A Response to The New York Times’ Biggest Loser Study

My feed and inbox were inundated with concerns about “The Biggest Loser” article published by The New York Times. On one hand, I think it’s great people are paying attention to the complexities of obesity and weight loss. On the other hand, I think there were a lot of problems and missing variables in the analysis of the study presented in the article. The result created a “gloom and doom” picture for people who are obese. It also puts the focus on resting metabolic rate (RMR) alone which as we see in research is not the only piece to this complex puzzle.

Obesity Is Not a Blanket Term

The first thing most people did with this study is associate it with themselves. They worried (rightfully so) what this means for them. “Can I ever lose weight?” “Will I have to starve for the rest of my life?” “I was already scared I can’t do this, what now?”

We speak of obesity much like cancer. The truth is the root of why someone is obese (arguably rated as someone with a BMI >30) is as varied as human beings. There is no one path to excess growth in body fat nor is there one to losing it. Some would say (myself included) it is as simple as caloric surplus and deficit, but it is far more complex.

There is also a difference between obesity developed in childhood versus adulthood. For example, if you’re morbidly obese with family history it’s very different than becoming slightly obese later as an adult.

In short, reading The Biggest Loser study and thinking it directly applies to you or fearing poor results makes as much sense as thinking you’re going to get cancer because somewhere someone your age has cancer.

Predicting Models of Metabolic Rate—Place Your Bets

When it comes to metabolic rates, we measure based on variables and averages using machines—which are based on those averages. Two people of the same height, weight, and age can have a 10-15% variation in RMR, even healthy individuals. These variations can also change through the years based on hormones, habits, and (healthy) alterations in metabolic function.

Through the years, we can move up and down the scale of “normal” for various reasons and even subclinical health issues (e.g. hyper/hypothyroidism).

We also have variations in RMR testing accuracy. That doesn’t mean we can’t find a general average or assessment standard but they aren’t without error.

The best way to look at the numbers is to include our total daily expenditure. Without expectation or anger, we have to determine what we require each day and not base it upon an arbitrary average.

A Closer Look at The Biggest Loser Contestants

Returning to the study, we see energy assessments taken before the show during times of rest and weight stabilization. It’s even possible before the show a “stuffing of the pot” occurred with some of the contestants. Contestants have admitted to drinking excessive water and eating more before the contest and then dehydrating aggressively afterward.

Let’s not forget this was a contest for money.

As far as study participants go, this is not a typical living situation we’re observing or a metabolic ward study. That doesn’t mean it should be entirely dismissed, but it’s not as sound as I’d desire. There is literally a payoff for being fatter and hyperhydrated at the beginning and dehydrated at the end of the show. Comparing their final weight to their current weight is like comparing fighters at their weigh-ins to their usual selves. Ask any fighter who cuts weight; they are significantly higher in normal life and at least 10-20 pounds heavier post fight—some more.

We can easily assume these contestants had to gain physical bodyweight post-contest end. The problem was, did they know this themselves? Most of the world thinks weight loss success is all in deficit numbers. While it is true obese individuals will have to lose actual weight in body fat, they will return to a homeostasis of water weight when the dieting phase is over. In the situation of The Biggest Loser, they will also return with a higher amount of lean body mass (in muscle) because they were untrained individuals who performed rigorous resistance and cardio training. Their post weight was bound to be higher and expectedly so. Were they informed of this? Highly unlikely and much like other “diet success” studies, any weight regain from the bottom loss point is seen as a negative not an expected return. Again, lean body mass recovery is 100% supposed to happen in a post-hypocaloric state.

Were They Weight Stable at the Time of Follow-Up Readings?

Readings in the study showed the subjects were not weight stable at the time of their final RMR readings. Activity expenditure was up and intake down. Were they doing this to look better for the study? To save face? Did they simply think they should? It wasn’t controlled.

To have optimal RMR readings, you should be at a stable weight maintenance and ideally a stable maintenance at your highest level of perceived metabolic rating. In other words, remember that sliding scale? Well, in a hypocaloric or deficit state, you are at the lowest end of that sliding scale or can even have readings below average and into subclinical or short-term metabolic instability levels. Deficits, even small ones, are not the best time to get an optimal reading of RMR. I say this not to be smarmy but in hopes the contestants themselves understand what they are working with as they expressed depression about their situation.

Do More Controlled Studies Show the Same?

I like studies that control for variables as any good research enthusiast should. This 2008 study shows the decrease in RMR was pretty insignificant but the decrease in daily energy expenditure was much more notable. In general, we see in research what slows down more is not resting metabolic rate (RMR) but our activity levels. Could those contestants have ramped up their activity at the time of testing? We don’t know. It wasn’t controlled. To me, while it is an interesting free-living experiment to chew on, it is not the smoking gun which says an RMR decrease is the reason we have a hard time keeping weight off once it is lost or lose it in the first place.

