There were a couple of pieces I read over the weekend that made me ponder for a few moments on weight loss, particularly in obese clients.

When they come to us for help, patients generally want change as soon as possible. So we put them on a low calorie plan and design a suitable exercise regime. If we do our job properly, they shed the pounds and their overall health improves. The problem occurs when they try and keep the weight off longer term.

One article from the weekend reading was a study of contestants on the TV show “The biggest Loser”. Apparently the goal is to lose as much weight as possible over the shows run, with advice given on exercise, diet, sleep and so forth. To win, one man spent up to 9 hours a day exercising, attempting to burn over 3000kcals a day, whilst eating 800 – 1000kcals. He won, but the research showed that it simply wasn’t sustainable, perhaps as expected, and over the course of the next few years, he gained much of it back.

http://www.nytimes.com/2016/05/02/health/biggest-loser-weight-loss.htm

Reading into the material a little more, this could have been due to a few basic factors. Firstly, his metabolism, in response to the perceived threat, had responded to the perceived famine and slowed down, subsequently staying low, such that even resuming a previously normal intake, he was still putting back the fat. The study indicated that for all of the contestants measured, this was approximately  500kcals less than their predicted Basal Rate per day. The other factor was that he possibly had not adopted and understood his eating triggers, such that he still had the urge to consume high amounts of low nutrient, energy dense foods.

The other article was a piece of research from Newcastle showing that well controlled weight loss has the ability to reduce the risk of type II diabetes, by reducing the intra abdominal fat and that this tends to happen first when losing weight.

http://www.ncl.ac.uk/magres/research/diabetes/reversal.htm

The Newcastle study reduced the caloric intake by half and recommended light to moderate exercise, using a medically managed supplement plan.

What we as practitioners can take away from both of these pieces is that health benefits can be seen from the weight loss but that past a certain point, we need to be careful to ensure the long term health of the client.

The biggest loser problem indicates that we need to avoid the famine reaction by only cutting the caloric intake slightly and whilst simultaneously increasing the exercise slightly, to create the negative balance. The weight loss, particularly in more obese clients, should be slow and gradual, and possibly driven more by diet than exercise initially, so the person can learn and understand the change in eating habits.

The Newcastle study shows the success of this and indicates that weight management is often supported by continued reduction in intake. One added point we can infer is that, as organ fat is used first, a possible plateau may occur when we come to start stripping off the subcutaneous, but aesthetically important fat, which will be far harder to do, since it is potentially more inert.