Monday, May 9, 2016

Why You Can’t Lose Weight on a Diet

SIX years after dropping an average of 129 pounds on the TV program “The Biggest Loser,” a new study reports, the participants were burning about 500 fewer calories a day than other people their age and size. This helps explain why they had regained 70 percent of their lost weight since the show’s finale. The diet industry reacted defensively, arguing that the participants had lost weight too fast or ate the wrong kinds of food — that diets do work, if you pick the right one.
But this study is just the latest example of research showing that in the long run dieting is rarely effective, doesn’t reliably improve health and does more harm than good. There is a better way to eat.
The root of the problem is not willpower but neuroscience. Metabolic suppression is one of several powerful tools that the brain uses to keep the body within a certain weight range, called the set point. The range, which varies from person to person, is determined by genes and life experience. When dieters’ weight drops below it, they not only burn fewer calories but also produce more hunger-inducing hormones and find eating more rewarding.
The brain’s weight-regulation system considers your set point to be the correct weight for you, whether or not your doctor agrees. If someone starts at 120 pounds and drops to 80, her brain rightfully declares a starvation state of emergency, using every method available to get that weight back up to normal. The same thing happens to someone who starts at 300 pounds and diets down to 200, as the “Biggest Loser” participants discovered.
This coordinated brain response is a major reason that dieters find weight loss so hard to achieve and maintain. For example, men with severe obesity have only one chance in 1,290 of reaching the normal weight range within a year; severely obese women have one chance in 677. A vast majority of those who beat the odds are likely to end up gaining the weight back over the next five years. In private, even the diet industry agrees that weight loss is rarely sustained. A report for members of the industry stated: “In 2002, 231 million Europeans attempted some form of diet. Of these only 1 percent will achieve permanent weight loss.”
The specific “Biggest Loser” diet plan is probably not to blame. Aprevious study found similar metabolic suppression in people who had lost weight and kept it off for up to six years. Whether weight is lost slowly or quickly has no effect on later regain. Likewise — despite endless debate about the relative value of different approaches — in head-to-head comparisons, diet plans that provide the same calories through different types of food lead to similar weight loss and regain.
As a neuroscientist, I’ve read hundreds of studies on the brain’s ability to fight weight loss. I also know about it from experience. For three decades, starting at age 13, I lost and regained the same 10 or 15 pounds almost every year. On my most serious diet, in my late 20s, I got down to 125 pounds, 30 pounds below my normal weight. I wanted (unwisely) to lose more, but I got stuck. After several months of eating fewer than 800 calories a day and spending an hour at the gym every morning, I hadn’t lost another ounce. When I gave up on losing and switched my goal to maintaining that weight, I started gaining instead.
I was lucky to end up back at my starting weight instead of above it. After about five years, 41 percent of dieters gain back more weight than they lost. Long-term studies show dieters are more likely than non-dieters to become obese over the next one to 15 years. That’s true in men and women, across ethnic groups, from childhood through middle age. The effect is strongest in those who started in the normal weight range, a group that includes almost half of the female dieters in the United States.
Some experts argue that instead of dieting leading to long-term weight gain, the relationship goes in the other direction: People who are genetically prone to gain weight are more likely to diet. To test this idea, in a 2012 study, researchers followed over 4,000 twins aged 16 to 25. Dieters were more likely to gain weight than their non-dieting identical twins, suggesting that dieting does indeed increase weight gain even after accounting for genetic background. The difference in weight gain was even larger between fraternal twins, so dieters may also have a higher genetic tendency to gain. The study found that a single diet increased the odds of becoming overweight by a factor of two in men and three in women. Women who had gone on two or more diets during the study were five times as likely to become overweight.
The causal relationship between diets and weight gain can also be tested by studying people with an external motivation to lose weight. Boxers and wrestlers who diet to qualify for their weight classes presumably have no particular genetic predisposition toward obesity. Yet a 2006 study found that elite athletes who competed for Finland in such weight-conscious sports were three times more likely to be obese by age 60 than their peers who competed in other sports.
