A New Obesity Study About the Difficulty of Permanent Weight Loss

A new Obesisty study, involving a follow-up on contestants of the TV show, The Biggest Loser, highlights several startling truths about why it’s so hard to lose weight and keep it off for the approximately 71 percent of American adults who are overweight or obese. Here are some lessons anyone should take away from the study:

Don’t lose hope.

It would be tempting to read the findings of the Obesity study and throw your hands up. If people who are the best at losing weight are at risk of gaining it all back, what’s the point? 

But that would be the wrong message to take away from the findings, said Morton. A full continuum of obesity care is out there, and these weight loss methods include dietary counseling, medication, temporary gastric balloons and bariatric surgery. The sooner you reach out for help, the more chance you have of losing the weight for good.  

“If you do have an issue with your weight, please don’t wait, and please don’t despair,” he concluded. “There’s a lot of solutions out there that can help folks, and what this study shows is that people can be helped if they seek out treatment sooner and they have lifelong maintenance help.”

Obesity is a chronic condition that requires lifelong maintenance.

 A few key components to help maintain weight loss include a new way of eating that you can stick to for life, a sustainable exercise routine that doesn’t put you at risk of injury, at least seven hours of sleep a night and stress management strategies, said Dr. John Morton, chief of bariatric surgery at Stanford Health Care. Finally, following up with a professional as you figure out your new life are crucial — at first on a monthly basis, and then down to quarterly meetings if you feel you’re getting a handle on things.

It takes a village of medical professionals to help a person lose weight safely, says Dr. Lawrence Cheskin of the Johns Hopkins Bloomberg School of Public Health. But the work doesn’t end once you hit goal weight: Cheskin’s weight loss patients continue to check with their clinicians at least once a month for an extended period of time so that they can iron out any post-program bumps in the road.

“The more frequently you follow up with people, the better their chance of sustaining weight loss,” he said. “As far as I know with ‘The Biggest Loser,’ when you’re done with the show, you’re done.”

Perhaps we should focus on health and weight maintenance, not weight loss.

The danger in waiting to take action against weight gain is that your body’s weight control processes are like a thermostat, explains Roseberry. Set it too high (by gaining weight) and you run the risk of that temperature becoming your new normal. If the room manages to get colder (through weight loss), that thermostat will kick in and work to get those temperatures up again.

“Your body actually fights you to go back to that weight you were at,” says Roseberry. And as “The Biggest Loser” study suggests, that “fight” can go on for at least six years.

It’s probably best to think about obesity as a something akin to high blood pressure, which can go down with the proper medications but will shoot back up if you stop taking the medicine, Morton added. Or think of obesity in terms of cancer: it’s better to nip it in the bud when the problem is small, instead of stalling treatment and letting the tumor spread.

“Don’t let yourself get too far,” Morton said. “If your BMI is about 30, it’s time to do something about your weight.”

While weight loss should be the goal if your BMI starts to reach unhealthy levels, even taking steps to maintain your weight accomplishes a great deal, because it prevents your body from getting used to that higher “set point” weight that could soon become its metabolic norm, Roseberry added.

“If we can find new ways to prevent more people from gaining weight and becoming overweight and obese, that would be a huge step forward,” he said. “And if we can focus more on health parameters than weight per se, I think whatever you can do to help increase your overall health is more important than your absolute weight.”

Losing weight can lower your metabolism — but that shouldn’t stop you.

Most people regain at least some of the weight they’ve lost. There are many possible reasons for this, like returning to one’s previous unhealthy levels of exercise and eating due to fatigue or boredom with the new healthy routine. But as the Obesity study illustrates, the more weight you have to lose, the more your metabolism rate and leptin levels decline. These two factors alone, along with other physiological processes that are not captured in the research, are relentless forces essentially trying to pull your body back to its previous unhealthy weight.

These physiological processes are relentless forces essentially trying to pull your body back to its previous unhealthy weight.

The metabolism decline makes sense; a person who loses weight is smaller than they used to be, and so requires fewer calories to fuel their body’s processes. But the researchers note that the study participants had a resting metabolic rate that was about 500 calories lower than you’d expect based on their body composition and age. And in fact, over time, that metabolism kept getting slower, especially in people who maintained the most weight loss. This is because the participants started off at very high weights (the average BMI was almost 50).

