The Biggest Loser: Are Weight Loss Attempts Doomed? Melinda M. - - PowerPoint PPT Presentation

The Biggest Loser:

Are Weight Loss Attempts Doomed?

Melinda M. Manore, PhD, RD, CSSD, FACSM College of Public Health and Human Sciences Oregon State University

1

• 1. Biggest Loser – What did we learn?
• 2. Weight loss/Mgt – What can we

recommend?

• 3. Rethinking how we talk about weight

management.

Today’s Focus

2

3

• 1. The Biggest Loser:

What have we learned?

Bill Germanakos from Biggest Loser Before After

Kevin Hall, PhD NIDDK Obesity, 2016 J Clin Endocrinol Metab, 2012 Eric Ravussin, PhD Pennington Biomedical Research Center

J Clin Endocrinol Metab, 2012

Question:

1. Does a weight loss program of diet restriction and vigorous exercise preserve FFM and RMR? 2. Does metabolic ‘adaptation” occur to counter weight loss and contribute to weight regain?

Subjects: Biggest Loser Participants (n=16; M=7; F=9) measured before & after weight loss (0,6,30wk) (33±10y). Methods: Housed in isolated ranch in LA, with 1 contestant voted

• ut every 7-10 d (n=11 at 6wk); 4 stayed for 13 wks. Participants

returned home & continued program on their own (30 wk). Exercise: 90min/d supervised (6d/wk, aerobic/strength) + encourage to do another 3 h/d. Min PA=2h/d; Mean PA=3 h/d Diet: 65-70% of baseline energy requirements (1300 kcal/d).

Body Size/En Expenditure

Baseline (n=16) Week 30 (n=16) Change ∆ Anthropometrics (DXA) Body Wt (kg) 149.2 (38.0) (330lbs) 91.6 (22.9) 57.6 kg (127lbs) BMI (kg/m2) 49.4 (9.4) 30.4 (6.4) 19.0 Wt Change (%) 39.9 (9.1) FFM (kg) 75.7(20.2) 65.2(15.5)

10.5 (17.4% Wt Loss)

FM (kg) 73.5 (21.1) 26.4 (13.8)

47.1 (82.6% Wt Loss)

Body Fat (%) 49(5) 28(10) 21% Energy Expenditure RMR (kcal/d) 2,679(624) 1,890 (423)

• 789

Predicted RMR (kcal/d) 2,393 (466) Metabolic Adapt (kcal/d)

• 504 (171) (n=14)

(7%↓ kcal/kg FFM) TEE (kcal/d) 3900 (957) 3114 (571)

• 786

6

∆ Body Size/En Expenditure

Baseline (n=16) Week 30 (n=16) Change ∆ Anthropometrics (DXA) Body Wt (kg) 149.2 (38.0) (330lbs) 91.6 (22.9) 57.6 kg (127lbs) BMI (kg/m2) 49.4 (9.4) 30.4 (6.4) 19.0 Wt Change (%) 39.9 (9.1) FFM (kg) 75.7(20.2) 65.2(15.5)

10.5 (17.4% Wt Loss)

FM (kg) 73.5 (21.1) 26.4 (13.8)

47.1 (82.6% Wt Loss)

Body Fat (%) 49(5) 28(10) 21% Energy Expenditure (DLW) RMR (kcal/d) (mea) 2,679(624) 1,890 (423)

• 789 kcal/d

Predicted RMR (kcal/d) used baseline data 2,393 (466) Metabolic Adapt (kcal/d)

• 504 (171) (n=14)

(20%↓kcal/kg FFM)

TEE (kcal/d) 3900 (957) 3114 (571)

• 786 kcal/d

7

Metabolic Changes

Significant Improvements (mean ∆):

• Fasting Glucose ↓ 19 mg/dl (20%)
• HOMA-IR ↓ 40%*
• C-Peptide ↓50%
• TAG↓ 64 mg/dl (216%)*
• HDL-Chol ↑ 12 mg/dl

8

Summary (Baseline-30 wks)

• Despite FFM preservation, high exercise

did not prevent the slowing of RMR more than predicted based on weight loss.

