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| If obesity is a chronic disease it cannot be surprising that it cannot be cured and weight loss maintenance requires life-long effort(s) on part of the formerly obese (note: things are different for non-obese individuals trying to shed extra-pounds). |
Now, a recent study from the US (Polidori. 2016) shows that this weight gain is mostly driven by a hitherto largely overlooked increase in appetite - an increase that goes way beyond any effects of "metabolic damage".
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"feedback control of energy intake plays an even larger role [than energy expenditure adaptations when it comes to the post-diet jojo-effect] and helps explain why long-term maintenance of a reduced body weight is so difficult" (Polidori. 2016)Using a validated mathematical method the authors calculated the energy intake changes of 153 patients who lost a significant amount of weight over the course of a 52-week placebo-controlled trial with canagliflozin, a sodium glucose co-transporter inhibitor, a commonly used diabesity drug that increases urinary glucose excretion.
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| Association between adaptive thermogenesis and weight loss in 151 overweight patients from three studies after dietary or bariatric surgery-induced weight loss. |
Now, this use of a sodium glucose co-transporter inhibitor and the resulting urinary loss of approximately 90 g of glucose per day (that's 360 kcal/day) is an important qualifier here, as it is a way of creating an energy deficit of which the scientists argue based on previous scientific evidence that the way the scientists induced an energy deficit ..."We calculated the free-living energy intake changes in 153 patients treated with 300 mg/day canagliflozin over a 52-week trial using the mea-sured body weight data and an assumed mean UGE [urinary glucose excretion] of 90 g/day as inputs to a mathematical model that has recently been validated against an expensive biomarker method" (Polidori. 2016 | note: it is still debatable how accu-rate this calculation is as it depends on a relatively simple formula that uses a bunch of input parame-ters based on theoretical assumptions).
Metabolic damage in Biggest Losers | more
- does not alter the subjects' energy expenditure (regular dieting would acutely decrease their metabolic rate) or central pathways controlling energy intake (hunger & appetite) and
- allows for weight loss even though the patients are not directly aware of being in an energy deficit - or, put more simply, without any 'dieting efforts' or austerity
Learning from those who did it: Wyatt et al. used data from the National Weight Control Registry (Wyatt. 2005) to follow a still barren path in obesity research: studying what those who manage to lose weight and keep it off did right. Until now, way too much effort is spend on identifying diet mistakes; mistakes that would be automatically avoided if you did the right things. Unfortunately, there's no magic bullet or, as the authors say: "If weight loss maintenance requires “swimming upstream” against the environment, then these are the best swimmers" (Wyatt. 2016).
What Wyatt et al. were able to show, however, is that people who have successfully maintained weight loss share similarities in how they keep weight off. And here's what they did: (1) They didn't rely on dieting, only, but have increased their total physical activity (to 3,293 kcal per week) as well (only 9% of those who kept the weight off did it with dieting, only); (2) they didn't stop dieting / return to their old habits after losing a certain amount of weight, but maintained a tightly energy controlled diet; (3) they constantly monitored their weight and intervened when they saw weight gain of more than 3-5 pounds; (4) cheri-shing improvements in quality of life and self-confidence.
Aspects I wouldn't include in the list, yet, are: consuming a low fat diet (that was probably due to the popularity of low fat back in the day), eating breakfast everyday (there simply is no convincing evidence that this will mechanistically promote weight loss and maintenance), and improve.
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| The use of refeeds was not part of Wyatt's research interest, but there's experimental evidence that refeeding twice a week promotes fat loss | more. |
Aspects I wouldn't include in the list, yet, are: consuming a low fat diet (that was probably due to the popularity of low fat back in the day), eating breakfast everyday (there simply is no convincing evidence that this will mechanistically promote weight loss and maintenance), and improve.
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| Beware: Chronic dieting at low deficit can make you fat | more! |
Is it futile to even try to lose weight? An excellent comment by Priya Sumithran & Joseph Proietto says NO - (1) Modest (5–10 %) weight loss confers significant reductions in the risks of several weight-related conditions such as type 2 diabetes, obstructive sleep apnoea and non- alcoholic fatty liver disease [18], and is likely to be accompanied by milder metabolic adaptation | (2) Although the majority of people will eventually regain much of the lost weight, results are variable, and a proportion of people manage to maintain clinically beneficial weight loss even in the long-term: more than 4000 U.S. adults in the National Weight Control Registry database (97 % Caucasian, 80 % women), for example, have maintained a loss of at least 13.6 kg (30 lbs) for a mean of over 5 years | (3) New pharmacological therapies that help weight loss and maintenance are becoming available (e.g. GLP-1 agonists) and other drugs that mimic the effects of RYGB surgery are in the development pipeline. And still, while there's hope, it's important to acknowledge that "[l]ike other chronic con-ditions, obesity is not cured after the phase of treatment (weight loss), and strategies for long-term management (maintenance of weight loss) are required " (Sumithran. 2016).
So does the study just confirm that people who have gotten fat once are doomed forever? That's difficult to tell, after all, some interventions such as RYGB weight loss surgery appear to have a decent rate of success. While the subjects may not turn into fitness models, many manage to maintain a decently healthy weight after crash-dieting down to a normal BMI-range.Surgery may yet not be the only option. After all, there's reason to believe that there's a threshold level of weight loss after which the previously discussed compensation effects occur. It may thus well be possible that small weight changes are uncompensated by changes in energy intake. If we consider the previously referred to concept of a weight set-point to be dynamic in both directions, it is thus not impossible that losing your weight in baby-steps with adequate periods at an energy equilibrium (calories in = calories out) and no further weight loss in-between the short dieting periods may help you to lower your set-point and achieve (in the long-run) meaningful weight-loss without compensatory increases in appetite that will get you back to your original weight in no time | Comment on Facebook!
- Müller, Manfred J., Janna Enderle, and Anja Bosy-Westphal. "Changes in Energy Expenditure with Weight Gain and Weight Loss in Humans." Current Obesity Reports 5.4 (2016): 413-423.
- Polidori, David, et al. "How strongly does appetite counter weight loss? Quantification of the feedback control of human energy intake." Obesity 24.11 (2016): 2289-2295.
- Sumithran, Priya, and Joseph Proietto. "Maintaining weight loss: an ongoing challenge." Current Obesity Reports 5.4 (2016): 383-385.
- Wyatt, Holly R., et al. "Lessons from patients who have successfully maintained weight loss." Obssity Management 1.2 (2005): 56-61.