explain why so many people fail to keep off the weight they lose.

Not all. Many. It's right there in the headline.

The infographic continues: Nearly all the contestants have slower metabolisms.

The comment you pull from to worry your experience is being erased: if we tell people in their teens that once you break the weight regulatory mechanisms (around about BMI28-32 depending on so many individual bloody variables...sigh) and stay above that for a period of time you may never regain 'normal' weight regulatory mechanisms and have this distressing and soul-destroying fight for the rest of your life.....it may help

The reporting does not use absolutes. It does not say it is impossible to lose weight through calorie reduction and increased exercise.

It simply says that it's not a large portion of the people who are currently obese. Your concern that a fat person might miss out on the opportunity to not be fat is problematic. Consider the underlying assumptions: Paternal concern some individuals are not trying as hard as you think they should. The judgement of being fat is so bad, we should spare everyone possible who can avoid it. That it's irresponsible to discuss fat people, without first prefacing all the ways that you can avoid being in this demographic.

I know that you say you don't hold those underlying beliefs because you hold the belief that people shouldn't be judged for their weight. But that's not how social values work. Cognitive dissonance is a phenomenon because it is possible to to live with contradictory beliefs. It's just so uncomfortable that we weasel ourselves out of acknowledging it (see: white fragility). Despite my deeply held beliefs about body positivity and feminism, I still struggle to break out of the unhealthy values that we collectively live in. I just have to be more vigilant about it, because falling into those holes is emotionally damaging because it's an unhealthy belief about myself.
posted by politikitty at 12:06 PM on May 3, 2016 [1 favorite]


calories in = calories out is bullshit.

Calories in, calories out being bullshit is not what this study is about. It's about explaining one way out of thousands that accurately calculating out is really hard for any particular individual. People who count calories tend to be pretty familiar with a lot of those ways. You can use two different pieces of equipment to track the same exercise and get widely different calorie numbers, for one thing, to say nothing of the individual body factors.

So what? You hear that message literally everywhere else.

American life is saturated with the message that if you just eat less and try hard, you can be thin.


What American life is saturated with is a cyclone of bullshit and fat shaming. I don't think that is what CDS is calling for. There are a lot of people who are stopped from losing weight by not knowing how, or because they were told misinformation about how, or because fat shaming in general complicated the whole thing so much they don't even try. I was one of them for a long time. I did need positive, factual information to be provided to me by a non-shaming group of people and I think that is not uncommon when, I think we are all agreed, there is so much misinformation out there. But I'm still fat, and I still love my body, and that's okay.

You are hearing that you finally get to be worthwhile because you lost 20-50 pounds.

Guess what? It doesn't make you worthwhile. It doesn't make you a better person. Your worth is not derived from your weight, and the fact that you need to be in here trumpeting your success says so much about the unhealthy messages that society can't seem to unpack.

-
I know that you say you don't hold those underlying beliefs because you hold the belief that people shouldn't be judged for their weight. But that's not how social values work. Cognitive dissonance is a phenomenon because it is possible to to live with contradictory beliefs.

What is CDS supposed to do with this? You baselessly accuse her of holding vile beliefs about her own body and of fat people and then chalk up anything otherwise she has to say about her own mental state to cognitive dissonance?
posted by Drinky Die at 12:23 PM on May 3, 2016 [5 favorites]


Mod note: Folks, this is a tough topic, but let's not make it worse by turning the focus on individual members and whatever they think about their own bodies. Plenty to talk about in how to understand the study etc.
posted by LobsterMitten (staff) at 12:25 PM on May 3, 2016 [4 favorites]


The comment you pull from to worry your experience is being erased: if we tell people in their teens that once you break the weight regulatory mechanisms (around about BMI28-32 depending on so many individual bloody variables...sigh) and stay above that for a period of time you may never regain 'normal' weight regulatory mechanisms and have this distressing and soul-destroying fight for the rest of your life.....it may help

I pulled that comment because I think it highlights one of those differences that might matter. I lucked out. That's what I'm saying, that's why I pulled it.