To test this idea rigorously, researchers could randomly assign people to worry about their weight, but that is hard to do. One program took the opposite approach, though, helping teenage girls who were unhappy with their bodies to become less concerned about their weight. In a randomized trial, the eBody Project, an online program to fight eating disorders by reducing girls’ desire to be thin, led to less dieting and also prevented future weight gain. Girls who participated in the program saw their weight remain stable over the next two years, while their peers without the intervention gained a few pounds.
WHY would dieting lead to weight gain? First, dieting is stressful. Calorie restriction produces stress hormones, which act on fat cells to increase the amount of abdominal fat. Such fat is associated with medical problems like diabetes and heart disease, regardless of overall weight.
Second, weight anxiety and dieting predict later binge eating, as well as weight gain. Girls who labeled themselves as dieters in earlyadolescence were three times more likely to become overweight over the next four years. Another study found that adolescent girls who dieted frequently were 12 times more likely than non-dieters to binge two years later.
My repeated dieting eventually caught up with me, as this research would predict. When I was in graduate school and under a lot of stress, I started binge eating. I would finish a carton of ice cream or a box of saltines with butter, usually at 3 a.m. The urge to keep eating was intense, even after I had made myself sick. Fortunately, when the stress eased, I was able to stop. At the time, I felt terrible about being out of control, but now I know that binge eating is a common mammalian response to starvation.
Much of what we understand about weight regulation comes from studies of rodents, whose eating habits resemble ours. Mice and rats enjoy the same wide range of foods that we do. When tasty food is plentiful, individual rodents gain different amounts of weight, and the genes that influence weight in people have similar effects in mice. Under stress, rodents eat more sweet and fatty foods. Like us, both laboratory and wild rodents have become fatter over the past few decades.
In the laboratory, rodents learn to binge when deprivation alternates with tasty food — a situation familiar to many dieters. Rats develop binge eating after several weeks consisting of five days of food restriction followed by two days of free access to Oreos. Four days later, a brief stressor leads them to eat almost twice as many Oreos as animals that received the stressor but did not have their diets restricted. A small taste of Oreos can induce deprived animals to binge on regular chow, if nothing else is available. Repeated food deprivation changes dopamineand other neurotransmitters in the brain that govern how animals respond to rewards, which increases their motivation to seek out and eat food. This may explain why the animals binge, especially as these brain changes can last long after the diet is over.
In people, dieting also reduces the influence of the brain’s weight-regulation system by teaching us to rely on rules rather than hunger to control eating. People who eat this way become more vulnerable to external cues telling them what to eat. In the modern environment, many of those cues were invented by marketers to make us eat more, like advertising, supersizing and the all-you-can-eat buffet. Studies show that long-term dieters are more likely to eat for emotional reasons or simply because food is available. When dieters who have long ignored their hunger finally exhaust their willpower, they tend to overeat for all these reasons, leading to weight gain.
Even people who understand the difficulty of long-term weight loss often turn to dieting because they are worried about health problems associated with obesity like heart disease and diabetes. But our culture’s view of obesity as uniquely deadly is mistaken. Low fitness, smoking,high blood pressure, low income and loneliness are all better predictors of early death than obesity. Exercise is especially important: Data from a 2009 study showed that low fitness is responsible for 16 percent to 17 percent of deaths in the United States, while obesity accounts for only 2 percent to 3 percent, once fitness is factored out. Exercise reduces abdominal fat and improves health, even without weight loss. This suggests that overweight people should focus more on exercising than on calorie restriction.
In addition, the evidence that dieting improves people’s health is surprisingly poor. Part of the problem is that no one knows how to get more than a small fraction of people to sustain weight loss for years. The few studies that overcame that hurdle are not encouraging. In a 2013 study of obese and overweight people with diabetes, on average the dieters maintained a 6 percent weight loss for over nine years, but the dieters had a similar number of heart attacks, strokes and deaths from heart disease during that time as the control group. Earlier this year, researchers found that intentional weight loss had no effect on mortality in overweight diabetics followed for 19 years.

