Have 'Biggest Loser' Contestants Ruined Their Metabolisms?

by David Greenwalt
“Biggest Loser” contestants have screwed their metabolisms for good and they, like anyone who loses a lot of weight quickly, are doomed to regain all their weight lost and be morbidly obese forever, a new study published in the respected journal “Obesity” didn’t say, at all.
If you read the headlines about this across a number of popular news and entertainment outlets you’ll be convinced we’re all screwed if we want to lose a lot of weight–absolutely screwed. Is it true?
Read this entire article, don’t skim it, and I’ll explain.
The first article I saw on this subject was from the New York Times. So for this piece I’m going to focus on what they said and then, you’ll see, I compare what they said to what the actual research published May 2nd said.
So the headline in the New York Times read “After ‘The Biggest Loser,’ Their Bodies Fought to Regain Weight.”
The sub-headline read “Contestants lost hundreds of pounds during Season 8, but gained them back. A study of their struggles helps explain why so many people fail to keep off the weight they lose.”
As you’ll learn, the primary headline is absolutely spot on – “Their Bodies Fought to Regain Weight.” Absolutely true.
The sub-headline? Partially true. Yes, the contestants lost hundreds of pounds but the sub-head makes it sound like they gained them ALL back. That’s false.
The Times, US Magazine, Business Insider, NPR, People Magazine, Self and more all jumped at the chance to grab their share of the headlines and tell partial stories of Danny Cahill and others from season 8 of “The Biggest Loser” which aired in 2009.

Analyzing, By the Numbers, Cahill’s Loss and Regain

Danny Cahill lost 239 pounds in the 30-week season 8’s ‘Biggest Loser.’ At the time this was the show’s most ever. Cahill droppped from 430 to 191 and now, six years later, weighs 295. First, kudos to Mr. Cahill! He has kept off 31% of his starting body weight. Or, if you’re the New York Times and others he regained 104 pounds from his all-time low. You decide your “truth.”
What’s really important to say, however, is maintaining 31% of your weight lost is incredibly rare. 80 percent of people who lose more than 10 percent of their starting body weight don’t keep 10 percent of their weight off.
So, by the numbers, how did Cahill drop from 430 to 191 in 30 weeks? How is that even possible? Does it make sense? Ready? Here we go!
Height: 5’11”
Start Wt: 430lbs
Finish Wt: 191lbs
Loss: 239lbs
Weeks: 30
Days: 210
Total caloric deficit for 239lbs: 836,500kcal
Estimated deficit/day to achieve goal: 3983kcal/d
Exercise: 7hrs/day
Age: 39 at the start of the show | 46 now
Est. RMR @ 430: 2888kcal/d
Est. RMR Now @ 295: 2240kcal/d
Source: http://shapeup.org/resting-metabolic-rate-calculator/

Creating the 3983 kcal/d Deficit Needed to Lose 239lbs During the 30 Weeks of the Show

Step 1:
Cut calories to 1,888 kcal/d – that’d give him the first 1,000kcal/d of the 3983 needed.
Step 2:
Need another 2983kcal/d of deficit. So will 7 hours of exercise a day get him a 2983kcal/d additional burn? Sure. It’s 426kcal/hour. 426kcal/hour with exercise is very reasonable, especially for such a large man. All makes sense so far.
The NY Times article says Cahill’s current RMR (resting metabolic rate) is 800kcal/d less than would be expected for a man his size (295lbs). So that means his actual RMR is about 1440 kcal/d. No doubt his RMR, after losing so much weight, IS LESS than someone at 295 who never had to lose any weight ever. The 800kcal/d is a metabolic reduction of 35% below the never-lost-weight-equivalent man at 295. No doubt that is harsh but what does it really mean he gets to eat right now to maintain 295?