If I failed to communicate what I meant, that's my error. But I really encourage you to consider refraining from making assumptions about people's intentions and state of mind.
posted by cotton dress sock at 12:27 PM on May 3, 2016 [4 favorites]


Half of the contestants were guys, the mean age was 35, and the mean weight after weight loss was around 200 lbs, so a middle-aged woman of average weight is a pretty skewed comparison. That's why they compared the RMR to what they would expect given the participant's gender, age, and weight.
But I think that comparing the RMR to that of other obese relatively young men is somewhat skewed too. At least, from the article it's easy to get the impression that these people are eating a small amount of food (800 calories less than average for their weight!) while still being obese. But on average they're still eating 3400 kcal/day (their TDEE). That was a pretty big disconnect for me. And while that doesn't mean that it's therefore easy to lose weight (It's not, been there, done that), I think it's still relevant to know that while they might not eat a lot when compared to other obese people, it's not really a small amount of food in general. I think this is important because it is relevant for the kind of help people need if they do want to lose weight/keep it off. If the problem is that they can only eat tiny amounts of food, that requires a different approach than if the problem is that they find it hard to eat less (because for example their hunger signals are out of whack, they're socialized to eat more, etc.).

Here's a link to an RMR calculator. A 50 year old women who is 5'5" with a BMI of 20.8 has a predicted RMR of about 1200 kcal/day.
posted by blub at 1:23 PM on May 3, 2016 [4 favorites]


consider refraining from making assumptions about people's intentions and state of mind.

You're right. Your intentions don't matter. The culture that exists and frames your message matters.

You might have the best of intentions. But consider how it feels as a fat woman, that I cannot discuss my experience as a fat woman, I can't read and discuss advances in obesity research, without having to divert a fair amount of attention to make sure we're clear about the ways people can avoid being me. Because being me would be a terrible experience.

We know how dehumanizing it is to tell that to trans folks, or gay folks, or any other minority that has a modicum of choice in how visible their identity is. I'd like you to recognize that it's dehumanizing to spend so much time in a society devoted to eradicating my existence. The health issues associated with my weight are pretty much a fig leaf.

The type of participation you're engaging in creates an unspoken expectation that I prove I'm one of the acceptable fat people. Who has acted with discipline well above the average person at all times, no exceptions for being human. Otherwise it is irresponsible to tell me that maybe it's okay I had priorities that I felt were more important than my weight.
posted by politikitty at 1:32 PM on May 3, 2016 [4 favorites]


We know how dehumanizing it is to tell that to trans folks, or gay folks, or any other minority that has a modicum of choice in how visible their identity is. I'd like you to recognize that it's dehumanizing to spend so much time in a society devoted to eradicating my existence.

I will do that, I recognize this.

The health issues associated with my weight are pretty much a fig leaf.

I disagree with this. I accept the findings of research on risks associated (at a population level) with weight. I am also sad about some people I've lost because of some outcomes that have been attributed by their direct care professionals to their weight, and I worry about the people I know whose health and quality of life have been adversely affected by their weight (according to them and their direct care professionals).

But consider how it feels as a fat woman, that I cannot discuss my experience as a fat woman, I can't read and discuss advances in obesity research, without having to divert a fair amount of attention to make sure we're clear about the ways people can avoid being me. Because being me would be a terrible experience.

I can understand this, but am not sure how it is to be avoided in a discussion of research on weight loss.
posted by cotton dress sock at 2:18 PM on May 3, 2016 [5 favorites]


The health issues associated with my weight are pretty much a fig leaf.

I disagree with this.


Clarification: not YOUR weight.
posted by cotton dress sock at 2:24 PM on May 3, 2016 [2 favorites]


Checking in on the weight loss thread (as I do) from the stairclimb machine (as I do, it says I burnt about 1000cal running 6mi in an hr)

STILL FAT.

In the last 6 months, I've added a personal trainer to my regimen, and doing a more guided mix of weight training and cardio. it is a privilege that I'm able to do this on the money and time allowed by my struggling business.

STILL FAT.

