Your Body Is Happy To Wait For Your Weight To Come Back
Tuesday, November 8, 2011
Regular readers are well aware that losing weight is never a ‘cure’ for obesity – in fact, we know that any weight loss (by whatever means – perhaps with the exception of surgery) leads to hormonal changes that will facilitate weight regain. This is why conventional (diet and exercise) weight-loss strategies sooner or later tend to result in relapse or weight regain.
Just how pervasive and multi-faceted these long-term hormonal responses to weight loss are, is demonstrated by Priya Sumithran and colleagues from the University of Melbourne, in a paper published in the New England Journal of Medicine.
In order to examine whether or not changes in the circulating levels of several hormones involved in the homeostatic regulation of body weight persist over time, the researchers studied 50 overweight or obese individuals, who participated in a 10-week very-low-calorie-diet weight-loss program.
The 36 subjects, who completed the intervention lost about 14% of initial weight and were still well below initial weight (about 8%) 62 weeks after the start of the study.
This weight loss was associated with significant reductions in levels of leptin, peptide YY, cholecystokinin, insulin, and amylin, whereas levels of ghrelin, gastric inhibitory polypeptide, and pancreatic polypeptide increased – most of these changes were still clearly evident at 62 weeks.
In addition, subjective levels of hunger increased and remained significantly elevated at 62 weeks.
Thus, the authors note that:
“One year after initial weight reduction, levels of the circulating mediators of appetite that encourage weight regain after diet-induced weight loss do not revert to the levels recorded before weight loss.”
Given these profound and persistent hormonal changes that affect hunger, appetite, and metabolism, it should come as no surprise that maintaining weight loss is so difficult. It certainly seems like the homeostatic system is happy to wait for the weight to come back – even if this takes several months or even years.
As I have noted before, the challenge in obesity treatment is never how to lose weight – it is all about how to keep it off. This is why, I am never too enthusiastic about new diets or medications that promise to help lose weight – unless these diets or medications also counteract or effectively block the counter-regulatory responses seen in this study, chances are that they will be ineffective in the long term.
Or, as the authors put it:
“..successful management of obesity will require the development of safe, effective, long-term treatments to counteract these compensatory mechanisms and reduce appetite. Given the number of alterations in appetite-regulating mechanisms that have been described so far, a combination of medications will probably be required.”
We do not really need new treatments for weight loss – we do, however, need treatments for weight-loss maintenance or for keeping patients in ‘remission’.
Unfortunately, the regulators still do not appear to have a pathway for approving drugs that will help with the latter.
AMS
Edmonton, Alberta
Hat tip to Bill Colmers for pointing me to this article.
Sumithran P, Prendergast LA, Delbridge E, Purcell K, Shulkes A, Kriketos A, & Proietto J (2011). Long-term persistence of hormonal adaptations to weight loss. The New England journal of medicine, 365 (17), 1597-604 PMID: 22029981
Tuesday, November 8, 2011
Although intuitively I am sure that the researchers’ findings are valid, I think that we need far more studies regarding the body’s mechanisms for regaining weight. Most dieters don’t go on such a radical, restrictive diet. If we are to help people understand that weight regain is the norm, and not the result of being lazy or gluttonous, we need similar studies to be done on individuals who have lost weight through less radical (though often equally questionable) means.
I would like to see hunger hormone levels measured in those who are on Weight Watchers, Medifast, Atkins, the “primarian” diet, simple, yet less extreme, calorie restriction (i.e. 1,200 calories a day). Would the findings be the same?
As far as I’m concerned, though interesting (and probably correct, in my opinion), the Australian study leaves itself open to attack and needs to be replicated with subjects who have lost weight using more conventional methods.
Tuesday, November 8, 2011
You wrote “in fact, we know that any weight loss (by whatever means – perhaps with the exception of surgery) leads to hormonal changes that will facilitate weight regain.”
I just want to say that I had bariatric surgery—the Duodenal Switch—nearly eight years ago, and I truly do think this surgery IS the exception! I lost 170 pounds, and have had NO regain—and I do not count calories or, really, restrict my eating. I think this surgery has made me ‘normal’.
Tuesday, November 8, 2011
I agree with NewMe here, I want to see some studies on people who made small changes. I actually consider 1200 cal/day to be semi-starvation, how about 1800+ cal/day? Or just stopped bingeing? Or didn’t change food, just added exercise? I would guess there would be less hormonal recoil here, it would be nice to see this hypothesis tested.
Tuesday, November 8, 2011
Great article Dr. Sharma.
I should really write a book devoted to the thousands of strategies I had to implement in order to continue losing over several years and ultimately keep the weight off over time.
I kept a journal on my progress and have realized that one of my keys to my success is my ability to adapt to change and the ability to understand when change was needed. I am guessing this is related, in part, to hormonal changes. My reaction, control logic and reasoning to solve my problems went through what I call an evolution. What once worked doesn’t work now….so now what? This evolution continues today.