“We expect patients to have a reduction in their basal metabolic rate,” said Dr. Holly Lofton, an assistant professor of medicine and the director of the medical weight management program at NYU Langone Medical Center. “This is congruent with other studies that have looked not only at metabolism but changes in hormones that affect appetite, desire for food and hunger in people who have lost weight from diet and exercise.”

One thing the study does illustrate, poignantly, is that weight problems are not simply a failure of will but instead a chronic medical condition. These “Biggest Loser” contestants have heart and drive in spades as they demonstrated on the show, and if weight loss was only a matter of self-control, they would have no problem maintaining it. 

Re-gaining some lost weight isn’t necessarily a failure

If a crop of “Biggest Loser” contestants who participated in the study is representative of the entire alumni, the show’s intensive diet and exercise resources weren’t for naught: While all but one regained weight in the intervening six years, it was also true that 57 percent of the 14 participants maintained at least a 10 percent weight loss, noted the study researchers. This is a significant amount of weight loss for anyone to sustain, but this number is all the more impressive considering that participants in this study started off with an average BMI of almost 50. 

Past research about other weight loss groups show that only about 20 percent of overweight people maintain at least a 10 percent weight loss after one year. Another study that followed up with weight loss participants eight years after an intensive lifestyle change found that only 27 percent maintained a 10 percent weight loss. 

“The good thing about [“The Biggest Loser”] is that these individuals did manage to keep a significant amount of their weight off,” said Aaron Roseberry, an assistant biology professor and a member of the Center for Obesity Reversal at Georgia State University. “Yes, they did gain weight back, but they are still lighter and ultimately healthier than when they started the show.”

True as that may be, not every doctor agrees with the show’s methods.  

“From what I’ve seen of clips of the show, I have concerns about ‘the support’ — if you will — that is offered to the patients,” said Lofton. “It seems at times to be punitive, which is not what I support when I try to induce weight loss in my own patients.”

While all but one regained weight in the intervening six years, it was also true that more than half of participants maintained at least a 10 percent weight loss.

We know that hormones control hunger cues, but there’s not much we can do about it right now.

The more weight you lose, the lower leptin levels get, leaving you hungry. The study notes that leptin levels in “Biggest Loser” participants plunged from a starting average of 41.1 nanograms per milliliter to 2.6 ng/mL at the end of the contest. Six years later, those decimated leptin levels had recovered somewhat, but only up to 27.7 ng/mL.

Currently there are five FDA-approved medications on the market to aid in weight loss, but none of them is a replacement for leptin, one of the key hormones that create feelings of fullness. The New York Times notes that the pharmaceutical company Pfizer is conducting animal trials for a medicine that imitates leptin, but they’re still ongoing. If scientists achieve a replacement for leptin in people who have lower levels due to genes or weight loss, it would be an obesity gamechanger, says Lofton.

“If we had a medication that would help patients who have leptin deficiencies, that would be a breakthrough,” she said. “And then for the rest of us, who lose weight and have lower leptin, it would be something that could improve our weight maintenance results.”

In the News: Oxytocin Could Increase Anxiety, Fear In Response ToFuture Stress

The "love hormone" may not be as warm and fuzzy as first thought. A new study shows that while oxytocin does play a huge role in social bonding and feelings of love, it also is the reason why terrible events can scar you for life.

This new finding is important because "by understanding the oxytocin system's dual role in triggering or reducing anxiety, depending on the social context, we can optimize oxytocin treatments that improve well-being instead of triggering negative reactions," study researcher Jelena Radulovic, the Dunbar Professsor of Bipolar Disease at Northwestern University's Feinberg School of Medicine, said in a statement.

The study, published in the journal Nature Neuroscience and conducted in mice, explains that oxytocin can not only make us remember stressful situations from the past (like being bullied), but they also increase feelings of anxiety and fear in the face of future stress.

