A new study was released on weight loss and maintenance that has been covered on many sites. Researchers from the National Institutes of Health (NIH) evaluated contestants from Season 8 of the TV show the Biggest Loser. They found that 13 of the 14 contestants studied regained some or all of their weight that was lost during the show. All the contestants studied also had slower metabolic rates than expected; it took less food than it should to maintain their weight. They also had lower levels of the hormone, leptin, than expected. Low levels of leptin make people feel hungrier.

Basically the body is always trying to get back to its heaviest weight. This is likely an evolutionary advantage. Extra adipose tissue means more storage for a potential famine and if food does become scarce using food more conservatively means a greater odds of survival. Survivors are the ones who pass along their genes. Even though modern life has eliminated famine for many of use, to the brain weight loss doesn’t mean trying to reclaim a healthier weight it still portends death. For such a level of complexity, our brains don’t have the greatest user interface where weight loss is concerned. Maybe in a few thousands of years, that programming will be reversed, but that doesn’t exactly help anyone struggling to lose weight now.

I am not surprised the Biggest Loser contestants regained their weight. Nothing about what they did was sustainable, and there was an excessive focus on exercise, which science tells us is not an effective weight loss tool. People have jobs, no one can go to the gym for four hours a day. Some people wonder if maybe they had less weight to lose or did it more gradually maybe their metabolic rate would have rebounded over time, but I’m not so sure.

I first started Weight Watchers when I was 15 years old and while I lost weight many times, I also regained it: often within a few months or even a few weeks of reaching goal. Each time it got harder and harder to lose the weight. And yet here I am now over 5 years from starting my last weight loss journey. As a chronic pain doctor, I decided if the brain could be changed to “rewire” pain, maybe I could hack the concept of neuroplasticity and change how I felt about hunger. I think it worked (or rather it has so far) as I have kept those 50 lbs. off for four years and three months. It is a daily exercise in assessing hunger and tracking calories and weighing and measuring and planning. Oh the planning. And the constant mindful attention to everything.

Even with a gradual weight loss (50 lbs. over 9 months) my metabolic rate is slower than expected, just like the former Biggest Loser contestants. Using the NIH metabolic rate calculator I should be able to eat 2,400 to 2,500 calories a day to maintain my weight, but I’d gain 1/2 lb. to 1 lb. a week on that. I know because I tried. When I first lost the weight I slowly added in calories: 100 calories per day each week. It turns out to maintain my loss I get 1,800 a day. That’s right, the difference between weight loss and maintenance for me is a couple of glasses of wine OR a slice of cheese pizza.

What is interesting is I have finally reduced the hunger sensations. Sometimes I get an unwelcome blast from the past, but using the mindfulness tools I have developed, I’m able to rein them in and typically bring the carnage down to one meal. I was a world champion binge eater, so no one is more surprised at this than me. It took several years of maintenance to get a better control of the hunger, but it happened, and that certainly helps a lot. Sometimes I think I should get my leptin level measured because I’m genuinely curious if it is normal or not.

It’s a bummer that I can’t eat 2,400 calories a day. Basically, I plan for three slices of cake a year, my birthday, my kids’ birthday (they are twins, so I lucked out with a two for one with their birthday meal), and a third for some unknown event. And yes, I do have a couple of days a month when I eat more than I had planned, but the next day I am back on the plan. It’s hard, but I’d rather be my healthiest weight.

Maybe one day there will be a hormone to block hunger signals so people won’t have to track their calories obsessively or go through the mental and physical routines I do to make sure I am really hungry and not thirsty or stressed or tired, but every single weight loss drug to date has come with unforeseen serious side effects, so there’s that.

This new study is small and may not be applicable to everyone as the weight loss routines were extreme and definitely not sustainable, although my n of 1 tells me my metabolic rate has slowed about as much as those who lost weight the Biggest Loser way, so I suspect all of us who lose weight are likely going to have to work around our metabolisms.

I think we definitely need more studies about the impact of different weight loss regimens on metabolic rate and hunger hormones, but I do feel we can draw one conclusion: While we may not yet know the best way to lose weight and keep it off it’s pretty clear that it’s not the Biggest Loser way.

Jennifer Gunter is an obstetrician-gynecologist and author of the Preemie Primer. She blogs at her self-titled site, Dr. Jen Gunter.

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