An article recently appeared in Obesity Journal that suggest that the future of America’s health is in danger. The article, which followed former contestants of The Biggest Loser, gives a graphic description of the difficulty of maintaining weight loss for any considerable length of time.
Scientists and media have been talking about the problem for years
The basic problem is that it is much easier to lose weight than keep it off. The second problem is that once someone is obese, long-term weight control becomes even more difficult. The study suggests to me that the real problem is hormone resistance, specifically, insulin resistance.
According to a Washington Post article from earlier this year on childhood obesity, it is estimated that 1/3rd of Americans born after 2000 will become diabetic. The top risk factor for diabetes is obesity from insulin resistance. An earlier article on life span projection, says that the country’s increase in obesity will lead to the first reduction in lifespan predictions in American history.
It’s not just that obesity is growing, but morbidly obese people (BMI greater than 40) are the fastest growing segment of the U.S. population. With morbid obesity comes the increased risk of diabetes and a significant increase in risk for its fellow travelers: heart disease and Alzheimer’s. This trio of chronic diseases will eventually break the back of the American health care system.
Is there a solution to America’s obesity epidemic?
How do you fix the obesity problem? The widely accepted answer is to simply “eat less and exercise more.” It’s so widely accepted that it has made the popular TV series The Biggest Loser one of the longest running reality shows in modern history. Each year, morbidly obese but relatively healthy contestants get to eat less and exercise more on national TV.
They do lose weight, but what happens after the stage lights go out? Sadly, most of them regain the weight they lost, and sometimes more. The implication is they don’t have the willpower or intelligence to keep the weight off, but the article in Obesity Journal suggests otherwise. Maybe the issue is that the show’s contestants are simply unable to fight powerful biological defenses that cause people to re-gain weight.
Why Doesn’t The Biggest Loser Work?
So why doesn’t eating less and exercising more work? First, eating less can cause stress to the system causing more hunger. The second is that the more people exercise, the hungrier they become. But don’t people lose weight on the Biggest Loser TV program? The answer is yes, because the diet they use on the TV series is essentially a version of the Zone Diet.
My book The Zone that described the Zone Diet was published in 1995. It sold more than 2 million copies and was a New York Times #1 bestseller. My follow–up books were all New York Times bestsellers as well, because the science in them was solid. It is not too surprising that when The Biggest Loser was published in 2005, the diet they used was remarkably similar to my earlier Zone books. After all, there were already 10 years of proof that The Zone works.
Comparing the Biggest Loser diet to The Zone
The Zone Pyramid that I published in my book is remarkably similar to the food pyramid published in The Biggest Loser.
Let’s compare the calories recommended by each program. For the Zone Diet, I recommend people eat between 1,200 to 1,500 calories per day. The Biggest Loser Diet, requires between 1,200 and 1,800 calories per day. The higher upper limit on the Biggest Loser Diet is a catch-all number for people who are morbidly obese because they require more calories.
The calculations used to personalize the Zone Diet cover that requirement more specifically. A person with morbid obesity has more muscle mass than the normal individual and therefore needs more protein. By calculating their protein requirements based on lean body mass using The Zone guidelines, their carbohydrate and fat requirements are more personalized, which balances their hormonal responses to the foods they eat. This will result in eating more calories, but will also result in maximal fat loss. As they lose fat, they can readjust their requirements.
The Biggest Loser Diet also recommends drinking a lot of water, eating three meals and two snacks per day and recommends that a protein serving size should be the size of the palm of the hand. Those were the exact dietary recommendations I made a decade earlier in my books. A big difference, and perhaps one of the reasons contestants’ long-term efforts failed, is that they are taken to camp (i.e. a metabolic ward) where all their meals are prepared for them. So even if they wanted to eat more calories, they couldn’t. Once they go home, they are on their own.
Wouldn’t all the exercise on The Biggest Loser help? Only a little, but it makes great TV
Remember that morbidly obese individuals already have a large amount of muscle mass since they are essentially weight training 24 hours a day because of the extra fat tissue they carry on their bodies.
Even with the most intense training people are unlikely to add more than five pounds of muscle in 12 weeks of weight training. The reason viewers see their muscles emerging as the show goes on is because as the layer of fat surrounding the muscles is lost, muscles become more visible. Those muscles were always there but covered by a mass of fat tissue.
When I talked to the chief nutritionist of the show at conference several years ago she said, “Of course, the weight changes are all due to the diet. But who wants to see obese people eating meals? There’s no drama in eating grilled chicken and vegetables. People want to see pain, tears, and hugs in the gym. That’s great TV.”
What really happens to the contestants’ bodies after the show?
Let’s look at the data from the Obesity Journal article. The average weight of the subjects was 327 pounds. Of that starting total weight, 161 pounds was fat and the other 166 pounds of their weight was fat-free mass, which is usually described as muscle mass. At the end of 30 weeks of dieting and exercise, the contestants had lost an average of 104 pounds of fat as well as 24 pounds of muscle. As they exercised more, they required more calories. Since they didn’t take in their minimum requirement, they lost muscle mass as well as fat.
