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Why it’s so hard to lose excess weight and keep it off: The Biggest Losers’ experience

March 12, 2018

About the Author

photo of Robert H. Shmerling, MD

Robert H. Shmerling, MD, Senior Faculty Editor, Harvard Health Publishing

Dr. Robert H. Shmerling is the former clinical chief of the division of rheumatology at Beth Israel Deaconess Medical Center (BIDMC), and is a current member of the corresponding faculty in medicine at Harvard Medical School. … See Full Bio
View all posts by Robert H. Shmerling, MD


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March 29, 2018

Agree that deprivation in dieting does not work. A good way to go is to eat healthy meals at regular times throughout the day. A lot of folks tend to crave unhealthy snacks more at the end of the day. having a decent, healthy meal at 4 o’clock and a good dinner at 7:30 workS for this. And healthy food doesn’t have to be expensive. For instance, a bag of frozen berries at my local store cost the same as an icecream or a bag of cookies. I also think it’s counterproductive and a waste of energy to weigh yourself constantly. Much more important is to figure out what you need to feel healthy and how different foods affect your energy levels.

Mandy Carrreno
March 27, 2018

I understand from what I’ve read lately, that we are all in the same boat. We have within us DNA a gene which tells us we are hungry. Some of us never get that signal that we are hungry or that we have had enough. They now have a way to turn off the gene, but I wonder what good would that do, if we who have no way of knowing if we are really hungry or not continue to gain weight. Will
they who may have this gene removed or altered gain more weight? Does anyone know? Thanks… : )

Richard Ross - London
March 27, 2018

Socrates said ‘nothing in excess’ which is what these extreme diets offer.
A long slow change in eating habits works, but most people don’t have the determination to run the course. The less sugar intake, the less the craving and eventually the better the outcome.
Keep away form crisps and all day snacking and have the occasional treat, shared with someone so you only half sin!
Most people lack long term determination, so what is needed is research to find how to create the resolve to achieve the desired weight loss, long term.

Madhur Kotharay
March 27, 2018

As you lose weight, presumably fat, the fat cells secrete less leptin which is a hunger inhibition hormone.

Your brain is used to certain level of leptin and low levels of leptin makes you feel more hungry.

Also, just as in Diabetes, you develop insulin resistance, in obesity you develop leptin resistance.

The good news is latest research shows that if you lose weight, and keep it down somehow for 14 months on an average, your brain gets used to the new levels of leptin.

Venu Adhiya Hirani
March 26, 2018

What about the effect of physical activity and focused increase in lean body mass? Won’t that counter the effect of lowered metabolism?

Fiona Cosgrove
March 26, 2018

We have to accept that it’s the go slow approach that will rep-set metabolism.. I love Dr. Amanda Sainsbury-Salis’ approach in her book, the “Don’t go hungry Diet”..

Charlie Dannelly
March 26, 2018

I am a personal trainer in Los Angeles of over 30 years. I had the privilege of working with a few of the BL contestants after they were eliminated from the show. They where given another chance to win if they lost more overall then the other eliminated contestants. On the show, the highest weight loss wins. So that means not gaining muscle mass as well. I think you know where i’m going with this. Low muscle mass + Low metabolism= Body fat gain. The body needs a reason to burn more energy and muscle mass is the only natural way. In closing I would say that the info on the metabolism after massive weight loss is good intel but the mindset after the weight loss is crucial! If your mind isn’t completely reset the right way then a relapse is certain. For more info on how I reset my clients mindsets check out the intel here.

bob choi
March 26, 2018

How about people in Ethiopia? How can they stay so skinny?