Despite sickness and depression, I've maintained a minimum of four 75 min or more. The only change in my diet is that I gave up alcohol for a couple months for my mood, but the numbers on the scale remained flat lined.

STILL FAT.

I *AM* gaining muscle, which I hopes accounts for the net gain of 5 pounds over the last 6 months, but the fat's still there. Big belly, big tits, big biceps, big calves. I'm glad some women are turned on by the Vincent D'onofrio as Kingpin/Michael Chiklis as anything look, because I think that's the best I can hope for if I never give up.

¯\_(ツ)_/¯
posted by elr at 2:56 PM on May 3, 2016 [5 favorites]


Correction: the best I can hope for if I can do slightly better than maintaining momentum to counteract my aging metabolism, assuming I am never sidelined by medical, emotional, or financial issue preventing me from continuing,

But hey, calories in calories out, not rocket science I guess, right?
posted by elr at 3:03 PM on May 3, 2016 [1 favorite]


Just to clarify, your RMR is your Resting Metabolic Rate. It is the bare minimum calories required to keep you alive - it is literally what you would use in a coma, not walking around and going to work and doing any sort of activity. So 1200 calories a day is what the woman in the above example needs to keep breathing, not actually live any kind of life.
posted by skycrashesdown at 3:05 PM on May 3, 2016 [2 favorites]


. . . without using any stored fat.
posted by chrchr at 3:13 PM on May 3, 2016


Yeah mea culpa I was looking at the number with the activity level added in.

And while that doesn't mean that it's therefore easy to lose weight (It's not, been there, done that), I think it's still relevant to know that while they might not eat a lot when compared to other obese people, it's not really a small amount of food in general.

I guess I just don't find 3,400 (or 3,000 calories, which was their average TEE right after the competition) to be a particularly shocking amount of food: I'm a below-average-BMI 31-year-old male with a desk job, but 3,000 calories is close to maintenance for me. That's why I'm not sure what the point of comparing to a middle-aged woman of average BMI is, because average RMR already varies so much by factors like age, gender, total weight, and total lean mass. If you look at those tables the average contestant had a lean mass of around 140 lbs; an average woman of your description would only have around 90 lbs (assuming a weight of 125 lbs and a body fat percentage of 25-30%, which is average for women). They're just not that comparable.
posted by en forme de poire at 4:36 PM on May 3, 2016 [1 favorite]


One of the study's findings was that former contestants had very low levels of leptin, a hormone that regulates hunger and satiety. Basically, their hunger cues were totally out of wack with their metabolisms: they got ravenously hungry even though they were eating enough calories to maintain their weight. So it's not just that they needed fewer calories than most people their size. It's also that their bodies kept telling them that they needed more calories. That's a seriously difficult double-whammy to content with, especially if you also want to do anything other than maintain your weight. Constant hunger is distracting.

The article says that this points to a potential avenue for treatment: it may be possible to simulate leptin and trick people's bodies into giving them more appropriate hunger cues. So that's something.
posted by ArbitraryAndCapricious at 5:22 PM on May 3, 2016 [5 favorites]


I can understand this, but am not sure how it is to be avoided in a discussion of research on weight loss.

That assumes that weight loss is unequivocally desirable and good.

It's not. It alleviates joint pain, and lowers the risk for joint damage. It might help alleviate comorbid issues like blood pressure, asthma, type 2 diabetes, heart disease, etc in some individuals. But it should be recognized that we don't fully understand the correlation and causation of these comorbid disorders, which is why not everybody who loses weight sees an alleviation in their symptoms. It also has a high failure rate. Not just because patient compliance is hard, but also because it's common (not universal, but common) that bodies reject the weight loss.

Any discussion about the research on weight loss MUST be able to acknowledge that weight loss is not a reasonable treatment plan for many people. Becoming me is not a bad thing. It is a morally neutral thing that *might* correlate with other life-altering diseases which have multiple treatment options besides diet and exercise, or even more broadly: weight loss.
posted by politikitty at 5:47 PM on May 3, 2016 [6 favorites]


some of the useful data coming out of England (which is now separate from the other nations of the UK in terms of healthcare)

The Health and Social Care Information Centre Statistics on Obesity, Physical Activity and Diet - England, 2016

This statistical report presents a range of information on obesity, physical activity and diet, drawn together from a variety of sources.