The hormone does this by triggering a molecule called ERK, which itself makes sensations of fear greater because it stimulates fear pathways in the brain's lateral septum region. This molecule is activated for hours after a stressful social experience.

Researchers noted this is the first time oxytocin has been identified to have a function that isn't just boosting feelings of love and connection.

Past studies have looked at the hormone's role in relationships and friendships. For instance, a study in the journal Psychoneuroendocrinology earlier this year showed that oxytocin makes people more likely to "tend and befriend" others who have just experienced social rejection.

And a 2012 study showed that oxytocin levels could be a predictor for how long a relationship lasts.

Gary Taubes: Why We Get Fat

Now on order for me at Amazon.

Science writer Gary Taubes, author of Why We Get Fat and possibly the country’s most prominent critic of the reigning theories on the obesity epidemic, has founded a non-profit research outfit of his own, he writes in the journal Nature.

Under the headline “Treat obesity as physiology, not physics,” he argues that the idea that obesity is simply a product of overeating and “calories in, calories out” has gotten us where we are today: Overweight or fat, many of us. He backs an alternate theory:

The alternative hypothesis — that obesity is a hormonal, regulatory defect — leads to a different prescription. In this paradigm, it is not excess calories that cause obesity, but the quantity and quality of carbohydrates consumed. The carbohydrate content of the diet must be rectified to restore health.


This conclusion is based on endocrinology that has been understood for 50 years: insulin regulates fat accumulation, and blood levels of insulin are effectively determined by carbohydrate intake. The more easily digestible are the carbohydrates we eat (the higher their glycaemic index) and the sweeter they are (the higher their fructose content) the higher are our blood insulin levels, and the more fat accumulates.

If this is true, it suggests that the obesity epidemic was caused at least in part by the research community’s failure to understand the nature of the disease, and by the food industry’s exploitation of that failure.

But is it true? Or is it the case, as conventional wisdom has it, that these competing hypotheses of obesity have been rigorously tested, and the energy-balance hypothesis has simply won out?

That’s what Taubes and colleague Dr. Peter Attia will be trying to figure out at the Nutrition Science Initiative (NuSI) in San Diego. So far, they’ve found a lot of flaws in previous research, and are aiming to organize some studies of their own.

Love Potion #1: "PEA The Hormone of Love" by Dario Nardi, Ph.D.





Ball-and-stick model of the phenethylamine molecule. Many of its derivatives are psychoactive drugs.

  

While a half-dozen hormones and neurotransmitters are involved in the experience of love, the hormone at the center of it all is Phenylethylamine (PEA).

PEA occurs naturally in the brain and acts as a natural amphetamine, promoting feelings of infatuation when we are in love. We might stay up all night interacting with someone new we find attractive.

When we start to fall in love, dopamine and norepinephrine levels also go up. These are the same hormones that rise when we win a prize, take drugs such as cocaine, or when we are frightened or angry.)

These hormones result in a infatuation -- high dopamine results in a feeling of addiction or obsession, while high norepinephrine results in an intense interaction with physical giddiness. The person feels aroused, many a little edgy, with a feeling of "butterflies" in the stomach.

There is also sleeplessness, loss of appetite, and a narrow focus on the mate and mating activity. PEA levels are also increased by high-intensity activities like skydiving, by eating large amounts of chocolate, and by taking certain drugs.

MDMA (also known as Ecstasy) is similar to PEA. MDMA dispels feelings of distrust, suspicion and jealousy, and replaces those with a general global sense of universal love. Most of the recreational drugs people indulge in work in one or more of the same ways that love happens in the brain.

Later, when love is serious, serotonin falls and the feeling of love begins to feel like madness.

We feel uncomfortable and obsessed when the other person is not around, while just being with them sharing the same space is enough. To avoid the negative feelings that come with low serotonin, we desire to spend all our time with the other person.

For better or worse, after a certain period of eighteen months to four years the body builds up a tolerance to the effects of PEA and related hormones. The hormones just don't deliver like they did before with the other person.

However, the brain still produces endorphins on a long-term basis in association with the person we are with. The endorphins provide a feeling of calmness and reduce anxiety and pain.