Maintaining 295

If we keep it simple and say that total daily energy expenditure (TDEE) is RMR + Physical Activity + TEF (thermic effect of food) then it goes like this for Cahill currently – and let’s assume he exercises one hour a day six days a week. He gets a WHOLE DAY OFF!
All Calculations Below Take Into Account Cahill’s 35% Reduction in Metabolic Activity
RMR w/35% reduction: 1440 kcal
Physical Activity Add On if Mostly Sedentary w/35% reduction: 187 kcal
Exercise Add On at 360 Minutes/Week w/35% reduction: 334 kcal
TEF w/35% reduction: 94 kcal
TEE w/35% reduction: 1440+187+334+94=2055 kcal/day to maintain 295 pounds
Why reduce all estimates above by 35%? Because the research is pretty clear on this matter. If your RMR is reduced due to weight loss then every single thing you do counts for less too. You burn fewer calories doing daily chores, you burn fewer calories exercising and you burn fewer calories digesting your food compared to someone your gender, age, height and weight but has never lost weight.
So how should we feel about “only” getting 2055 calories a day? Should we pity Cahill? How should HE feel about it? It’s a pretty subjective decision right? But one thing I can say is 2055 calories isn’t even remotely close to starvation. 2055 calories isn’t living on chicken breast and broccoli-it’ll allow for quite a variety of foods-even a grain every day! What it won’t allow? Daily binges of 2000 calories in a single sitting. Nope. That won’t work.

How Did Cahill Regain 104 Pounds of the 239 He Lost?

He could have maintained 191 by eating about 1800-2000 real-food calories a day and exercising an hour a day six days a week, much less than the 7 hours of exercise a day eating even less, which was necessary to get him to goal.
What specifically contributed to the regain?:

• Food-like-substance addiction
• WHY wasn’t strong enough
• Obesogenic environment
• Long-standing habits not replaced/overcome in 7 months of cutting
• Unreconciled issues from the past
• Faulty thinking about Maintenance
• Lost the emotional, personal and professional support
• Reduced RMR
• Hormonal adaptations favoring hunger, weight regain and fat storage
• Fill in any number of a dozen other possibilities

Issues that absolutely were NOT reasons for the regain:

• Stupidity
• Laziness
• Weak willpower

Erinn & Sean: Comparing a Massive Success and Massive Failure From the Show

Erinn Egbert is a full-time caregiver for her mother in Versailles, KY. She burns 552 fewer calories a day than a woman of equal age, height and weight who has never lost weight before.
Sean Algaier, a pastor from Charlotte, NC burns 458 fewer calories a day than a man of equal age, height and weight who has never lost weight before.
Both Erinn and Sean suffer from the metabolic adaptation that occurs with weight loss–especially significant weight loss. So far they are similar–both suffering from “adaptive thermogenesis”–the fancy way of saying their RMRs are reduced since losing weight compared to people who have never lost weight.
This is important, as you’ll soon see, since the NY Times and so many others make the case that the metabolic adaptation makes it nearly impossible to succeed long term.
Here’s where Erinn and Sean part ways.
Erinn is the only contestant who actually weighs less now than she did at the end of the show. At the end of the show she weighed 176, losing 87 pounds. Today she weighs between 152 and 157, now more than 100 pounds down.
Sean weighs more today than he did at the start of the show. He started the show at 444, dropped to 289 and now weighs 450.
The Times quotes Erinn as saying

“What people don’t understand is that a treat is like a drug. Two treats can turn into a binge over a three-day period. That is what I struggle with.”

The Times quotes Sean as saying, upon realizing his RMR is 458 calories lower than his equal-but-never-lost-weight counterpart,

“It’s kind of like hearing you have a life sentence.”

In this 30+ year wellness coach’s opinion? Their results and the quotes say a great deal. Erinn gets it. It IS a lifelong battle and she struggles with, but manages, her junk-food addiction every day. Maintenance is not the absence of action but instead a reduced intensity of the same actions that got you to goal.
Sean, on the other hand, suffers from everything Cahill and others do (listed above) that causes the regain and he looks at this reduced 458-calorie RMR as a “life sentence” – a punishment. And so it is – for him.
Erinn is living proof that the metabolic adaptation which reduces RMR after weight loss does make maintenance harder than it is for someone who’s never had to lose weight before but it’s not insurmountable and it’s only as difficult as you define it. She defines it as “a struggle.” Sean defines it as “a life sentence.”
Note: According to the study, the mean RMR after 6 years was ~500 kcal/day lower than expected based on the measured body composition changes and the increased age of the subjects.