• Metabolic adaptation persisted through

weight maintenance, which may increase risk of weight regain unless high level PA maintained and energy restriction remained.

9

Alan Smith

Objective:

1. Measure long-term changes in RMR & body composition in participants of “Biggest Loser”.

Subjects: Biggest Loser participants (n=14/16; M=6; F=8) returned to NIH 6y after weight loss. 1 subject maintained wt loss; 5 subjects were with 1% of baseline or above. Methods: For 2 wk prior to 3-d NIH Clinical Ctr stay, remote body weight monitoring occurred (bluetooth; electronic). RMR, TEE (DLW) and body composition (DXA), and hormones & metabolite measurements done.

Kevin Hall Obesity, 2016

Fothergill et al, 2016

Body Size/En Expend. at 6 y

N=14 Baseline Age=34.9y Week 30 Age= 35.4y 6 y Age = 41.3y Anthropometrics (DXA) Body Wt (kg) 148.9 90.6 131.6 (87% of baseline) BMI (kg/m2) 49.5 (10.1) 30.2 (6.7) 43.8 FFM (kg) 75.5(21.1) 64.4(15.5) 70.2 (93% baseline) FM (kg) 73.4 (22.6) 26.2 (13.6) 61.4 (84% baseline) Body Fat (%) 49(5) 28(9) 44.7 (91% baseline)

Energy Expenditure (DLW)

PA (kcal/kg/d) 5.6±1.8 10.0 ± 4.6 10.1±4.0 RMR (kcal/d) (mea) 2,607(649) 1,996 (358) 1,930 (466) Predicted RMR (kcal/d) 2,577 (574 2,272 (435) 2,403 (507) Metabolic Adapt (kcal/d)

• 275 (205)
• 499 (207)

TEE (kcal/d) 3804 (957) 3,002 (573) 3,429±581

11

Body Size/En Expend. at 6 y

N=14 Baseline Age=34.9y Week 30 Age= 35.4y 6 y Age = 41.3y Anthropometrics (DXA) Body Wt (kg) 148.9 90.6 131.6 (87% of baseline) BMI (kg/m2) 49.5 (10.1) 30.2 (6.7) 43.8 FFM (kg) 75.5(21.1) 64.4(15.5) 70.2 (93% baseline) FM (kg) 73.4 (22.6) 26.2 (13.6) 61.4 (83% baseline) Body Fat (%) 49(5) 28(9) 44.7 (91% baseline)

Energy Expenditure (DLW)

PA (kcal/kg/d) 5.6±1.8 10.0 ± 4.6 10.1±4.0 RMR (kcal/d) (mea) 2,607(649) 1,996 (358) 1,930 (466) Predicted RMR (kcal/d) 2,577 (574 2,272 (435) 2,403 (507) Metabolic Adapt (kcal/d)

• 275 (205)
• 499 (207)

TEE (kcal/d) 3804 (957) 3,002 (573) 3,429±581

12

Individual ∆ BW, FFM & FM

13

Body Weight Fat Free Mass Fat Mass Regained FFM Fat Mass Gains

Individual ∆ RMR & Metabolic Adaptation

14

∆ RMR

Who experienced the most metabolic adaptation?

15

• 1. Weight regain was not significantly correlated with

metabolic adaptation.

• 2. Subjects who maintained weight loss at 6 y experienced

the greatest metabolic adaptation.

Wt regained from Baseline

Biggest Loser Summary

• 1. Participants regained 87% of their

lost weight in 6 y. UNSUCCESSFUL?

• 2. 50% of participants maintained at

least a 10% weight loss. SUCCESS?

• 3. Metabolic adaptation was NOT

related with weight regain – but with long-term weight loss.

• 4. Long-term weight loss requires

vigilant combat against weight regain.

16

Diet + Exercise vs Diet?

• 2. Weight Loss – What can we

recommend?

