Hi folks - I am passing along an article from the NY Times science column which is reporting on a long term study of the contestant's of the reality TV show "The Biggest Loser". What has been found is that most people regained their weight. More interesting though, was the monitoring of their metabolism (which slowed significantly) and hunger hormones (which increased significantly) across the six years of the study.

While this explains a lot, frankly it is a little daunting too, for someone who wants to achieve and maintain a large weight loss long term. After I thought on it for a little while though, I think it's much better to know what is happening, so you can strategize against these effects. For me, for example, this means monitoring my weight daily (whether I like the news or not, in fact - more important if the news isn't all good, to be aware of my status). To be mindful of what I am eating, even if it's much less than before, and, if I stop losing weight or gain some weight, to return to keeping a food/calorie diary.

See:

http://www.nytimes.com/2016/05/02/health/biggest-loser-weight-loss.html

Great article. I really wonder how that compares to surgery. We have had hormones removed from us so maybe the metabolic issues are different for us.

Great article. I really wonder how that compares to surgery. We have had hormones removed from us so maybe the metabolic issues are different for us.

Hi LondonHawke - on the metabolism side of things, I don't think we escape the slowdown - when you look at two factors:

• Weight loss rates gradually slow, and total weight loss tends to level off with time, at roughly 60% of excess weight lost, on average
• Patients eat a good deal less than would be expected for a person of their age, sex, height and weight

I actually asked the guy who became my surgeon this exact question in one of the pre-surgery group info sessions - is the metabolism permanently slowed, given the above, and does that explain why people stop losing, and why they need to continue eating so little? He didn't really answer - not sure if he didn't know, or if he thought I wouldn't like the answer.

Edited May 2, 201610 yr by Barry W

@@Barry W

Thanks for the article. I still have so many questions about obesity and surgery.

I don't meet many surgery patients 6+ years out. I think for many reasons. Life turn to normal..You don't Identify with weight loss mode and some experience weight gain.

Patients in my area don't keep follow up appointments for 5 years. The studies at my surgeons office are not correct due to the lack of continued participation.

My metabolism was messed up before surgery. I wish I knew what is now at two years out.

I don't fit the normal statistics. I lost over the 60% average. I am older. I eat healthy. I took on competitive sports and I consume more food.

Weight gain is still a big fear for me. I am vigilant to keep maintaining my weight. Anyone of us can gain.

This Leave me with more questions than answers.

I still depend on all the senior surgery patients. I follow what keeps them successful. Again, I wish I met more people long term out.

@@jenn1 - thanks for sharing your experiences. I don't think they necessarily contradict the results of this study. I think each person's physiology will be different, and also each person's lifestyle choices will be different.

Would you be willing to share what you average in calories per day? And what a typical week looks like for physical activity?

Your ability to reach the healthy weight and sustain it over a long period is an inspiration to me as it shows that it is possible. :-)

@@Barry W

I would like to think surgery statistics would be different than the biggest looser weight loss program.

Eating at one year out/ maintenance was mentioned in this thread.

http://www.bariatricpal.com/topic/366690-a-year-out-from-surgery-what-is-your-daily-diet-consist-of/

I want to make this clear...I'm not advising anyone to eat as I do. Maintenance is different for each of us. food and exercise is not a one size fits all program. I would suggest consulting your dietician.

When I'm not training..I consume 1300 to 1700 calories..Low carb - high Protein bariatric diet

If you choose to be a bariathlete, getting enough food in is an all day project. What is listed for a meal..I eat until full. take a break and come back to it. I still wait 30 mins before drinking Water.

I have two races in May. The 7th - 5k (Race for the cure in memory of my mom) May 21st - half marathon Idaho potato run.

This weeks workout schedule:

Monday- Run outdoor on pavement 2 hours - then strength training an hour.

Tuesday - Strength training and hour

Wednesday - Run our door sprints/ jog intervals hour - Then strength train an hour

Thursday Friday - rest

Saturday - Race day

Sunday - Rest

When I train, I consume up to :

2400 Calories.

217g protein

192g carbohydrates ( I try to get my carbs higher than this)

Breakfast.