NY Times Claims Compared to Study Facts

Overall, not surprisingly, the Times does a decent job with their article. But a few things stood out to me that are worth contrasting with the actual study-author statements.
The times writes

“most of that season’s 16 contestants have regained much if not all the weight they lost so arduously. Some are even heavier now.”

True true. 13 of 14 regained at least some of their weight lost. Four now weigh more than they did before the show started. What’s also true?
“The participants rapidly lost massive amounts of weight, primarily from body fat mass (FM) with relative preservation of fat-free mass (FFM), likely due to the intensive exercise training.” (1)
“~80% of the weight changes at both 30 weeks and 6 years were attributable to FM.” (1)
“While most subjects experienced substantial weight regain in the 6 years since “The Biggest Loser” competition, the mean weight loss was 11.9% +- 16.8% compared with baseline and 57% of the participants maintained at least 10% weight loss. In comparison, it has been estimated that 20% of overweight individuals maintain at least 10% weight loss after 1 year of a weight loss program. Only 37% of the lifestyle intervention arm of the Diabetes Prevention Program maintained at least 7% weight loss after 3 years, and 27% of the intensive lifestyle intervention arm of the Look AHEAD trial maintained 10% weight loss after 8 years.” (1)
“…overall [“Biggest Loser” participants] were quite successful at long-term weight loss compared with other lifestyle interventions.” (1)
The Times article said …

“When it [the show] ended, their metabolisms had slowed radically and their bodies were not burning enough calories to maintain their thinner sizes.”

This just makes no friggin sense. Read it again. Their bodies weren’t burning enough calories to maintain their thinner sizes? Huh? While weight management IS more complex than just calories in and calories out there really are laws of thermodynamics that none of us can escape – it’s a survivor game of managing inputs and outputs – and it goes well beyond the five-word diet of “Eat less and exercise more.” But their comment is bewilderingly ignorant.
The Times article said …

“As their weight returned, their leptin levels drifted up again, but only to about half of what they had been when the season began, the researchers found, thus helping to explain their urges to eat.”

Fact: Baseline Leptin (ng/ml) 41.14; Follow-up at 6 years 27.68 (67% recovery compared to baseline). Why not say their leptin recovered nearly 70 percent of baseline at the six-year follow-up? is 67% “about half” or is it nearly 70%?

What About Blaming the Regain Issue on the Fast Weight Loss?

Study authors said this …

“Rapid weight loss, such as that experienced by “The Biggest Loser” participants, is sometimes claimed to increase the risk of weight regain, but recent studies have failed to support this idea since weight loss rate per se was not observed to affect long-term weight regain. The relatively greater success at maintaining lost weight in “The Biggest Loser” participants may have been due to the massive weight loss experienced during the competition since the magnitude of early weight loss is the best predictor of long-term weight loss.”

(1)

I Must Admit – This DID Surprise Me

It’s been well known for a long time, research supported, that RMR is reduced (metabolic adaptation or adaptive thermogenesis) by about 15 percent in those who lose substantial weight. It’s less well studied or known but it’s been thought, with research supporting, that RMR recovers pretty well once the weight loss stops and the body’s had time to stabilize in weight maintenance. But not in the case of these “Biggest Loser” contestants.
Six years after the contest ended, with most either weight stable or actually gaining weight, the RMRs were still significantly reduced. In fact the RMRs six years after the contest were about the same as they were at the end of the 30-week contest.
Reduced RMR after weight loss, as I’ve already acknowledged here and for years, does make it harder for the weight reduced person to maintain. Let’s face it. If you could eat another 500 more calories a day compared to having to eat 500 fewer calories we’d all choose the more version.
Metabolic Adaptation Not Limited to ‘Biggest Loser’ Nor Fast-Lost Reducers
A key “shock and horror” aspect of this piece of research is the fact that RMR remained persistently reduced, even six years after weight loss, by about 500kcal/d compared to a matched never-lost-weight counterpart. The media will portray this as new and they’ll say that ‘Biggest Loser’ tactics are likely to blame. Well, I can’t entirely blame them as I hadn’t seen other research, prior to now, that reflected whether those who had lost substantial weight also had persistently lower RMR by a similar magnitude. But they do.
In a 2008 study the authors found similar reductions in RMR (i.e., similar metabolic adaptation) as the authors of the more-recent ‘Obesity’ study. They said …

“The major finding of the present study is that there are similar, significant declines in TEE, NREE, and, to a lesser extent, REE in subjects maintaining a reduced body weight, regardless of whether that reduced weight has been maintained for weeks or years. In other words, bioenergetic responses to maintenance of a reduced body weight do not wane with time.”