In fact, when a spouse dies or is away, some people experience "separation anxiety." This feeling could be considered a kind of chemical withdrawal. Oxytocin, a hormone produced by the pituitary gland, also plays a role in love, since physical touching promotes higher levels of this hormone. Variations in the levels of hormones related to love are an opportunity for people to exercise maturity in relationships instead of relying on chemistry alone to do the work for them.

PEA is documented to have severe cyclical highs and lows in some people, creating up-and-down experience of excitement, interest, arousal and obsession.

Silk Stockings - Cyd Charisse 's own voice - It's a Chemical Reaction

https://www.youtube.com/watch?v=p71V6HRP1IY

Insomnia Tied to Lack of Brain Chemical



"Gabba Gabba Hey" is a catchphrase associated with the punk rock band the Ramones. The phrase is included in the song "Pinhead" (1977), which contains the lyrics: "Gabba gabba, we accept you, we accept you, one of us." The song ends with: "Gabba gabba hey, gabba gabba hey!..."



By Aalok Mehta

December 24, 2008

Scientists have identified the first known brain chemical abnormality associated with insomnia: a substantial reduction in levels of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA).

Otherwise healthy people with insomnia have, on average, 25 to 30 percent less GABA in their brains than do normal sleepers, according to the new study, which appeared in the Nov. 1 issue of the journal Sleep.

Scientists have long suspected a link between GABA and insomnia. The neurotransmitter is known to help brain regions shut down by reducing electrical activity, and several common sleeping pills work by helping nerve receptors link to the chemical more efficiently. But the new study is the first to quantify GABA levels in the brains of insomniacs.

Because the GABA measurements were made during the day, the findings also lend further credence to the theory that insomnia is a “state of hyperarousal” extending throughout the waking hours rather than just a nighttime disease, the study authors wrote.

“The results suggest that insomnia is not just a sleep problem,” says principal investigator John Winkelman, a physician at Brigham and Women's Hospital, which is an affiliate of Harvard Medical School. “It’s a 24-hour-a-day problem.”

Mysterious disease

In many ways, insomnia remains largely a mystery to the medical community. “It’s the most common sleep disorder but the most poorly understood,” says Jerome Siegel, a psychiatry professor at the University of California, Los Angeles.

Part of the difficulty is that most people with insomnia also have other medical or psychiatric conditions, making it difficult to isolate the exact effects and possible causes of each one.

To get around this problem, Winkelman and his colleagues looked at 16 people with primary insomnia—that is, people free from any other known medical or sleeping conditions. About one-quarter of chronic insomniacs fall into this category.

Researchers collected data on the sleeping habits of the study participants using electroencephalography (EEG) and other monitoring devices. To measure GABA levels noninvasively, the scientists used a novel form of magnetic resonance spectroscopy, which uses magnetic resonance imaging to investigate brain tissue as well as structure. The team averaged GABA signals from the basal ganglia, thalamus and parts of the parietal, temporal and occipital lobes.

In addition to finding lower levels of GABA overall, Winkelman says, “one of the things that encouraged us we were on the right track was that in each of these sleep studies, the amount of wake time during the night was inversely correlated—highly—with GABA levels.”

Despite the promising results from those tests, Winkelman says much work remains to clarify the link between GABA levels and insomnia. “It could be that insomnia produces low GABA, or low GABA produces insomnia, or hyperarousal causes both,” he says. “We just don’t know.”

More details needed

Siegel, who has studied GABA release during sleep but was not involved with this study, echoed Winkelman’s caveat but was impressed by the findings and techniques used.

“This is sophisticated, elegant, cutting-edge work,” he says. “It’s one of the first, if not the first, to use this technique. I expect to see a lot more people using the technique they’re using.

“People with insomnia are not sleepy all the time,” he says. “People with chronic insomnia are more awake all the time. This may be what they are seeing with GABA levels.”

More work also is needed to identify the exact areas affected by these GABA levels. The neurotransmitter is one of the most common in the brain and can have opposing effects in different brain regions, including stimulating some areas that promote wakefulness.

Winkelman agrees. “We’re now trying to find out the specific areas of the brain that are active in insomniacs,” he says.