Metabolic Damage in Biggest Losers: Will Diet & Intense Exercise Make You Fat, While Surgery Will Make You Lean? Plus: How to Avoid / Correct Diet-Induced REE Reductions

If you start to work out when you are already obese, it'll still help you lose weight, but if you'd been active the years before chances are you'd not have such weighty problems and wouldn't have to fear metabolic slow down.

Let me answer the question in the headline of today's SuppVersity Article right away, 'cause the answer short and easy: "No!" If you compare the body composition of the Biggest Losers who were included in a recent study by scientists from the National Institutes of Health in Bethesda and the Pennington State Biomedical Research Center, the Vanderbilt University School of Medicine and the University of California-Los Angeles to that of their bariatric surgery patients, the "Biggest Losers" (BLC) had lower body fat and higher lean mass percentages than their peers who took the easy way out (Knuth. 2014). What is non-debatable, though, is the fact that the thirteen "Big Losers" also exhibited significantly more reduced resting metabolic rates - a phenomenon that caused quite a stir in two Facebook groups I am frequenting regularly.
If you know the exercise drill and "diet" regimen on the TV show, you are probably not surprised to hear that the calorie restriction along with vigorous exercise in BLC participants resulted not just in a higher preservation of fat free mass (FFM), but also in a significantly more pronounced "metabolic adaption" compared to RYGB subjects.

Now, the fact that this happened despite comparable weight loss clearly suggests that we are dealing with "metabolic damage", right? Well, this is exactly what neither I, nor Nicolas D. Knuth and his colleagues who published the results of their NIH funded research in the peer-reviewed journal "Obesity" would say.

Figure 1: Changes (%) in BMI, lean mass and body fat (%) after 7 (BLC) and 6 months, respectively (Knuth. 2014)

The thing we are dealing with is not "damage", it's adaptation and it's an adaptation process that occurred during the weight loss intervention (30 weeks; see Johannsen. 2012), not after an appropriate reintegration to a normal life.
Against that background and in view of the fact that recent studies show that the contribution of body fat and other organs to the resting metabolic rate may have been significantly underestimated it is questionably how significant this comparison is. A comparison, by the way, that's not exactly fair:

• Sugar + phosphate can limit the reduction in T3 during diets in women (read more)

  6 months in the RYGB patients vs. 7 months in the BL competitors, 
• being sedentary vs. working out vigorously, 
• not being able to cheat vs. being able to stick to a diet and exercise regimen, 
• type II diabetic w/ HOMA-IR >8 vs. still pretty healthy w/ HOMA-IR = 2.0 

Where's the level playing field, here? And how significant are the reductions in leptin (tells the hypothalamus that there is still enough body fat left) and T3 (is the active thyroid hormone and a main determinant of resting metabolic rate) that suggest that the Biggest Losers competition ruined their metabolism temporarily, when they came with significant reductions in blood pressure, andimproved HDL and C-peptide levels, which did not occur in the bariatric surgery group?
Moreover, if you look at my plot of the data in Figure 1, you will see that the that it is a perfectly normal adaptations to exuberant caloric deficits (>50%).

Figure 2: The metabolic "damage" is rather a metabolic "adaptation" (y-axes; in kcal/day) in response to significant energy deficits (x-axes; calculated energy expenditure (includes exercise induced energy expenditure, therefore it can approach 100%) expressed relative to calculated RMR) - the problems begin with intakes >50% below maintenance.

Whether or not the exercise component made things worth, is something that cannot be said based on the data from this study. What it certainly did, though, was to protect the lean mass of the subjects - a vital requirement to achieve what most people are dieting for: Health and being happy with what they see in the mirror.

In conjunction with the previously cited health benefits (reduced blood pressure, increased HDL, ...) it would thus be idiotic to use the study at hand as evidence against the repeatedly proven usefulness of exercise for weight loss and health improvements in obese and non-obese individuals.
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