Bariatric Patients Don’t Suffer the Same RMR Penalty?
It is well established that a relatively high percentage of bariatric patients lose substantial mass and, compared to commercial weight-loss programs, do better at keeping the weight off as well.
The authors of the ‘Obesity’ study referenced another study when they wrote “In contrast, a matched group of Roux-en-Y gastric bypass surgery patients who experienced significant metabolic adaptation 6 months after the surgery had no detectable metabolic adaptation after 1 year despite continued weight loss.”
Hmm, so, at least in one study, the Roux-en-Y type of bypass surgery, didn’t seem to permanently damage RMR. Well, that’s it then. Case closed! Bariatric surgery doesn’t permanently harm RMR but losing weight with both big exercise output AND restricted dietary input does! Oh, wait, maybe not so fast.
A 1998 study (see table image below)





clearly shows quite similar drops in resting energy expenditure (REE) – synonymous with RMR – in multiple groups of patients after surgery and massive weight loss. Does the type of surgery matter? Probably. Can anyone say that Roux-en-Y WILL protect people from permanent RMR drops? Heck no. More research is needed.

In Conclusion

So what do we make of this potential 500 calorie reduction in RMR after massive weight loss?
It’s only a death sentence if you make it so. Cahill, who I discussed at length above, likely gets to consume about 2055 kcal/d to maintain 295 pounds. That’s a nice amount of food if you choose wisely. It’ll also allow for a splurge meal or two every week. That ain’t all bad when you consider the amazing health benefits of weighing 295 vs. 430.
And let’s not forget Erinn – even though her RMR has slowed about average compared to all the contestants measured – she has actually lost weight compared to her weight at the end of the 30-week contest. I’ve already discussed why but this quote from the current-study authors states an inescapable truth, one we all must deal with if we want to lose a significant amount of weight or we’ve lost it and want to keep it off.
“Therefore, long-term weight loss requires vigilant combat against persistent metabolic adaptation that acts to proportionally counter ongoing efforts to reduce body weight.”
Amen to that.
I refer to this as “keep dancing with the one who brought ya.” Once you get to goal or your substantially-reduced weight you MUST remain vigilant. You can’t abandon what got you there. Every tool, every resource, trick, habit and technique you used to get the weight off needs to be kept close by and re-engaged quickly and as needed for many years after the initial weight loss occurs.
No one wants to lose weight only to regain it. Forever weight loss mandates that you keep in place everything you used to get the weight off. But maintenance is not action – it’s a less intense version. In maintenance you’ll get to reduce intensity by 50-75% for both the dietary and exercise portions of the equation.
In the end, in deciding whether it’s even worth it to get out of the most-dangerous obesity zones if you’re there, I agree with the authors of a New England Journal of Medicine study who said …

“Physicians should be aware that for some obese patients the achievement of what is considered to be a more healthful body weight may be accompanied by metabolic alterations that make it difficult to maintain the lower weight. Nevertheless, the beneficial effect of even a modest weight loss on lipid and carbohydrate metabolism in obese patients justifies persistent efforts at weight reduction and maintenance of a reduced body weight for the treatment of obesity.”

Significant weight loss and the weight maintenance that follows is not for the meek. I congratulate everyone fighting the good fight and I look forward to helping anyone wanting to champion their overweight or obese state with evidence-based, practical methods that can help you get the weight off one more time for the last time.
Please share this article on Facebook and elsewhere. Help others get the facts. It’s important that ignorance is reduced for not only those wanting to lose weight but everyone standing on the sidelines, arms folded in ignorant confidence, spouting misinformation to those who want to lose weight.
Source: (1) Fothergill, E., Guo, J., Howard, L., Kerns, J. C., Knuth, N. D., Brychta, R., Chen, K. Y., Skarulis, M. C., Walter, M., Walter, P. J. and Hall, K. D. (2016), Persistent metabolic adaptation 6 years after “The Biggest Loser” competition. Obesity. doi: 10.1002/oby.21538