Maybe, like me, you’re a couple of weeks into your New Year’s Resolution. I hope it’s going well. If your resolution centers on weight, let me suggest a strange source of motivation to continue. You may remember the dozen-year run of the NBC reality TV series The Biggest Loser. Contestants engaged in brutal exercise regimens and draconian calorie restriction (65%!) in an office-style weight loss competition, but only if your office manager trained under a third-world dictator and wore spandex. Through a 2022 prism, the show is horrifying, with its subtext that the value of the contestants as people was inextricably linked to their success in a crash diet and our knowledge that contestants abused diuretics for the sake of losing a few extra pounds for their public weigh-ins. The long-term weight-maintenance success rate of the contestants was, to put it mildly, not high.
So, I hope that any health-oriented 2022 resolutions bear little in common with The Biggest Loser. If you’re working on weight reduction, I hope you’ll focus more on the journey than the destination. But I also hope that we can all take a few lessons from the contest. A small number of contestants actually kept significant weight off after leaving the show, and a new analysis by Kevin Hall of NIH, maybe the most influential metabolic researcher in the world, looks at what may have led to their sustained success.
One of the major challenges in weight reduction is that we all gravitate toward a weight “set point” that is determined fairly early in life. When we lose a lot of weight, a la The Biggest Loser contestants, our resting metabolic rate–the calories we burn just to breathe, think, and live–slows significantly, and it becomes ever harder for us to keep weight off as our physiology inevitably pushes us back toward that set point. Investigators call this “metabolic adaptation.”
Distressingly, Hall found that six years after the competition ended, former contestants who maintained a very meaningful 12% weight reduction still exhibited a ~500 kcal/day metabolic adaptation. That is, their bodies burned 500 calories per day less at rest than they had prior to their weight reduction. And, paradoxically, the people who had the highest levels of physical activity (i.e., those who continued to burn the most energy through exercise) had the largest reductions in basal metabolic rate even though they were also the group who kept off the most weight. We can only conclude that physical activity not only burns extra calories but may have an effect on appetite. Other mechanisms are possible as well. It’s a big unknown.
Regardless of the uncertainty, this is even more evidence that we should focus more on the process of healthy living than we do on any individual measure, like body weight, waist circumference, or pant size. As we’ve said before, patients who enter programs like the Diabetes Prevention Program are often surprised at how little their weight is mentioned in class compared to, say, their daily activity levels. As you struggle with your resolution this year, consider altering your strategy if things get tough. Instead of saying “I’m going to lose five pounds this month,” consider process-based SMART objectives, like eating at least five servings of fruits and vegetables daily, taking a tablespoon of psyllium husk daily, and at least 30 minutes a day of real physical activity.
And if you’re interested in promoting this kind of strategy to your employees through resources like the Diabetes Prevention Program, please let us know.
As the Medical Director of the Kansas Business Group on Health, I’m sometimes asked to weigh in on hot topics that might affect employers or employees. This is a reprint of a blog post from KBGH.