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Do Changes in Leptin, Ghrelin or Insulin Predict Weight Regain?



sharma-obesity-blood-sugar-testing2One of the main reasons why keeping weight off, is because of the complex neuroendocrine response to weight loss, which serve to promote weight regain.

While some of the players involved in these responses are known, whether or not measuring them would help predict who may have a harder time losing weight or who is more likely to regain weight is not.

As paper by Stohacker and colleagues from Brown University, Rhode Island, USA, published in the International Journal of Obesity suggests that this may be more complicated than some may think.

In their review of 12 studies reporting changes in leptin, ghrelin or insulin during intentional weight loss with a follow-up period to assess regain, no consistent relationship was found between any of these factors and weight regain.

Indeed, if anything, the data on this issue is more than confusing.

For e.g. as the authors note,

“…two of the nine studies examining leptin suggested that larger decreases were associated with great regain, three studies found the opposite (smaller decreases were associated with regain) while four studies found no significant relationship”.

Similarly,

“One study suggested that improvements in insulin resistance were associated with weight gain, but five subsequent studies reported no association.”

Thus, the notion that simply measuring some of the hormones associated with weight loss is unlikely to predict weight regain in a given individual.

This should come as no surprise.

Not only, are these only three of a whole array of possible biological mediators of weight regain but, as the authors point out, there may also be important behavioural and environmental (and I would add psychological and medical) reasons why some people may find it easier to sustain weight loss than others. And of course, genetic factors as well as past weight-loss history may also play a role in this.

Overall, there does not appear to be any simple test that clinicians can use to predict who is likely to regain weight and who is not.

On the other hand, given that the vast majority of people who lose weight ultimately put it back on (perhaps with the exception of those undergoing bariatric surgery – but even there regain may happen), this question may not be the most pressing – after all, spotting weight regain when it happens is not rocket science.

@DrSharma
Edmonton, AB

ResearchBlogging.orgStrohacker K, McCaffery JM, Maclean PS, & Wing RR (2013). Adaptations of leptin, ghrelin or insulin during weight loss as predictors of weight regain: a review of current literature. International journal of obesity (2005) PMID: 23801147

 

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4 Comments

  1. I think this is very important research. Ultimately, I see it (maybe in the year 2050) leading to more productive patient-doctor relationships. Currently, Joe Public is told that before starting a diet or exercise program he should check with his doctor. Dutifully, Joe does and his average doctor (NOT present company!) tells him that he’s clear to Eat Less and Move More, and adds condescendingly that it’s a “lifestyle” change not a quick fix “diet.” Joe Public then loses 60 pounds on ELMM street, and then regains it the next year.

    In 2050, prior to weight-loss, Joe will go to his doctor and spend a day getting a baseline profile of his endocrine system. He’ll know all about his “normal” ebbs and flows. Then he will embark on his weight-loss regimen. As is normal, he will lose the first pounds rapidly, then over time the rate of loss will slow. When it has been three months since he has lost a pound, he will go back to his doctor and declare himself in maintenance. He’ll undergo a new endocrine profile, and they’ll discuss it:

    Doctor: “Well, I see you have a ghrelin spike at roughly 9 am, and it is 24% higher than your normal or baseline reading at highest established weight. You’re probably going to want to make sure that you do a moderate to high intensity cardio exercise routine before 9 am and see if you can nudge that down. It will likely lead to a cascade of hormonal reactions that will help you manage your eat impulses and other hunger cues.”

    Joe: “Thanks, Doc. That was productive information.”

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  2. No, there is no simple clinical test that predicts weight gain, but in my experience one predictor already works more often than not: seeing “diet” as a tempory versus a permanent change.

    I lost 35 lbs five years ago and have been able to maintain the new weight, very likely due to me having become more active, making more conscious food choices and, most importantly, keeping an eye on my weight.

    Being able to do that may have to do with personality structure, but in my opinion working with patients in that direction may be more worthwhile than trying to predict success from an endocrinological profile.

    Or, to put it differently: should a doctor advise a patient with an unfavorable profile to not attempt losing weight?

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  3. This interests me.

    I used to be overweight (BMI 26.5), so went on a low carb diet, got down to a healthy weight which I maintained for a year despite reverting to a more balanced diet.

    I then developed anorexia nervosa and ended up with a BMI of 16.5 which was obviously far more unhealthy than being overweight was. I attempted recovery once before relapsing again. In total I had my eating disorder of about 18 months and I’m now in recovery again.

    I found I could not eat normally in recovery. I had a huge problem with binge eating which I’m aware is common in anyone suffering from malnutrition. In the end I went for it and just flat out binged to see where it would take me, consuming over 6000kCal per day or more in processed carbohydrates. I regained back to a healthy BMI of 22 and my eating patterns slowly normalised over a few months.

    I don’t know why I never regained the weight. I had dieted before and always regained but how the heck did I avoid it whilst overeating so much? More than I’d ever eaten, even at my highest weight. I never had any problems with binging until I started refeeding from a BMI of 16.5.

    Could it have been that eating so much increased my metabolic rate? When I dieted before, I went with the GI, got to a healthy weight but slowly regained without binging.

    Or is it possible the low carb diet improved my insulin sensitivity?

    I’m currently taking fluoxetine (Prozac) to help with depression which was part of what caused my eating disorder in the first place.

    I’m a striaght male and was 29 when I developed AN and I’m 31 now so I don’t represent the typical teenage girl seen to be a greatest risk of AN.

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