The Important Factors to Focus on for Obese Subjects Trying to Lose Fat

I couldn’t possibly highlight all the nuances, complications, and handicaps for obese subjects. I can give you food for thought on things to keep in mind if you are working with obese subjects or if you are one yourself.

1. Do Only What You Have to Do

Time again we see people ramping up physical activity to aggressive levels when trying to lose weight. It’s why gyms fill up with people who have weight loss resolutions after New Year’s. The truth is one of the biggest metabolic advantages you have is that moderate activity causes you to burn more calories. Trainers don’t talk about it because their jobs are tied to physical activity, but excessively driving yourself to peak conditioning may not be the best idea when you are trying to lose fat. It’s also when you have the least resources for recovery and injury prevention. This in no way means to avoid physical activity or training programs while losing fat. Intelligently designed programs can do wonders for muscle mass and fat loss results. I am not talking in extremes. It simply means it isn’t the time for oxygen mask training…wait it’s never the time for that.

Do only what you have to do while fat loss is the primary goal.

2. Tests, They Matter

I had a teratoma the size of a softball in my stomach, extremely high testosterone, the appetite of a 25-year professional baseball player, and the body temperature of an old-old woman (I recently found out that old-old is an actual medical term, and I’m still offended and intrigued by it). I can say with the greatest empathy, if that is how an obese individual feels, even a little bit, RMR is the least of your concerns. Had I not had education and accountability, I could have gained more weight.

Instead of worrying over the minutia of a slightly lowered RMR (unless you have an actual disorder) focus on things you can control. Things, by the way, which can positively raise RMR and improve factors like hunger signaling, stress management, and sleep quality. What would some of those tests be? Thyroid levels, insulin response, testosterone levels, iron, B12, and serotonin levels are a great start. Making sure all these readings are in normal or toward the higher levels of normal range means your system is functioning better on a metabolic level.

You should also remember to take these tests in a weight stable and maintenance fed situation.

3. Low-Grade Activity Is Your Friend

In research, n=1, and clients I have seen low-grade activity efforts to be tremendous in advancing fat loss. People like results and they like them to come as easily as possible. The low-grade/low-intensity activity allows for more caloric burn in a day with less strain to the body. Taking part in an hour walk, taking the stairs, or low-grade intensity gym machines (elliptical, bikes, treadmills) can make losing fat more predictable (and less painful). Before joining CrossFit to bust out a bunch of “HIIT super fat loss metabolic crunchy workouts” think about walking around an art gallery for an hour on a lunch break. You’d be surprised how well it works for fat loss and how little you expose yourself to injury.

4. Sleep, “Boring” Sleep

“Leigh, this isn’t advanced fat loss protocol. What is with these suggestions?”

Oh, that’s right. I’m supposed to be telling you about leptin signals, short-term ketogenic protocols, bio-hacking and what stacks aid in thigh fat depletions, right? Or, you could get a good nights sleep which helps more than most super “advanced” protocols.

Research is clear. Less sleep = more hunger (the majority of the time). If you are having issues achieving diet adherence or hitting optimal metabolic levels, start with your sleep efficiency and habits.

5. Mindset Matters

Your expectation is crucial in the role of fat loss. More often than not, fat loss is seen as no different than hoping to win the lottery—and it shouldn’t be. Fat loss should be a mostly predictable process when you understand what you’re putting in (be it food, drugs, or drink) and putting out. The rest is trying to adhere to the process long enough to get results which is easier said than done. For most people, the road to fat loss is going to be a long journey requiring a lot of patience. Barring rare circumstances and situations (like The Biggest Loser) we are not in a fat loss boot camp with every bit of focus on that need. We are in the real world with work, kids, procrastination, distractions, and more emotions than we know how to handle.

If you don’t believe in the process or think the process is untrustworthy, you’re not going to commit. The process does work. You will not be broken by the end of it.

6. Breaks and Refeeds Help Us All

Anyone engaging in fat loss has to understand taking breaks from a deficit for a period is expected. Your “fat loss” will be in cycles of maintenance and deficits. You will regain water lost during your time in a deficit, recover, and then start again until you’re done. Doesn’t sound sexy? It isn’t, but for most people it is the best way to go about things and certainly the most predictable. To read more about dieting breaks you can check out this article here.