If dieting doesn’t work, what should we do instead? I recommend mindful eating — paying attention to signals of hunger and fullness, without judgment, to relearn how to eat only as much as the brain’s weight-regulation system commands.
Diets often do improve cholesterol, blood sugar and other health markers in the short term, but these gains may result from changes in behavior like exercising and eating more vegetables. Obese people who exercise, eat enough vegetables and don’t smoke are no more likely to die young than normal-weight people with the same habits. A 2013 meta-analysis(which combines the results of multiple studies) found that health improvements in dieters have no relationship to the amount of weight they lose.
Relative to chronic dieters, people who eat when they’re hungry and stop when they’re full are less likely to become overweight, maintain more stable weights over time and spend less time thinking about food. Mindful eating also helps people with eating disorders like binge eating learn to eat normally. Depending on the individual’s set point, mindful eating may reduce weight or it may not. Either way, it’s a powerful tool to maintain weight stability, without deprivation.
I finally gave up dieting six years ago, and I’m much happier. I redirected the energy I used to spend on dieting to establishing daily habits of exercise and meditation. I also enjoy food more while worrying about it less, now that it no longer comes with a side order of shame.
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Thursday, May 5, 2016

Prince’s Addiction and an Intervention Too Late

But Prince appears to have shielded from even some of his closest friends that he had a problem with pain pills, one that grew so acute that his friends sought urgent medical help from Dr. Howard Kornfeld of California, who specializes in treating people addicted to pain medication.
Dr. Kornfeld, who runs a treatment center in Mill Valley, Calif., sent his son on an overnight flight to meet with Prince at his home to discuss a treatment plan, said William J. Mauzy, a lawyer for the Kornfeld family, during a news conference on Wednesday outside his Minneapolis office.
But he arrived too late.
When the son, Andrew Kornfeld, who works with his father but is not a doctor, arrived in Chanhassen, the Minneapolis suburb where Prince lived, the next morning, he was among those who found the entertainer lifeless in the elevator and called 911, Mr. Mauzy said. Emergency officials arrived but could not revive Prince. He was dead at 57.
As law enforcement officials continue to investigate exactly what killed the pop and rock icon, there is mounting evidence that he had become seriously dependent on painkillers, something sure to rattle some of those who knew him well. Many have insisted in recent days that they never even saw Prince take pills, let alone abuse prescription medication, even though some knew he had had hip surgery years ago.
When his private jet had to make an emergency landing in Moline, Ill., in mid-April after he went unresponsive, friends decided they may need to intervene, according to a person with knowledge of the situation. Prince assured his friends in the following days that nothing was wrong. He had the flu, his publicist said.
“I’m doing perfect,” Prince told his lawyer, L. Londell McMillan, two days after the emergency landing. Three days after that conversation with Mr. McMillan, though, Prince’s representatives were looking for help from an addiction doctor.
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Prince in 2010 in Rome. For his final acts, he shared more intimate performances.CreditFabio Campana/European Pressphoto Agency

A Very Private Star

Prince’s penchant for privacy may help explain how he kept his secret from so many. At the Jehovah’s Witness Kingdom Hall near here, where Prince was a worshiper, congregants scoffed at the first reports that Prince may have been abusing painkillers.
And rarely did he let the musicians who toured with him know how much his hips actually hurt from decades of high-voltage performances, jumping onstage in platform heels. They would only notice small things, like that he stopped doing splits.
“There wasn’t a tour we did where he wasn’t sometimes performing in pain,” said Alan Leeds, Prince’s former tour manager in the 1980s and later the president of the singer’s Paisley Park Records. “He was that kind of old school, the-show-must-go-on guy, so the idea of him medicating himself in order to perform isn’t strange to me.”
But Mr. Leeds and others said Prince never discussed pain pills with him. And questions about how he felt would often be met with a shrug or an assurance that he was O.K.
Unlike many stars of his magnitude, who are known to employ extensive entourages and teams of staffers to handle everyday business, Prince was also surprisingly autonomous, friends and associates said, often driving himself around and making appointments without the knowledge of his assistant. Such insistence on maintaining his independence may have made keeping a secret easier, they said.
Many of Prince’s closest friends, relatives and associates have declined to answer questions about his health. So it is unclear who contacted Dr. Kornfeld, but a person with knowledge of the situation said the musician had willingly sought treatment.
The younger Mr. Kornfeld was sent to Paisley Park to try to get Prince’s condition stabilized, Mr. Mauzy said. Dr. Kornfeld then contacted a doctor in the Minneapolis area who cleared his schedule on the morning that Prince was found dead so that he could have time to meet with and assess Prince, Mr. Mauzy said.
“The hope was to get him stabilized in Minnesota and convince him to come to Recovery Without Walls in Mill Valley,” Mr. Mauzy said. “That was the plan.”
Dr. Kornfeld “felt it was a lifesaving mission,” Mr. Mauzy said.
Prince began taking painkillers for his ailment years ago and ultimately decided to have hip surgery in the mid-2000s, after which he was prescribed more pain medicine, according to a person who worked with him and requested anonymity because of the nature of the case.
Jason Kamerud, chief deputy at the Carver County Sheriff’s Office, which is investigating the death, said that investigators are looking into, among other things, whether Prince may have overdosed from painkillers at his residence. But Deputy Kamerud declined on Wednesday to comment on Mr. Mauzy’s statements. The sheriff’s office has said that it did not believe suicide or murder were to blame for Prince’s death.
Officials with the Drug Enforcement Administration and the United States Attorney’s Office announced Wednesday that they were joining the investigation.
The mystery of Prince’s death mirrors the enigma of his life. He shunned the selfie culture and didn’t allow people to take his picture at his estate. Yet at the same time, he regularly opened his doors here and invited the public in for house parties where he would address the crowd.
On the Saturday before he died, Prince had done just that, giddily unveiling a new purple guitar and piano before about 200 guests. He had just started on his memoir, tentatively titled “The Beautiful Ones.” He had tour dates lined up in eight cities across the country.
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Fans have visited Paisley Park, Prince’s home and studio in Minnesota, to remember him.CreditCraig Lassig/European Pressphoto Agency