The topics covered include:
Part 1: Overweight and obesity prevalence among adults and children
Part 2: Health Outcomes; presents a range of information about the health outcomes of being obese or overweight which includes information on health risks, hospital admissions and prescription drugs used for treatment of obesity
Part 3: Physical activity levels among adults and children
Part 4: Diet among adults and children, including trends in purchases, and consumption of food and drink and energy intake

Each section provides an overview of the key findings from these sources, as well as providing sources of further information and links to relevant documents and sources.

Read more at the site linked to above
posted by Wilder at 6:29 AM on May 4, 2016




Adding to my previous comment: exercise may contribute in a small way to weight loss (if weight loss is your goal and your eating plan / genetics / etc. are supportive) but we've all heard that it's a good thing to make part of your life if at all possible (physical limitations considered).

But what about mental and emotional blocks? This article is explicitly written for depressed people who have gotten the lecture but feel overwhelmed and guilty and utterly incapable of even starting, but it's probably applicable to even more people who find that anxiety, perfectionism, ADHD or just a busy, complicated life makes them think they can't even start.
If you’ve struggled with depression at any point in your life, you’ve probably heard some well-meaning soul say “just try to get some exercise, it’s good for your mood!” Annoyingly, they’re right; I don’t think that exercise can single-handedly cure depression or treat its symptoms, but it’s clearly helpful for many people who struggle. In the 10 years I spent in the fitness industry, both as a personal trainer with depressed clients and as the depressed client myself, I’ve seen physical activity provide focus, routine, comfort, and even assistance with physical health when it feels like everything else is going to hell.

But there’s one thing that never, ever helps people who are dealing with situational or clinical depression: telling them that exercise will help. ...

The fitness industry talks a lot about “exercise lifehacks for depression!!!”, but it seems to be coming from a place of ignorance about the cold war going on in the average depressed person’s head. Most of these training tips and listicles read like they came from people who have faced very little adversity in their lives, and who think that their own health is entirely the product of their own hard work. Even if that’s not true, these pieces are certainly written by people who haven’t let their hardships add any nuance to their argument. The introductions talk about how great exercise is for you, and then they jump straight to tips on motivation, routine, and the physical activity itself. Those tips aren’t necessarily wrong, but when you’re actually suffering, they sound about as realistic as South Park’s underwear-thieving gnomes. Step 1. Realize that you should exercise. Step 2 ? Step 3. HEALTH!

When you’re depressed, that question mark can be a barely navigable labyrinth of garbage fires fueled by physical and mental exhaustion, self-loathing, defeat, and frustration. The last time I found myself trying to hack through that mess during a particularly dark period, I started to come up with my own list of bare-bones, practical tips to help me face the idea of moving again. Now I’m sharing them, in case they might help someone else in a similar position. I stress the word “might.” If you’re depressed, the last thing you need is another asshole telling you what you should do. But if you’re looking for somewhere to start, I’ve been there too.
posted by maudlin at 7:36 AM on May 5, 2016 [4 favorites]


I guess I just don't find 3,400 (or 3,000 calories, which was their average TEE right after the competition) to be a particularly shocking amount of food:

Sorry if this is insensitive given the topic of this thread but I'm supposed to eat 2000 calories according to my personal trainer and it's incredibly difficult. I feel almost sick by the end of the day. I honestly don't have any clue how people do this. What are you eating? (not directed at you specifically, en forme du poire)
posted by AFABulous at 10:45 AM on May 5, 2016 [1 favorite]


Here is a followup article that I liked



http://www.huffingtonpost.com/summer-mclane/post_11814_b_9843878.html
posted by bartonlong at 11:39 AM on May 5, 2016


AFABulous - when we did our big diet change, we relied on a lot of lower carb nuts. if you snack on them all day it doesn't feel like a lot, but the calories stack up. cheese is another good place to look for calories. get you a membership to sams or costco if you can to help with the sticker shock.

