The Science of Successfully Maintaining Weight Loss

The Science of Successfully Maintaining Weight Loss
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4 Ways to Fight Back Against Your Body Fighting Back to Regain Weight

<p>Our biology is programmed for regaining weight after weight loss</p>

Our biology is programmed for regaining weight after weight loss

Photo credit: 123RF

One of the biggest challenges in reversing obesity is maintaining weight loss. Many people who carry extra weight have successfully lost weight many times on many different diets—only to face the disappointment of gaining the weight back.

The tendency of our body to fight back against weight loss may be a primal instinct. For most of our history, starvation was one of the biggest threats to our survival. In response, we developed a built-in energy feedback system designed to protect us from getting dangerously undernourished. This system is thought to maintain our weight at a particular “set point,” much like a setting on a thermostat. When our weight dips below this set point, hard-wired changes in our hormones and metabolism kick in to drive us toward our original weight. All this happens without our awareness.

Foods high in fat may gradually ratchet up our set point, to where our body will defend a weight that is in the range of obesity. When that happens, even healthy weight loss is sensed as a threat. Our energy feedback system, mistakenly thinking it is protecting us from starvation, kicks in to revert us to our unhealthy new obesity-range thermostat setting. So powerful is this survival instinct that it underlies the reason we notoriously “fail” at maintaining weight loss.

Putting the numbers in perspective, a 2015 study in the American Journal of Public Health found that among people who achieved the commonly recommended goal of 5% weight loss, 53% regained the weight within two years. 78% had regained it within five years.

Discouraging, yes. But insurmountable, no. Even though our bodies are designed to resist weight loss, there is a lot we can do to keep the weight off. Here is a closer look at four critical instinctive challenges that we face after weight loss, and how we can successfully work with our biology to overcome them.

Challenge #1: Weight loss causes hunger to go into overdrive.

Your body has complex pathways for maintaining energy balance so that the calories you take in balance the calories you burn. The drive to eat or burn fat, for example, is tightly controlled by a feedback circuit between your hypothalamus, appetite hormones, and fat stores. With the slightest drop in calories or loss in fat, the level of the “hunger hormone,” ghrelin, spikes. Your brain becomes pre-occupied with food until your hunger is satisfied. After completing its job, ghrelin backs off.

Getting cued to eat ensures adequate energy for doing your daily activities. However, even if you intentionally cut back on calories or try to maintain weight loss, ghrelin unrelentingly stays elevated signaling persistent hunger. Your own body inadvertently sabotages your efforts. If that seems counterproductive, remember that our energy balance system wasn’t designed to keep us healthy. It was programmed for survival.

A New England Journal of Medicine study found that participants who lost weight through a ten-week weight-loss program continued to release appetite hormones in amounts that subconsciously favored hunger and weight gain for a year after successful weight loss. A 2014 study found ghrelin remained elevated even longer—up to three years after weight loss. The tendency to regain weight after weight loss is far more complicated than simply reverting to old habits.

What you can do: Listen to your brain, not your hunger level.

If you are trying to lose weight or maintain weight loss, realize that your body is working against you. Relying on your appetite can be misleading. Your brain, however, can make logical and structured decisions about your calorie intake to override deceptive hunger cues. Using judgment and reason, you should plan well-proportioned meals, making sure they are balanced in calories and nutrients. Even if you feel hungry after eating, stick with your plan.

Challenge #2: Your body will crave fat and sugar.

Leptin is one of the many hormones involved in the checks and balances that regulate appetite and weight. Referred to as the “satiety hormone,” its job is to tell your brain when you are full. In turn, your brain sends out the stop eating command. A rise in leptin level also reduces the reward value of food—so your pleasure and want for food decrease.

When you lose weight, the opposite happens. Leptin level drops. Your brain is enticed to seek food. In addition to restoring calories, a drop in leptin also intensifies the pleasure you get from food. Your want is heightened for food that is particularly rewarding: fat, sugar, and salt. Like nicotine, amphetamine, and sex, these foods cause the brain to release the feel-good neurotransmitter, dopamine. And similar to an addict, you can end up uncontrollably overeating these highly gratifying foods.

What you can do: Choose your food wisely.

Making wise choices may seem like common sense. But you have to select foods that don’t overstimulate your reward pathway. Instead of chips and cookies, choose foods that are high in micronutrients, such as vegetables, fruits, legumes, nuts, whole grains, and lean chicken or fish. Doing so will help you dodge out of control, dopamine triggered binges.

Challenge #3: Metabolism slows disproportionate to weight loss.

When you lose weight, your metabolism slows. That is expected. With a lower body mass, your body burns fewer calories carrying out essential body functions like breathing and digesting.

What is surprising and disheartening is that metabolism drops beyond that predicted by a lower muscle and fat composition. Called “metabolic adaptation,” this further slowing is yet another way your body combats maintaining weight loss.

The longest follow-up study to see how long metabolic adaptation persists after weight loss was carried out on “The Biggest Loser” contestants. Researchers measured the metabolic rate of fourteen participants up to six years following the competition. By the end of the show, the contestants’ resting metabolic rate was an average of 500 calories per day lower than expected based on their measured body composition. In other words, due to metabolic adaptation, their metabolism was 500 calories per day slower than someone else with the same weight and body composition who had never lost a massive amount of weight.

Even more astonishing, despite substantial weight regain in the years after the competition, the contestants’ resting metabolic rate didn’t proportionately increase. It remained suppressed at the same average level as at the end of the weight loss competition. Six years later, their bodies were still fighting back with a vengeance.

What you can do: Raise your resting metabolic rate.

It is encouraging that despite metabolic adaptation, “The Biggest Loser” contestants were successful at weight loss by the measure typically used to define success: Fifty-seven percent were able to lose at least 10% of their initial body weight and keep it off at least one year, compared to an estimated 20% of overweight individuals who have been shown to do so on other weight loss programs. Even more promising, each contestant‘s success was independent of the degree they experienced metabolic adaptation. In fact, some of the contestants most successful at maintaining weight loss worked against the greatest slowing in their metabolism. Their tenacious efforts at raising their metabolism, to the extent in their control, paid off.

Resting metabolism increases in proportion to muscle mass. Muscle burns three times more calories than fat. By doing strength resistance exercises at least twice a week, such as with weights or yoga, you can build muscle to boost your metabolism, and to some degree, negate metabolic adaptation.

Challenge #4: Obesity disrupts the normal functioning of appetite hormones.

Obesity is a disease. It is a state where your appetite and energy hormones, such as insulin and leptin, are abnormally regulated. They don’t function the same as in a person who is normal in weight. Yet, unlike most other diseases, there is still a stigma against seeking medical management. Treatments for obesity are often viewed as last resort, even to some, a personal failure.

What you can do: Accept obesity as a disease.

If you have repeatedly struggled with maintaining weight loss, acknowledge that the formidable challenge you face is different than that in a person that is at their goal weight. Consider seeking treatment, with appetite suppressants or weight loss surgery, akin to seeking treatment for any other health condition.

Weight loss surgery, such as with Roux-en-Y gastric bypass, works in ways far more intricate than just reducing stomach size. By rewiring appetite hormones, it strikes at the core of the reason behind notorious weight yo-yo-ing. Even though the exact way the surgery works remains elusive, patients who have undergone surgery are no longer pre-occupied with food and do not experience the same reward from food. Some scientists even speculate that it lowers a person’s weight set point. Roux-en-Y gastric bypass holds promise for leading us to a better understanding of how to approach obesity— so that in the future we will have more ‘knifeless’ ways to fight against our biologically encoded drive to fight back.

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