The Biggest Loser: Are Weight Loss Attempts Doomed? Melinda M. Manore, PhD, RD, CSSD, FACSM College of Public Health and Human Sciences Oregon State University 1
Today’s Focus 1. Biggest Loser – What did we learn? 2. Weight loss/Mgt – What can we recommend? 3. Rethinking how we talk about weight management. 2
1. The Biggest Loser: What have we learned? Before After Bill Germanakos from Biggest Loser 3
J Clin Endocrinol Metab, 2012 Obesity, 2016 Kevin Hall, PhD NIDDK Eric Ravussin, PhD Pennington Biomedical Research Center
J Clin Endocrinol Metab, 2012 Question: 1. Does a weight loss program of diet restriction and vigorous exercise preserve FFM and RMR? 2. Does metabolic ‘adaptation” occur to counter weight loss and contribute to weight regain? Subjects: Biggest Loser Participants (n=16; M=7; F=9) measured before & after weight loss (0,6,30wk) (33±10y). Methods: Housed in isolated ranch in LA, with 1 contestant voted out every 7-10 d (n=11 at 6wk); 4 stayed for 13 wks. Participants returned home & continued program on their own (30 wk). Exercise: 90min/d supervised (6d/wk, aerobic/strength) + encourage to do another 3 h/d. Min PA=2h/d; Mean PA=3 h/d Diet: 65-70% of baseline energy requirements ( 1300 kcal/d ).
Body Size/En Expenditure Baseline (n=16) Week 30 (n=16) Change ∆ Anthropometrics (DXA) Body Wt (kg) 149.2 (38.0) (330lbs) 91.6 (22.9) 57.6 kg (127lbs) BMI (kg/m 2 ) 49.4 (9.4) 30.4 (6.4) 19.0 Wt Change (%) 39.9 (9.1) FFM (kg) 75.7(20.2) 65.2(15.5) 10.5 (17.4% Wt Loss) 47.1 (82.6% Wt Loss) FM (kg) 73.5 (21.1) 26.4 (13.8) Body Fat (%) 49(5) 28(10) 21% Energy Expenditure RMR (kcal/d) 2,679(624) 1,890 (423) -789 Predicted RMR (kcal/d) 2,393 (466) Metabolic Adapt (kcal/d) -504 (171) (n=14) (7% ↓ kcal/kg FFM) 6 TEE (kcal/d) 3900 (957) 3114 (571) -786
∆ Body Size/En Expenditure Baseline (n=16) Week 30 (n=16) Change ∆ Anthropometrics (DXA) Body Wt (kg) 149.2 (38.0) (330lbs) 91.6 (22.9) 57.6 kg (127lbs) BMI (kg/m 2 ) 49.4 (9.4) 30.4 (6.4) 19.0 Wt Change (%) 39.9 (9.1) FFM (kg) 75.7(20.2) 65.2(15.5) 10.5 (17.4% Wt Loss) 47.1 (82.6% Wt Loss) FM (kg) 73.5 (21.1) 26.4 (13.8) Body Fat (%) 49(5) 28(10) 21% Energy Expenditure (DLW) RMR (kcal/d) (mea) 2,679(624) 1,890 (423) -789 kcal/d Predicted RMR (kcal/d) used baseline data 2,393 (466) Metabolic Adapt (kcal/d) -504 (171) (n=14) (20% ↓kcal/kg FFM) 7 TEE (kcal/d) 3900 (957) 3114 (571) -786 kcal/d
Metabolic Changes Significant Improvements (mean ∆) : • Fasting Glucose ↓ 19 mg/dl (20%) • HOMA-IR ↓ 40%* • C-Peptide ↓50% • TAG ↓ 64 mg/dl (216%)* • HDL-Chol ↑ 12 mg/dl 8
Summary (Baseline-30 wks) • Despite FFM preservation, high exercise did not prevent the slowing of RMR more than predicted based on weight loss. • Metabolic adaptation persisted through weight maintenance, which may increase risk of weight regain unless high level PA maintained and energy restriction remained. Alan Smith 9
Obesity, 2016 Kevin Hall Objective: 1. Measure long-term changes in RMR & body composition in participants of “Biggest Loser”. Subjects: Biggest Loser participants (n=14/16; M=6; F=8) returned to NIH 6y after weight loss. 1 subject maintained wt loss; 5 subjects were with 1% of baseline or above. Methods: For 2 wk prior to 3-d NIH Clinical Ctr stay, remote body weight monitoring occurred (bluetooth; electronic). RMR, TEE (DLW) and body composition (DXA), and hormones & metabolite measurements done. Fothergill et al, 2016
Body Size/En Expend. at 6 y N=14 Baseline Week 30 6 y Age=34.9y Age= 35.4y Age = 41.3y Anthropometrics (DXA) Body Wt (kg) 148.9 90.6 131.6 (87% of baseline) BMI (kg/m 2 ) 49.5 (10.1) 30.2 (6.7) 43.8 FFM (kg) 75.5(21.1) 64.4(15.5) 70.2 (93% baseline) FM (kg) 73.4 (22.6) 26.2 (13.6) 61.4 (84% baseline) Body Fat (%) 49(5) 28(9) 44.7 (91% baseline) Energy Expenditure (DLW) PA (kcal/kg/d) 5.6±1.8 10.0 ± 4.6 10.1±4.0 RMR (kcal/d) (mea) 2,607(649) 1,996 (358) 1,930 (466) Predicted RMR (kcal/d) 2,577 (574 2,272 (435) 2,403 (507) Metabolic Adapt (kcal/d) -275 (205) -499 (207) TEE (kcal/d) 3804 (957) 3,002 (573) 3,429±581 11
Body Size/En Expend. at 6 y N=14 Baseline Week 30 6 y Age=34.9y Age= 35.4y Age = 41.3y Anthropometrics (DXA) Body Wt (kg) 148.9 90.6 131.6 (87% of baseline) BMI (kg/m 2 ) 49.5 (10.1) 30.2 (6.7) 43.8 FFM (kg) 75.5(21.1) 64.4(15.5) 70.2 (93% baseline) FM (kg) 73.4 (22.6) 26.2 (13.6) 61.4 (83% baseline) Body Fat (%) 49(5) 28(9) 44.7 (91% baseline) Energy Expenditure (DLW) PA (kcal/kg/d) 5.6±1.8 10.0 ± 4.6 10.1±4.0 RMR (kcal/d) (mea) 2,607(649) 1,996 (358) 1,930 (466) Predicted RMR (kcal/d) 2,577 (574 2,272 (435) 2,403 (507) Metabolic Adapt (kcal/d) -275 (205) -499 (207) TEE (kcal/d) 3804 (957) 3,002 (573) 3,429±581 12