Since the maintenance of muscle mass requires calorie burn, and losing muscle mass slows the metabolism, contestants may have been better off simply eating three Zone meals and two Zone snacks per day and skipping the heavy exercise. They would have retained more of their initial muscle mass.
So why did they gain all the weight back? The answer is hormone resistance. Ultimately, weight gain, weight loss, and weight maintenance is governed by hormone communication in the gut, blood and the brain. If the hormones are not getting their signals through to the target cells, then this is called hormone resistance. The best-known example of hormone resistance is called insulin resistance.
If you have insulin resistance, then the levels of insulin increase in the blood as the pancreas secretes more insulin into the blood to accomplish its primary task, which is to reduce elevated toxic blood glucose levels as high levels of glucose are toxic. This excess insulin in the blood also increases the deposition of fat into the fat cells and prevents its release for energy production. In essence, excess insulin in the blood makes people fat and keeps them fat. However, the same insulin resistance also prevents insulin from interacting with its receptors in the brain to tell people to stop eating.
At the molecular level, the underlying cause of insulin resistance is increased inflammation. Keeping inflammation under control is key to preventing weight from returning. Following The Zone and taking high doses of fish oil are essential to this process.
Long-term weight loss can only be attained when inflammation is resolved
Long-term weight control will only come from calorie-restriction without hunger or fatigue. This means you have to decrease insulin resistance in the gut, blood, and the brain. Following an anti-inflammatory diet like the Zone Diet and highly restricting intake of omega-6 and saturated fats in the diet for a lifetime is the only way to keep weight off.
In addition, the diet must have a low glycemic load. This is achieved by eating primarily non-starchy vegetables balanced with adequate levels of low-fat protein to keep your blood hormones in balance. This requires following a protein-adequate, carbohydrate-moderate, low-fat diet. That is the definition of the Zone Diet, and it is clinically proven.
Gastric bypass surgery is not the solution, but it does leads to a dietary discovery
Rather than recommending gastric bypass surgery, which reduces insulin resistance, I developed Zone PastaRx to reproduce many of the same hormonal changes in the gut that are generated by surgery. Our clinical trials have demonstrated that Zone PastaRx is very effective in reducing insulin resistance. In essence, it becomes a potential dietary alternative to gastric bypass. However, unlike gastric surgery, it is a desirable, convenient and sustainable source of protein which makes it easier to follow the Zone Diet for a lifetime.
The best part is that the same clinical trials that indicated Zone PastaRx builds lean body mass and reduces fat is just like being on The Biggest Loser but without the screaming trainers.
The Zone Insulin Resistance Calculator helps determine your extent of insulin resistance, and also provides clinically-based dietary recommendations that may help reduce your levels of insulin resistance. See your Insulin Resistance Score, and Zone recommendations tailored to you, and what you can do to reduce it.
Sources and Further Reading:
- Fothergill E et al. “Persistent metabolic adaption 6 years after ‘The Biggest Loser’ competition.” Obesity 24: doi: 10.1002/oby.21538 (2016)
- Skinner AC et al. “Prevalence of obesity and severe obesity in US children, 1999-2015.” Obesity 24:1116-1123 (2016)
- Ferdman RA. “A widely held belief about childhood obesity that simply isn’t true.” Washington Post. May 2, 2016
- Narayan KM et al. “Lifetime risk for diabetes mellitus in the United States.” JAMA 2003 290:884-1890 (2003).
- Olshansky SJ et al. “A potential decline in life expectancy in the United States in the 21st century.” N Eng J Med 352: 1138-1145 (2005).
- Sears B. The Zone. Regan Books. New York, NY (1995)
- Sears B. Mastering the Zone. Regan Books. New York, NY (1997)
- Sears B. Zone Meals in Minutes. Regan Books. New York, NY (1997)
- Greenwood-Robinson M. The Biggest Loser. Rodale. Eramus, PA (2005)
- Sears B. Toxic Fat. Thomas Nelson. Nashville, TN (2005)
- Sears, B. The Mediterranean Zone. Ballantine Books. New York, NY (2014)
- Sears B and Perry M. “The role of fatty acids in insulin resistance.”
Lipids Health Dis 14:121 (2015)
- Edholm D et al. “Long-term results 11 years after primary gastric bypass in 384 patients.” Sur Obesity and Related Dis 9:708-713 (2013)
- Kolata G. “After ‘The Biggest Loser’, their bodies fought to regain weight.” New York Times. May 2, 2016
- Chan JL et al. “Peptide YY levels are elevated after gastric bypass surgery.” Obesity 14:194-198 (2006)
- Ludwig DS et al. “High glycemic index foods, overeating, and obesity.” Pediatrics 103:E26 (1999)
- Agus MS et al. “Dietary composition and physiologic adaptations to energy restriction.” Am J Clin Nutr 71:901-907 (2000)