Need for change can be expressed in boredom with food, struggles with life’s ups and downs, stress with social situations, craving changes,”cheating”, fond reminiscence of old habits, and struggles with program commitment just to name a few.
When I say change I am not speaking of changing my food program. I am speaking of making changing within my life that allow for me to continue on the program.
It is a tough row to hoe when you continually face these challenges/changes alone and thankfully my program offered and continues to offer a great deal of support through this change.
Is eating a restricted diet easier now? Yes. Is it simple- No. But I don’t have to go to bed at 7:00 anymore just to stop the mental battle that used to rage in my head. And that is priceless to me. Perhaps those hormones responsible are at a lower level.
(if ever you find a magic pill I’ll be the first in line but until then this working, albeit and ever vigilant approach)
Tuesday, November 8, 2011
I am so glad I came across your blog Dr Sharma. Your previous articles on this topic “Will losing weight make you fat?” and “Why is it so hard to maintain a reduced body weight” have enlighted me and made me joyful and optimistic for the first time in years — to have medical scientific evidence saying “it’s not all your fault” — and looking forward to my own bypass.
I am 43 years old with a BMI >50, Type II diabetes, osteo-arthritis, and top end scale high BP, I was finally referred for a bypass in January 2011 by a new GP.
My op is due to be during Spring 2012 (approx March fingers crossed!) as I am on a UK waiting list, but I am content that I have had 10+ months waiting as it has given me time to read as much research as possible about the surgery and effect it will have on my life.
Like many in my position I had been obese for a long time (since I was 20) and first asked a doctor about the possibility of surgery when I was 35. Unfortunately it took another 8 years of (more) failed diet attempts before I finally found a doctor with a totally different, pro-active attitude.
I get frustrated when friends ask why I could not go back on “just one more” diet, one more attempt at Weight Watchers / Slimming World / Jenny Craig / Rosemary Conley etc etc.
Only now, with the assistance of your articles (links to which I email frequently!), am I able to answer their questions and prove that for me, with BMI over 50 and long term history of obesity, gastric bypass is likely to be the only long term permanent solution, and will have less health risks than actually remaining at my current weight with my current co-morbidities !!!!
Tuesday, November 8, 2011
The body is quite conservative–if it doesn’t have to do something it doesn’t–that is why people strated phoning to there workmates versus getting up to go to there desks that is why so many would rather use the elevator or esculator versus the stairs.
The conservative body may even be why farming was started keeping things in one place was easier then following or chasing after them.
If the body can avoid doing something it will risist doing anything therefore drive throughs versus cooking even quick and easy cooking or on the table in 20 minutes type of cooking. The easier food is to get even if it is healthy food the more a person is inclined to eat–and the more often the eprson is inclined to eat. Therefore, when weight lose is started there is an easy stage where the weight comes off faster then the weight lose platoes.
Tuesday, November 8, 2011
Count me in the crowd that considers 1,200 calories to be extreme caloric restriction.
Wednesday, November 9, 2011
I went from 250 to 190, then over 3 years gained 30 lbs,
I may have gained 30 lbs because of what you talk about – or I may have gained 30 lbs because I went back to the same way of eating that got me up to 250 in the first place.
I figure that if I had not lost the 60 lbs, I’d have gone up to 280 lbs over that 3 years.
I’ll always have to “diet”. if I don’t “diet” I gain weight.
So I decided that if I have to “diet”, I might as well make it a weight-loss diet. Down 6 lbs so far.
I figure that means I’m about 9 lbs less than I would be if I were eating when I felt hungry, instead of following a diet plan.
Wednesday, November 9, 2011
I read about this study from James Kreiger’s weightology “members only” blog. What is a bit confusing to me is how it is being reported. I agree with all those who thought that eating a VLC diet to lose weight is no different than the average person following a fad diet, like HGC; however, while I find it interesting that the subjects’ hormonal profiles changed and their appetite increased over the duration of the study, the fact that they didn’t regain all of their lost weight puzzles me.
Maybe I’m just more of the glass is “half-full” kinda guy, but they were able to actually maintain some of their initial losses despite the researchers’ findings. So, I’m more interested in knowing why we don’t see the usual “post-starvation” weight gain, which is usually rapid once one goes off such a restrictive diet, especially in the face of such hormonal and appetite changes?
Thursday, November 10, 2011
To be honest, I don’t know how useful a study on acute starvation is. All that tells me is that switching to disordered eating is extremely bad for your body. Where’s the research on people who try to do it very slowly? Maybe that’s a good strategy?
Thursday, November 10, 2011
I would put my money on the slow-and-healthy losers also showing prolonged endocrine changes. I base this on my own battles with “eat impulses.” While the study design is weak and the media coverage ridiculous, the one good thing to come of this is that scientists are not buying the notion that hunger is a discrete sensation that can be measured on a scale of one to ten. There are dozens of hormones involved in hunger and satiety and they trigger many mechanisms — from saliva production to cueing reward circuitry in the brain, etc. “Hunger” is complex.
Friday, October 12, 2012
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