March 27, 2018

If I’m not mistaken, Ethiopia has an extrmely low ability toward sustainable nutrition, similar to a number of African countries. It contributes to the Ethiopian life expectancy of only 65 years. “The infant mortality rate is 59 deaths per 1000 live births, while the overall under-five mortality rate is 88 per 1000 live births. A total of 67% of all deaths of children aged under 5 years in Ethiopia take place before a child’s first birthday.” see

March 26, 2018

why doesnt the authors reply to questions in comments to article .
many good comments .,deserve a medical reply

March 26, 2018

The only reason why people gain weight after they lose some pounds is because they return to their bad habits. They don’t understand that exercising and eating healthy is the right way to live forever not only to lose weight.

Lisa M.
March 26, 2018

The whole POINT of this article, is proving it, in FACT, is NOT simply returning to bad habits, but the changes set off in their metabolism FROM DIETING that causes PERMANENT slowing of the metabolism! QUOTE
“Six years later, competitors regained an average of 90 pounds, but the significant slowing in metabolic rate persisted.
There was not a direct correlation between the amount of metabolic slowing and the amount of weight lost during the show. However, after six years those who kept the most weight off had the most slowing.
These findings confirm that weight loss may lead to significant changes in metabolism that, in turn, “RESIST FURTHER WEIGHT LOSS”. In addition, keeping weight off may be especially difficult “BECAUSE THESE CHANGES PERSIST OVER TIME”. The metabolic slowing that accompanies weight loss varies, however, so it may create less resistance to weight loss for some than others.

March 26, 2018

This is the old “set Point” theory. Anyone who has tried to lose weight throughout life knows that the biggest loser was just reality TV gone wrong for dieters. Of course they would gain it back after they left the boot camp mentality and tried to re-integrate into their lives. It just did what most weight-loss fads do, make money for the promoters. Please look into sane ways to be healthy like eating healthy, living balanced, and getting help for stressors. Many people use 12-step OA, dieticians, licensed counselors, healthy exercise. Other research indicates that adipose tissue is metabolically active and tends to send out starvation signals with significant weight loss. And bariatric surgery is not for everyone, either.

Cora Rubenstein
March 26, 2018

What if they lost the weight slowly?

How does this apply to a person, who at age 64, weighing 142 pounds, lost 30 pounds in 6months?

Stephanie B
March 26, 2018

How did you do it??

March 26, 2018

This article addresses lowered metabolism after extreme weight loss over a very short period of time. The question I have is, are the results the same for people who lose weight more slowly? Seems like that would be important information to know.

David Bulkley
March 26, 2018

Are there any studies on the effects of fasting one day a week? I have done this at different times during my life for extended periods, and have found that this is the best way to keep a steady healthy weight. The fast is water only or perhaps a small amount of juice with water, starting after dinner on one day, not eating the following day, and breaking the fast with breakfast. The fast lasts about 36 hours. My sense is that fasting only one day per week does not reset my body’s metabolism, so that my body still burns fuel at the same rate. I am reducing my food consumption by one seventh and am not restricting my diet on days that I eat.

M Huffman
March 26, 2018

Evolution seems to always be the answer when there isn’t an answer…. and in my humble opinion is certainly a stretch in this case….

Ask scientists such as Dr. Brad Harrub of Focus Press..

Merijane McTalley
March 26, 2018

As a registered dietitian, I see this daily. I even see it in myself. I did the 23 and me DNA test and YES, it is genetic but not 300 lbs worth.
Deprivation in dieting doesn’t work. I believe in eating anything you want, but in smaller portions. If I say to a patient, ” you can never have cheesecake”. We won’t be successful. That method doesn’t work.
It is discouraging. So many give up and go the surgical route and graze all day and gain it back.
I believe, that the new MINDFUL EATING trend may hold some hope.

bob barnes
March 26, 2018


So does diet and exercise still count as a means of weight loss?

Can I resolve the effects of lower metabolism with a proactive diet and exercize program?

AF Leger
March 26, 2018

Found that change of diet, without wheat products, sugar, cakes , allowed one to drop 17 kgs, sustained after 6 years,

limited exercise: about 4 hours fast walking a week,
The Mediterranean regime mainly , with limited wine and lots of olive oil –
no other restrictions or privation

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