The Biggest Loser: Are Weight Loss Attempts Doomed?

Transcription

1 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

2 Today s Focus 1. Biggest Loser What did we learn? 2. Weight loss/mgt What can we recommend? 3. Rethinking how we talk about weight management. 2

3 1. The Biggest Loser: What have we learned? Before After Bill Germanakos from Biggest Loser 3

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

5 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 out 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).

6 Body Size/En Expenditure Baseline (n=16) Week 30 (n=16) Change Anthropometrics (DXA) Body Wt (kg) (38.0) (330lbs) 91.6 (22.9) 57.6 kg (127lbs) BMI (kg/m 2 ) 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)

7 Body Size/En Expenditure Baseline (n=16) Week 30 (n=16) Change Anthropometrics (DXA) Body Wt (kg) (38.0) (330lbs) 91.6 (22.9) 57.6 kg (127lbs) BMI (kg/m 2 ) 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

8 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

9 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. Alan Smith 9

10 Obesity, 2016 Objective: 1. Measure long-term changes in RMR & body composition in participants of Biggest Loser. Kevin Hall 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. Fothergill et al, 2016

11 Body Size/En Expend. at 6 y N=14 Baseline Age=34.9y Anthropometrics (DXA) Week 30 Age= 35.4y 6 y Age = 41.3y Body Wt (kg) (87% of baseline) BMI (kg/m 2 ) 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± ± ±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

12 Body Size/En Expend. at 6 y N=14 Baseline Age=34.9y Anthropometrics (DXA) Week 30 Age= 35.4y 6 y Age = 41.3y Body Wt (kg) (87% of baseline) BMI (kg/m 2 ) 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± ± ±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

13 Individual BW, FFM & FM Body Weight Fat Free Mass Fat Mass Regained FFM Fat Mass Gains 13

14 Individual RMR & Metabolic Adaptation RMR 14

15 Who experienced the most metabolic adaptation? 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 15

16 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

17 2. Weight Loss What can we recommend? Diet + Exercise vs Diet?

18 PLoS One, 2009 Subjects: M/W (n=48); Age: 38y; BMI=27.8(kg/m 2 ); <2d/wk PA Diet: (TEE determined by DLW over 14-d); Wk 1-12 & 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, 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.

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

20 Redman et al PLoS 2009 CR+Exercise + 129±86 CR = 25% CR + EX = 12.5% ea LCD = 900 kcal/d Caloric Restriction only -240±114 kcal

21 Dr. Barbara Rolls, Distinguished Professor Penn State University Author: Volumetrics Weight-Control Plan: Feel Full on Fewer Calories & The Volumetrics Eating Plan

22 Low Energy Density (LED) (kcal/g) Diet Types of Foods: Whole fruits Whole Vegetables High fiber whole grains Low fat foods (dairy/meat) ¼ c raisins vs. 1 2/3 c grapes Characteristics of Foods High fiber & water content = High volume/weight Less energy (kcal) per weight (g) of food (kcal/g) Aid in satiety & promote feeling of 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

23 Results: 2006, AJCN. Portion Size Effects: kcal/d; 10% kcal Energy Density Effects: -575 kcal/d; 24% kcals

24 Examples of very low, low, medium, Very-low (< 0.6 kcal/g) Most whole fruits, berries Most whole vegetables Skim milk; low-fat yogurt/dairy Broth based soups and high energy dense foods Low ( kcal/g) Other fruits: bananas, papayas Starchy vegetables: peas, corn, winter squash, baked potato Fat-free cottage cheese Cooked whole grains:(oatmeal, brown rice) Legumes, low-fat meats Medium ( kcal/g) Dried fruits: apricots, raisins, apples Whole wheat (WW) breads, bagels, English muffins Mozzarella or Swiss cheese Baked snack foods: pretzels, tortilla chips Eggs, sirloin steak, pork chops High (>4.0 kcal/g) Nuts and nut butters Cookies, muffins, pastries; foods with added sugar and fat Other cheesescheddar, Brie-, mayo, sour cream Potato chips, regular tortilla chips, pretzels Candy-all types, chocolate 24

25 Challenges to Weight Mgt Recommendations from ACSM Position Paper for Weight Control for adults (Donnelly et al. MSSE 2009): Prevent weight gain = min/wk (20-35 min/d) Improve weight loss = 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 off typically exercise at least ~1 1h/day (NWCR data).

26 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 of the small everyday choices you make!

27 Thank you! Questions?