Milk - Reduced fat, 2% milkfat, 1 cup

whey Isolate Protein - Six Star , 1 scoop

Jimmy Dean - Turkey Sausage 4 Links

Cascade Pride - 100% Stone ground Whole Wheat Bread, 0.5 slice

lunch

- Sunflower Crunch Chopped salad, 1.5 cups

Avocado, 1 Medium Avocado (150g)

Wheat Thins - Big, 16.5 pieces (31g)

Great Value canned chicken - Canned Chicken, 5 oz

Nosblast - Pre-work Out, 1 scoops

dinner

Walmart - Bacon, 1 pieces

Trader Joes's - Bbq Cut Salmon Filet, 5.2 oz

Marketside - French Beans (Green Beans), 0.5 cup

Sweet Potato Baked Sweet Potato - Baked Sweet Potato,, 4 oz

Snacks

Dynatize - Elite Protein shake, 1 scoop

Milk - Reduced fat, 2% milkfat, 1 cup

Quest - chips, 1 bag

Tillamook - Cheddar cheese - Medium, 1 oz (28g)

Safeway - Salsa, 4 T

Frog Fuel - Energy Gel, 3 packet

Walgreens - Glucose Tablets - Orange, 4 tablet

I just finished reading that article this morning and was sooooo appreciated to my surgery because I have always had that little voice in my head telling me that I should of tried harder☺️

Thank God, I did the right dessesion????????????????????????

Great article. I really wonder how that compares to surgery. We have had hormones removed from us so maybe the metabolic issues are different for us.

Hi LondonHawke - on the metabolism side of things, I don't think we escape the slowdown - when you look at two factors:

• Weight loss rates gradually slow, and total weight loss tends to level off with time, at roughly 60% of excess weight lost, on average
• Patients eat a good deal less than would be expected for a person of their age, sex, height and weight

I actually asked the guy who became my surgeon this exact question in one of the pre-surgery group info sessions - is the metabolism permanently slowed, given the above, and does that explain why people stop losing, and why they need to continue eating so little? He didn't really answer - not sure if he didn't know, or if he thought I wouldn't like the answer.

I understand that as our weight drops the calories required to operate our body at rest should drop to match the actual calories we consume, but the article seemed to indicate that the TBL contests actually had a change in that their bodies metabolic resting rate was lower than the norm of an individual of the same size ie. their body lowered the resting rate in an attempt to help itself adjust back to its programmed weight. It seems to imply that even if they kept up their rigorous exercise routine they would have regained weight or had to increase the exercise level in order to maintain.

My question is that TBL contests would technically have the same amount of grehlin in their body regardless of their existing weight, we don't our chemistry has been altered so will or do we suffer the same consequence.

Great article. I really wonder how that compares to surgery. We have had hormones removed from us so maybe the metabolic issues are different for us.

Hi LondonHawke - on the metabolism side of things, I don't think we escape the slowdown - when you look at two factors:

• Weight loss rates gradually slow, and total weight loss tends to level off with time, at roughly 60% of excess weight lost, on average
• Patients eat a good deal less than would be expected for a person of their age, sex, height and weight

I actually asked the guy who became my surgeon this exact question in one of the pre-surgery group info sessions - is the metabolism permanently slowed, given the above, and does that explain why people stop losing, and why they need to continue eating so little? He didn't really answer - not sure if he didn't know, or if he thought I wouldn't like the answer.

I understand that as our weight drops the calories required to operate our body at rest should drop to match the actual calories we consume, but the article seemed to indicate that the TBL contests actually had a change in that their bodies metabolic resting rate was lower than the norm of an individual of the same size ie. their body lowered the resting rate in an attempt to help itself adjust back to its programmed weight. It seems to imply that even if they kept up their rigorous exercise routine they would have regained weight or had to increase the exercise level in order to maintain.

My question is that TBL contests would technically have the same amount of grehlin in their body regardless of their existing weight, we don't our chemistry has been altered so will or do we suffer the same consequence.

That's correct - metabolism slows during weight loss - this is well established - the body is trying to preserve your weight at your previous equilibrium point. What's new here is just how big the shifts were, and how long they lasted - for these people at least, they appear to be permanent, having lasted 6 years. The subjects had their resting metabolic rates measured repeatedly over the study, and they declined steadily - and yes, far more than the weight loss would be predicted to cause.

Now, these people in the study had extremely rapid weight loss, of a very large amount, so bariatric patients won't necessarily be in the same position quantitatively - in fact most bariatric patients maintain most of the weight loss they achieve.

