Why Some “Biggest Losers” Gain Weight

By Keith-Thomas Ayoob, ED.D.

TV shows such as The Biggest Loser are hugely successful, attracting viewers who watch contestants compete to see who can lose the most weight.

Over the long term, however, the show has had more ratings success than participants have had success at keeping the pounds off. A recent New York Times article profiled several contestants. The piece highlighted how difficult it was for them to maintain their significant weight loss.

In some ways, the added weight wasn’t a surprise; during the show they lived and breathed exercise and weight loss and, of course, pounds melted away. The results of a study tracking some of the contestants’ experiences were recently published in the journal Obesity.

The participants in the article returned to their usual lives, hoping to be able to maintain their new, svelte selves. That didn’t happen, but not just because they couldn’t keep up the impossible training and dieting routine.

Some of the weight gain, as both the Times and Obesity articles note, also came from metabolic aberrations that work against “yo-yo” dieters. Another theory is that weight loss often comes from lean tissue, especially muscle, and that much of the regained weight tends to be fat, especially in individuals who don’t exercise much.

The silver lining
Perhaps one of the most unsettling aspects of recent media stories is that they appear to offer little hope to those who want to lose weight and keep it off. For these individuals, however, I offer a silver lining–because certain weight-loss programs can actually work.

Here’s the evidence, which comes from the National Weight Control Registry, established in 1994 by doctors Rena Wing of Brown University and James O. Hill of the University of Colorado. To qualify for this registry, you must have lost at least 30 pounds and kept the weight off for at least a year, verified by some type of objective documentation (for example, from a physician or weight-loss program).

Most of these winners actually lost about 66 pounds and kept them off for five years–far better than the minimum requirement for registry qualification. They used various diets to get the weight off, but they have common lifestyle factors that have helped them maintain their “new normal” weights:

  • Four out of five eat breakfast every day.
  • Three out of four weigh themselves at least once a week.
  • Nearly two out of three watch less than 10 hours of TV per week.
  • Nine out of 10 exercise, on average, about an hour per day.
  • Most eat a low-calorie diet, with about 28 to 30 percent of their calories from fat.

Real-world weight loss

Still, none of this helps me when I’m with patients at the Children’s Evaluation and Rehabilitation Center at Montefiore. I can’t tell them to hold on until everything about weight loss and regain gets sorted out. My advice to them?

  • Choose a realistic weight goal. Start at 10 percent below your current weight; get there, then reevaluate.
  • Eat as healthfully as you can, taking a few weeks to adapt to each new diet or lifestyle change.
  • Aim for some physical activity every day and make it a priority.
  • Engage in habits and lifestyles aligned with those of people who have lost weight and kept it off.
  • Do these things because they’re good for your overall health, not because of how they will make you look or what they may do for your weight.

For all of us, it’s important to realize that slow and steady wins over fast and furious because you’re not on TV; you’re in reality. Besides, a slower, steadier loss gives you more time to adjust to the lifestyle changes needed to align yourself with those who have crossed the finish line. Be one of the biggest maintainers, not losers, I say. It may not be as sexy a title, but you’ll be a winner and I’ll be your biggest cheerleader.

Dr. Ayoob is director, Nutrition Clinic, Children’s Evaluation and Rehabilitation Center at Montefiore and associate clinical professor, pediatrics at Albert Einstein College of Medicine.


This post was originally featured on The Doctor’s Tablet, the blog of Albert Einstein College of Medicine.

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