Weight lost on TV show, returns after its end

Danny Cahill stood, slightly dazed, in a blizzard of confetti as the audience screamed and his family ran on stage. He had won Season 8 of NBC’s reality television show “The Biggest Loser,” shedding more weight than anyone ever had on the programme – an astonishing 239 pounds in 7 months.

When he got on the scale for all to see that evening, December 8, 2009, he weighed just 191 pounds, down from 430. Dressed in a T-shirt and knee-length shorts, he was lean, athletic and as handsome as a model.

“I’ve got my life back,” he declared. “I mean, I feel like a million bucks.” Cahill left the show’s stage in Hollywood and flew directly to New York to start a triumphal tour of the talk shows, chatting with Jay Leno, Regis Philbin and Joy Behar. As he heard from fans all over the world, his elation knew no bounds.

But in the years since, more than 100 pounds have crept back onto his 5-foot-11 frame despite his best efforts. In fact, most of that season’s 16 contestants have regained much if not all the weight they lost so arduously. Some are even heavier now. Yet their experiences, while a bitter personal disappointment, have been a gift to science. A study of Season 8’s contestants has yielded surprising new discoveries about the physiology of obesity that help explain why so many people struggle unsuccessfully to keep off the weight they lose.

Kevin Hall, a scientist at a federal research centre who admits to a weakness for reality TV, had the idea to follow the “Biggest Loser” contestants for 6 years after that victorious night. The project was the first to measure what happened to people over as long as 6 years after they had lost large amounts of weight with intensive dieting and exercise.

The results, the researchers said, were stunning. They showed just how hard the body fights back against weight loss. “It is frightening and amazing,” said Hall, an expert on metabolism at the National Institute of Diabetes and Digestive and Kidney Diseases, which is part of the National Institutes of Health. “I am just blown away.”

It has to do with resting metabolism, which determines how many calories a person burns when at rest. When the show began, the contestants, though hugely overweight, had normal metabolisms for their size, meaning they were burning a normal number of calories for people of their weight. When it ended, their metabolisms had slowed radically and their bodies were not burning enough calories to maintain their thinner sizes.

Researchers knew that just about anyone who deliberately loses weight – even if they start at a normal weight or even underweight – will have a slower metabolism when the diet ends. So they were not surprised to see that “The Biggest Loser” contestants had slow metabolisms when the show ended.  What shocked the researchers was what happened next: As the years went by, the contestants’ metabolisms did not recover. They became even slower, and the pounds kept piling on. It was as if their bodies were intensifying efforts to pull the contestants back to their original weight.

Cahill was one of the worst off. As he regained more than 100 pounds, his metabolism slowed so much that, just to maintain his current weight of 295 pounds, he now has to eat 800 calories a day less than a typical man his size. Anything more turns into fat.
Their experience shows that the body will fight back for years. And that, said Dr Michael Schwartz, an obesity and diabetes researcher who is a professor of medicine at the University of Washington, is “new and important.”

“The key point is that you can be on TV, you can lose enormous amounts of weight, you can go on for 6 years, but you can’t get away from a basic biological reality,” said Schwartz, who was not involved in the study. “As long as you are below your initial weight, your body is going to try to get you back to it.”

The study’s findings are part of a scientific push to answer some of the most fundamental questions about obesity. Researchers are figuring out why being fat makes so many people develop diabetes and other medical conditions, and they are searching for new ways to block the poison in fat. They are starting to unravel the reasons bariatric surgery allows most people to lose significant amounts of weight when dieting so often fails. And they are looking afresh at medical care for obese people.

The hope is that this work will eventually lead to new therapies that treat obesity as a chronic disease and can help keep weight under control for life.

Most people who have tried to lose weight know how hard it is to keep the weight off, but many blame themselves when the pounds come back. But what obesity research has consistently shown is that dieters are at the mercy of their own bodies, which muster hormones and an altered metabolic rate to pull them back to their old weights, whether that is hundreds of pounds more or that extra 10 or 15 that many people are trying to keep off.

Specific weight
There is always a weight a person’s body maintains without any effort. And while it is not known why that weight can change over the years – it may be an effect of aging – at any point, there is a weight that is easy to maintain, and that is the weight the body fights to defend. Finding a way to thwart these mechanisms is the goal scientists are striving for. First, though, they are trying to understand them in greater detail.

Dr David Ludwig, the director of the New Balance Foundation Obesity Prevention Centre at Boston Children’s Hospital,  said the findings showed the need for new approaches to weight control. He cautioned that the study was limited by its small size and the lack of a control group of obese people who did not lose weight. But, he added, the findings made sense.

“This is a subset of the most successful dieters,” he said. “If they don’t show a return to normal in metabolism, what hope is there for the rest of us?” Still, he added, “that shouldn’t be interpreted to mean we are doomed to battle our biology or remain fat. It means we need to explore other approaches.”

All this does not mean that modest weight loss is hopeless, experts say. Individuals respond differently to diet manipulations – low-carbohydrate or low-calorie diets, for example – and to exercise and weight-loss drugs, among other interventions.

But Ludwig said that simply cutting calories was not the answer. “There are no doubt exceptional individuals who can ignore primal biological signals and maintain weight loss for the long term by restricting calories,” he said, but he added that “for most people, the combination of incessant hunger and slowing metabolism is a recipe for weight regain – explaining why so few individuals can maintain weight loss for more than a few months.”
Cahill knows that now. And with his report from Hall’s group showing just how much his metabolism had slowed, he stopped blaming himself for his weight gain. “That shame that was on my shoulders went off,” he said.