if carbs aren't as much of a worry, and you want it cheaper, spoonfuls of natural peanut butter with some local honey mixed in. for low carb and cheaper, avocados are great (and can be easily whipped into a dressing to toss cold chicken/cucumber/tomoates/red onion in if you don't want to eat it in chunks.
posted by nadawi at 12:00 PM on May 5, 2016 [1 favorite]


oh, and the weightlifter guys i see at the grocery store can always be picked out by their relatively empty carts and gigantic supply of milk - i assume both for post work out protein and for raw calories.
posted by nadawi at 12:11 PM on May 5, 2016 [1 favorite]


Why the weight loss study everyone has been sharing is misleading:

Although the study was a damning indictment of the show, it doesn’t apply to those of us trying to lose weight with less extreme measures. There’s a substantial body of research on whether, and how much, your metabolism slows after weight loss, and the “Biggest Loser” study is a definite outlier. No other study shows such a large slowdown over such a long period of time.
posted by chrchr at 6:25 PM on May 5, 2016 [2 favorites]


I honestly don't have any clue how people do this. What are you eating?

Carbs (some complex) and some saturated fat, tbh. A normal dinner portion for me would have around a can's worth of beans and a couple of cups of pasta, plus vegetables and cooking oil -- it's not hard to get to ~1K calories with that meal alone, especially if I add some grated cheese. A somewhat lighter breakfast and lunch gets me to the mid-to-upper 2000s; I also push milk (or Lactaid, or kefir) and snack between meals when I'm trying to bulk. But I totally get what you're talking about; breaking my set point is work, and bulking often leaves me feeling kind of bloated and sluggish.

Why the weight loss study everyone has been sharing is misleading

I think this is really sloppy. The studies they compare this one to are 1. a study where people only tried to lose 5% of their body weight (not that comparable), 2. studies of bariatric surgery, which as I said before ITT is known to be a super different intervention from mere diet and exercise and is thought to actually have a unique mechanism of action, and 3. a bunch of studies that do indeed show some amount of metabolic adaptation, just not as much.
posted by en forme de poire at 6:50 PM on May 6, 2016 [4 favorites]


‘Biggest Loser’ drugged us so we’d lose weight

I have no idea if this is credible.
posted by Drinky Die at 7:13 AM on May 22, 2016


That story misquotes Yoni Freedhoff and he's furious. Tweets start here: I've quoted the whole thing below.
I hate being misquoted. Did an interview about the Biggest Loser with the NY Post. Reporter really wanted me to say that the reason for recent study's results could have been metabolic stress. [I think he means that the story quotes him as saying it could have been due to psychological rather than metabolic stress] Over and over again I pointed out that as to why the outcomes were what they were there really was no way of knowing, and that while it was possible it had to do with psychology, that was extremely unlikely given there ... Is really crappy to give interviews and have your words warped for the sake of a journalist's angle. In this case journalist wanted to blame outcomes on the show's awful nature. Readily agree the show sucks. That I always knew. Now I know @NYPost' reporting sucks too. I also was extremely clear to point out that non-surgical weight losses of >40-50% of body weight in the absence of extreme efforts were exceedingly rare. Of course plenty do lose that much through non-surgical extremes of effort, it's just that the point I was making, and zero doubt I made it clearly, was that maybe the Biggest Loser results would have been found if a person had slowly lost the same amount of weight. That's the control group we don't have. Slow losers, over a year or two, of 50% of their weight. Plenty of folks crash their weights down through ridiculous extremes. No doubt in large part due to idiotic shows like The Biggest Loser telling them to. I also never stated that I knew Dr. Huizenga. Long story short, I can't share the piece now because I don't trust the rest of it and never again will I interview with/for the @NYPost.
posted by maudlin at 4:08 PM on May 22, 2016 [2 favorites]


Can never go wrong saying you don't know if something is credible when you link to the NY Post, heh.
posted by Drinky Die at 4:44 PM on May 22, 2016 [3 favorites]


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