However, I am almost certain that the same forces are occurring in us at some level though. That's why weight loss is slowing down over time and levels off normally. As a man of 56 at 6 feet tall and my current weight of 241 pounds with light activity, I should be able to eat 2300 calories per day and maintain weight, according to the calorie calculator at Mayo Clinic:

http://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/calorie-calculator/itt-20084939

...I can't do that though, and yes, these calculators used to agree very well with my experience.

Ghrelin affects hunger, but not metabolism. There is a whole suite of hormones producing the sensation of hunger, because that's critical for survival. The writeup mentions leptin, which causes you to feel satisfied - this declined in the study subjects.

Edited May 3, 201610 yr by Barry W

I agree that the exercise routine and the controlled environment has a lot to do with TBL contestants success. I also imagine that keeping those lifestyle alterations once you go home is extremely difficult especially when for most of us there is a direct link between our emotional state and our overeating. So unless the emotional links are severed or dealt with it is hard to break that cycle. I also wonder how they can possibly manage to maintain the 8 hours plus of daily workouts!

I know SVG alters other things in your metabolism, insulin production etc so it could also have some effect on our metabolic rate and while we will eventually reach an equilibrium I am hopeful that it would be lower than in the TBL contestants.

I also understand that eating Protein, 5-6 meals, weight lifting, eating real foods as opposed to processed, Water consumption and a lot of other variables effect metabolic rate.

It just seems to further demonstrate that the whole weight issue is more complicated than simple calories in and calories out because even if you get it right your body alters itself to do what it is programmed to do in order to return you to the state it needs to get to.

My surgeon maintains that the surgery actually resets our metabolic set point so that our bodies don't try to regain what we've lost. I think I read that in a Mayo paper somewhere too.

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Although he also said they have no idea why or how it works.

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My surgeon maintains that the surgery actually resets our metabolic set point so that our bodies don't try to regain what we've lost. I think I read that in a Mayo paper somewhere too.

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Although he also said they have no idea why or how it works.

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I think there are a lot of unanswered questions still. I did find this review article from 2013. A review article is not the results of a study - instead, they take an expert in the field and ask them to look across everything that is known at that point in time and to summarize it in one report. Review articles tend therefore to be more reliable than a single study. It's not right up to date, but it's fairly current.

"Nutrition Care for Patients with Weight Regain after Bariatric Surgery", Carlene Johnson Stoklossa and Suneet Atwal,

Gastroenterology Research and Practice, Volume 2013 (2013), Article ID 256145, 7 pages.

http://www.hindawi.com/journals/grp/2013/256145/

If you read section 1.3 (Energy Requirements), you will see that they are reporting reductions in resting metabolic rate beyond what can be expected from weight loss alone, in patients having bariatric surgery.

Thank you for passing along an informative article.

I am always curious about long term weight loss.

I will be celebrating 10 years post op with my lap band later this year.

I find it takes regular dr visits with my bariatric dr,

Compliance with my high protein diet and regular work outs to stay the course .

I'm wondering about rmr

Also. It would appear that 1000-1300 calories a day is my zone to maintain.

I don't believe I could adhere to this without my band. I would love to hear from others experiencing years post op.

Great article.

It seems to be an incredibly complex issue but I feel it kind of reconfirms what I thought. Activity, any activity is essential. Altering life habits not just eating habits is important and being 100% honest in your food journal, if it goes in your mouth it goes in the journal are all keys to making this work.

It just reinforces that thinking that SVG is a tool not an an answer we have to do all the other stuff ourselves.

Great article.

It seems to be an incredibly complex issue but I feel it kind of reconfirms what I thought. Activity, any activity is essential. Altering life habits not just eating habits is important and being 100% honest in your food journal, if it goes in your mouth it goes in the journal are all keys to making this work.

It just reinforces that thinking that SVG is a tool not an an answer we have to do all the other stuff ourselves.

I agree. We still need to do what we should do. But we shouldn't take results for granted, and to some extent, should be willing to take what our body's will give us - that's the way that I think about it - I try to learn all that I can and to make sure that I do my part in terms of getting sensible regular exercise, eating right, watching the scale like a hawk and counting calories when need be, but I am not overly invested in a particular result, because I know that I can't completely control things.