Concluding Thoughts

The method one chooses to lose fat is important. While The Biggest Loser has shown to be an effective way to lose body fat, it is not turning out to be the best method to maintain body fat loss. The main reason it’s ineffective is an incomplete education for the contestants. To some degree, this rests on the education of the doctors and trainers themselves. Degrees are obviously not a problem being their credentials are top level. Still, there is a big gap in the system. At the release of this article, I saw a flood of trainers and doctors share the article and study as the “smoking gun” without any critical thought given to the method behind it. The best trainers and doctors utilized this information as food for thought not the end of the world and scare tactics.

We know metabolic rates alter from one person to the next based on healthy factors. With alterations in thyroid function or other hormones, the “normal” range is not much more than a light suggestion. If you have an actual disorder? You can expect even further variations from the norm. Regarding metabolic rate, your best bet is not to quibble over the numbers but focus instead on your habits and consistency.

To summarize:

– RMR is but one factor to determine overall caloric burn. In controlled research, drops in RMR when returning to weight stable and fed states are minimal and mostly related to body weight and activity not RMR itself.

– Putting a focus on daily low-grade activity and caloric awareness are still your best bets to lose and keep weight off. This does not have to translate to suffering.

– Focus on the variables in your own caloric “normal” to optimize your daily metabolic rate.

– Obsessing over the minutia of the numbers is far more damaging than maximizing your habits and focusing on your long-term mindset.

– Don’t get caught up in an entitlement game and instead live in a critical and reality-based system of physical and mental change.

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Noted research, studies, or sources for articles. This includes some but is not limited to all. Chronological order.

Am J Clin Nutr. 1992;56:848–56
Prediction of resting energy expenditure from fat-free mass and fat mass.
5. Nelson KM, Weinsier RL, Long CL, Schutz Y.

Am J Physiol. 1992 Oct;263(4 Pt 1):E730-4. Links
Concomitant interindividual variation in body temperature and metabolic rate.
Rising R, Keys A, Ravussin E, Bogardus C.

Curr Opin Clin Nutr Metab Care. 2004 Nov;7(6):599-605.
Variability in energy expenditure and its components.
Donahoo WT1, Levine JA, Melanson EL.

Nat Clin Pract Endocrinol Metab. 2007 Jul;3(7):518-29.
The role of physical activity in producing and maintaining weight loss.
Catenacci VA1, Wyatt HR.

Med Sci Sports Exerc. 2008 Oct;40(10):1781-8. doi: 10.1249/MSS.0b013e31817d8176.
Weight regain is related to decreases in physical activity during weight loss.
Wang X1, Lyles MF, You T, Berry MJ, Rejeski WJ, Nicklas BJ.

Am J Clin Nutr. 2008 Oct;88(4):906-12.
Long-term persistence of adaptive thermogenesis in subjects who have maintained a reduced body weight.
Rosenbaum M1, Hirsch J, Gallagher DA, Leibel RL.

Curr Opin Clin Nutr Metab Care. 2011 Jul; 14(4): 402–412.
doi: 10.1097/MCO.0b013e3283479109
Sleep and obesity
Guglielmo Beccutia,b and Silvana Pannaina

J Nutr Metab. 2011;2011:237932. doi: 10.1155/2011/237932. Epub 2011 Jul 28.
A review of weight control strategies and their effects on the regulation of hormonal balance.
Schwarz NA1, Rigby BR, La Bounty P, Shelmadine B, Bowden RG.

J Obes. 2011; 2011: 360257.
Published online 2010 Aug 12. doi: 10.1155/2011/360257
PMCID: PMC2931400
Physical Activity Plays an Important Role in Body Weight Regulation
Jean-Philippe Chaput,1,* Lars Klingenberg,1 Mads Rosenkilde,2 Jo-Anne Gilbert,3 Angelo Tremblay,3 and Anders Sjödin1

Adv Nutr. 2015 Sep 15;6(5):592-9. doi: 10.3945/an.115.008615. Print 2015 Sep.
Reciprocal Compensation to Changes in Dietary Intake and Energy Expenditure within the Concept of Energy Balance.
Drenowatz C1.

Journal Of Obesity
Persistent metabolic adaptation 6 years after “The Biggest Loser” competition
Erin Fothergill1, Juen Guo1, Lilian Howard1, Jennifer C. Kerns2, Nicolas D. Knuth3, Robert Brychta1, Kong Y.
Chen1, Monica C. Skarulis1, Mary Walter1, Peter J. Walter1 andKevin D. Hall1,*
Article first published online: 2 MAY 2016

http://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/

http://www.burnthefatinnercircle.com/public/The_Biggest_Loser_Pros_And_Cons.cfm

http://nypost.com/2015/01/18/contestant-reveals-the-brutal-secrets-of-the-biggest-loser/

https://www.leighpeele.com/starvation-mode