PLoS One, 2009

Subjects: M/W (n=48); Age: 38y; BMI=27.8(kg/m2); <2d/wk PA Diet: (TEE determined by DLW over 14-d); Wk 1-12 & 22-24 all food provided; Wks13-22 self-selected diets based on targets; 30% FAT; 15% PRO; 55% CHO

• Control (ad libitum diet);
• Caloric restriction (CR) (↓ 25% of en);
• CR (↓12.5% en) + Ex (↑12.5% en; 5d/wk, 45-55 min/d using HRM)
• Low calorie diet (LCD) = 890 kcal/d until lost 15% BW then

maintenance

Duration: 6 months Data collection body comp (DXA): baseline, 3, 6.

↓25% en

CR = ↓ 25% CR + EX = 12.5% ea LCD = 900 kcal/d Key point: Weight loss the same with CR (-10.4%↓) and CR + EX (-10%↓). 6 mo

CR+Exercise Caloric Restriction only Redman et al PLoS 2009

CR = ↓ 25% CR + EX = 12.5% ea LCD = 900 kcal/d

• 240±114 kcal

+ 129±86

Author: “Volumetrics Weight-Control Plan: Feel Full on Fewer Calories” &

“The Volumetrics Eating Plan”

• Dr. Barbara Rolls, Distinguished Professor

Penn State University

Low Energy Density (LED) (kcal/g) Diet

Types of Foods:

• Whole fruits
• Whole Vegetables
• High fiber whole grains
• Low fat foods (dairy/meat)

Characteristics of Foods

• High fiber & water content =

High volume/weight

• Less energy (kcal) per weight (g)
• f food (kcal/g)
• Aid in satiety & promote feeling
• f fullness
• Low in fat; no sweetened bev

Summary: LED diets may result greater losses in BW & reduction in kcals + with no reduction in portion

• sizes. Rolls et al, 2004

¼ c raisins vs. 1 2/3 c grapes

Results:

Portion Size Effects: - 231 kcal/d; 10%↓ kcal Energy Density Effects:

• 575 kcal/d; 24%↓ kcals

2006, AJCN.

Examples of very low, low, medium, and high energy dense foods

Very-low

(< 0.6 kcal/g)

Low

(0.6-1.5 kcal/g)

Medium

(1.5-4.0 kcal/g)

High

(>4.0 kcal/g)

Most whole fruits, berries Other fruits: bananas, papayas Dried fruits: apricots, raisins, apples Nuts and nut butters Most whole vegetables Starchy vegetables: peas, corn, winter squash, baked potato Whole wheat (WW) breads, bagels, English muffins Cookies, muffins, pastries; foods with added sugar and fat Skim milk; low-fat yogurt/dairy Fat-free cottage cheese Mozzarella or Swiss cheese Other cheeses- cheddar, Brie-, mayo, sour cream Broth based soups Cooked whole grains:(oatmeal, brown rice) Baked snack foods: pretzels, tortilla chips Potato chips, regular tortilla chips, pretzels Legumes, low-fat meats Eggs, sirloin steak, pork chops Candy-all types, chocolate

24

• Recommendations from ACSM Position Paper for

Weight Control for adults (Donnelly et al. MSSE 2009):

• Prevent weight gain = 150-250 min/wk (20-35 min/d)
• Improve weight loss = 150-250 min/wk (20-35 min/d)

+ moderate energy restriction

• Keep weight off after dieting =>250 min/wk
• 3-5% ↓ in wt can significant ↓ CHD factors
• People who lose wt and keep it
• ff typically exercise at least ~1

1h/day (NWCR data).

Challenges to Weight Mgt

• 3. Surviving our obesogenic

environment?

• Weight management is difficult in today’s

food/built environment.

• Identify what you can manipulate & understand

what you cannot change.

• Identify a weight that is ‘healthy’ and allows you

participate in physical activities.

• Remember your diet & PA level is the sum total
• f the small everyday choices you make!

Thank you! Questions?