Did you read it? I’m referring to the May 2nd New York Times article on obesity, which was focused around the weight regain experience of some contestants from The Biggest Loser. If you are interested in the biological aspects of weight gain and loss it is worth the lengthy read. https://www.nytimes.com/2016/05/02/health/biggest-loser-weight-loss.html?_r=0).
As a health psychologist specializing in weight management, I believe it is so important for often-inaccessible science on weight and obesity to be distributed in a readable, understandable format, and covered in a way that maintains the integrity of scientific findings rather than grabbing a quick sensational headline at the expense of the science. I can also appreciate this New York Times piece and the well-qualified researchers who were interviewed, for describing the metabolic and hormonal changes that occur with body weight reduction.These biological adaptations make it challenging (in some cases, extremely challenging) to maintain a lower body weight. If you have ever found yourself having the same experience (seeing the weight come back on quickly and easily), or witnessed someone in your life having this experience, you have probably asked the question “What’s wrong with Me?” or “How could I have let this happen?”
Even a basic understanding of the complex systems that influence weight regulation, appetite, metabolism, and genetic expression, allows for a greater appreciation of the uphill battle faced by those working to maintain a weight reduction. The article included a quote from one of the former contestants about the burden of shame that was lifted when he learned of the very real biological factors that contributed to his weight regain. And they are very real factors.
Yet, the article left me wondering whether the biological changes are as impactful for everyone who loses weight, or are there individual differences in how powerful the biological drive is to “restore” the lost weight. Does the manner in which the weight was lost have an impact on all of this?
The individuals followed in the “Biggest Loser” study that were highlighted in the article lost large amounts of weight in relatively short time frames….often around 50% of their starting weight in well under a year. That rate of weight loss is much higher than recommended by weight management experts, who suggest aiming for a 1-2% reduction per week (e.g., approximately 3-4 lbs per week for a 300-lbs person). Bottom line, there is increasing scientific consensus around the biological mechanisms that make it easy to regain weight, but there are still many questions to answer before we all conclude that this is a futile endeavor.
One of the biggest gaps in this Biggest Loser story involves behavior and psychology. The article discusses how changes in appetite hormones (leptin and ghrelin) can lead to frequent, persistent, and intense feelings of hunger, food cravings, and even compulsions to binge eat. This may all be true, but it is also true that our environments, emotions, and learned food associations can also trigger feelings of hunger, food cravings, and compulsions to binge. With no shaming or blaming intended whatsoever, we must remember that most individuals become overweight even when their metabolism, leptin, and ghrelin levels are in normal ranges. While genetics are likely playing a substantive role in initial weight gain, so are:
- lifestyle patterns
- food-centered social activities
- being sedentary
- excessive availability of energy dense foods
- learned behaviors that train us to eat in response to cues other than hunger (such as emotions
- other neglected areas of self-care, such as sleep insufficiency
Biological barriers or not, these other factors that were probable contributors at the time of initial weight gain are likely lurking in the mix and should be as closely examined as biological barriers when studying what leads to weight regain. Not only does this allow for a more holistic appreciation of the human beings trying to maintain a lower body weight, it reminds us that biology isn’t the only player.
What also matters is our day-to-day efforts to:
- maintain a healthy, balanced, regulated relationship with food
- prioritize and care about ourselves enough to carve out time for sleep, physical activity, relaxation, social connection, and pleasurable activity
- make changes in our lives, relationships, routines, coping strategies, and emotional challenges that support and facilitate – rather than prohibit – healthy behaviors.
In the game of lifelong weight management, these all matter, too. And we probably have more control over some of these than we do our leptin levels.
Finally, there is a pretty amazing field of science called Behavioral Epigenetics (how nurture shapes nature) which is increasingly revealing the ways that our behavior can influence our biology. Though in the relatively early stages of being applied to obesity, epigenetics research has shown that behaviors such as eating a lower-fat diet and exercising regularly can have a significant impact on the expression of genes known to predispose humans to obesity. This means that our behaviors, when performed consistently, can help determine whether or not a genetic predisposition becomes a reality. Without getting too far afield, I mention this because it adds another layer in the quest to better understand obesity management, including the problem of weight regain. This reminds us that although our biology is part of the problem, our behavior is part of the solution. I am not yet ready to declare Biology the Biggest Winner, and I hope you’re not either.