Individual ∆ BW, FFM & FM Body Weight Fat Free Mass Fat Mass Regained FFM Fat Mass Gains 13
Individual ∆ RMR & Metabolic Adaptation ∆ RMR 14
Who experienced the most metabolic adaptation? 1. Weight regain was not significantly correlated with metabolic adaptation. 2. Subjects who maintained weight loss at 6 y experienced the greatest metabolic adaptation. Wt regained from Baseline 15
Biggest Loser Summary 1. Participants regained 87% of their lost weight in 6 y. UNSUCCESSFUL? 2. 50% of participants maintained at least a 10% weight loss. SUCCESS? 3. Metabolic adaptation was NOT related with weight regain – but with long-term weight loss. 4. Long-term weight loss requires vigilant combat against weight regain. 16
2. Weight Loss – What can we recommend? Diet + Exercise vs Diet?
PLoS One, 2009 Subjects : M/W (n=48); Age: 38y; BMI=27.8(kg/m 2 ); <2d/wk PA Diet: (TEE determined by DLW over 14-d); Wk 1-12 & 22-24 all food provided; Wks13-22 self-selected diets based on targets; 30% FAT; 15% PRO; 55% CHO • Control (ad libitum diet); • Caloric restriction (CR) (↓ 25% of en); • CR (↓12.5% en) + Ex (↑12.5% en; 5d/ wk, 45-55 min/d using HRM) • Low calorie diet (LCD) = 890 kcal/d until lost 15% BW then maintenance Duration: 6 months Data collection body comp (DXA): baseline, 3, 6.
CR = ↓ 25% CR + EX = 12.5% ea LCD = 900 kcal/d 6 mo ↓25% en Key point: Weight loss the same with CR (- 10.4%↓) and CR + EX ( - 10%↓).
CR = ↓ 25% CR + EX = 12.5% ea CR+Exercise LCD = 900 kcal/d + 129±86 Caloric Restriction only -240±114 kcal Redman et al PLoS 2009
Dr. Barbara Rolls, Distinguished Professor Penn State University Author: “Volumetrics Weight-Control Plan: Feel Full on Fewer Calories” & “The Volumetrics Eating Plan”
Low Energy Density (LED) (kcal/g) Diet Characteristics of Foods Types of Foods: High fiber & water content = • • Whole fruits High volume/weight • Whole Vegetables • Less energy (kcal) per weight (g) • High fiber whole grains of food (kcal/g) • Low fat foods (dairy/meat) • Aid in satiety & promote feeling of fullness • Low in fat; no sweetened bev Summary: LED diets may result greater losses in BW & reduction in kcals + with no reduction in portion sizes. Rolls et al, 2004 ¼ c raisins vs. 1 2/3 c grapes
Results: 2006, AJCN. Energy Density Effects: Portion Size Effects: - -575 kcal/d; 24% ↓ kcals 231 kcal/d; 10%↓ kcal
Examples of very low, low, medium, and high energy dense foods Very-low Low Medium High (< 0.6 kcal/g) (0.6-1.5 kcal/g) (1.5-4.0 kcal/g) (>4.0 kcal/g) Most whole fruits, Other fruits: Dried fruits: Nuts and nut berries bananas, papayas apricots, raisins, butters apples Most whole Starchy vegetables: Whole wheat (WW) Cookies, muffins, peas, corn, winter breads, bagels, pastries; foods with vegetables squash, baked English muffins added sugar and fat potato Skim milk; low-fat Fat-free cottage Mozzarella or Swiss Other cheeses- yogurt/dairy cheese cheese cheddar, Brie-, mayo, sour cream Broth based soups Cooked whole Baked snack Potato chips, grains:(oatmeal, foods: pretzels, regular tortilla brown rice) tortilla chips chips, pretzels Legumes, low-fat Eggs, sirloin steak, Candy-all types, meats pork chops chocolate 24
Challenges to Weight Mgt Recommendations from ACSM Position Paper for Weight Control for adults (Donnelly et al. MSSE 2009): Prevent weight gain = 150 -250 min/wk (20-35 min/d) Improve weight loss = 150 -250 min/wk (20-35 min/d) + moderate energy restriction Keep weight off after dieting =>250 min/ wk 3-5% ↓ in wt can significant ↓ CHD factors People who lose wt and keep it off typically exercise at least ~1 1h/day (NWCR data).
3. Surviving our obesogenic environment? Weight management is difficult in today’s food/built environment. Identify what you can manipulate & understand what you cannot change. Identify a weight that is ‘healthy’ and allows you participate in physical activities. Remember your diet & PA level is the sum total of the small everyday choices you make!
Thank you! Questions?
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