Talk of Depression

Yet people who knew Prince wondered whether he was in a malaise, his ailments limiting his ability to tour, and battling melancholy after the death in February of Denise Matthews, also known as Vanity, a former girlfriend and collaborator. In Australia during a show on Feb. 16, the day after she died, he became emotional.
“Someone dear to us has passed away,” Prince told the crowd before dedicating the song “Little Red Corvette” to her, according to local news media accounts of the show. Later, he told the audience, “I’m trying to stay focused, it’s a little heavy for me tonight.”
Concerned friends said they had recently been discussing Prince’s emotional state. He had told some people that he was feeling depressed, and some suspected he was going through a period of professional stagnancy.
In fact, Prince shunned an $85 million offer to do a large-scale world tour in favor of smaller shows, said Kim Worsoe, his tour coordinator. “I don’t do tours, I do events,” Mr. Worsoe recalled Prince telling him.
Others said they did not detect any depression. His small concerts, said Damaris Lewis, a friend and dancer, were an indication that he had found peace with himself. “His fans were his family,” she said.
For his final acts, Prince, who on New Year’s Eve had given a powerful show in the Caribbean, shunned his high-energy performances with a big band for something more intimate and less taxing: just himself, playing piano and singing. The “Piano and a Microphone” tour, he called it.
In March, he held a last-minute party and performance in New York to announce his memoir. He held three concerts in Canada before returning home on March 23 and attending a service at his Jehovah’s Witness Kingdom Hall, dressed in a suit and tie, his hair slicked back.
Prince was baptized into the faith in 2003 under the guidance of Larry Graham, a bass guitarist whose band regularly performed with Prince and who moved his family to Minnesota to be near the entertainer. As a witness, he would go door to door with a fellow congregant in their three-suburb territory, quoting the Bible and introducing himself as Rogers Nelson.
“He was very into spiritual things,” Mr. Graham said. “He already had been interested in the Bible and a love for God.”
Associates said that Prince’s dedication to religion, in addition to his commitment to pure living, may have contributed to a sense of shame about his growing dependency on medication.
Prince’s next scheduled tour dates were two back-to-back shows on April 7 at the Fox Theater in Atlanta. But as she was brushing her teeth around 10 on the morning of the show, Lucy Lawler-Freas, the Atlanta promoter, said she got a call from Mr. Worsoe: Prince was sick with the flu.
“He can barely speak; his voice is really hoarse,” she recalled Mr. Worsoe telling her.
It was the first time in the more than a quarter-century that he had worked with Prince that the artist canceled a show, Mr. Worsoe said.
But two days later, Prince rescheduled the show for the 14th.
On the rescheduled date, Prince landed in Atlanta late day and needed a police escort to make it to the theater on time. He said he was still feeling sick, but back in the dressing room where water and fresh fruit was awaiting Prince, Mr. Worsoe said he did not notice any visible signs of illness.
With his Afro picked out, Prince took the stage, sidling up to his purple piano and surrounded by candelabras. He performed two sets, at 7 and 10 p.m.
“He was epic,” Ms. Lawler-Freas said. No signs of the flu.
Prince said it was his best show ever, Mr. Worsoe recalled. But afterward, Prince said that his stomach hurt. Prince wanted to go back to Minneapolis to get checked out by a doctor, Mr. Worsoe said, and asked to postpone shows in St. Louis, Nashville and Washington that were scheduled, but not yet announced, for the next week.
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The authorities on duty at Paisley Park, Prince’s home and studio, the day after he died. The Carver County Sheriff’s Office is investigating the death. CreditScott Olson/Getty Images

Midair Medical Crisis

Prince and two other passengers boarded his private jet, which left at 12:51 a.m. Eastern on the Friday after his Atlanta show. Just over an hour in, the pilot radioed to air traffic controllers that he had an unresponsive passenger on board. The plane, only about 48 minutes from its destination of Minneapolis, turned around and quickly landed in Moline, touching down at 1:18 a.m.
Prince’s bodyguard carried him off the plane to emergency responders waiting on the ground, according to city records. They rushed him to a hospital. Prince was treated with a Narcan shot, typically administered to those suffering from an opioid overdose, according to published reports. But he stayed at the hospital for only a few hours before flying back home.
A master of image control, Prince started shaping the narrative right away.
He hastily organized a party at his home for the following evening. Later, he casually rode a bicycle in a stripmall parking lot.
Prince’s representatives asked Jeremiah Freed, a blogger who runs drfunkenberry.com, to help spread the word of the party on Saturday night. Before that night, Mr. Freed said, he never really had any concerns about Prince’s condition, though he was struck by something that the musician told him in January. Prince spoke of David Bowie’s death, Mr. Freed recalled, saying he was having lucid dreams in which he communicated with people who died.
When Prince first strolled into the party, before he was in full view of the public, “He looked upset to me,” Mr. Freed recalled. They locked eyes, he added. “When I saw him, there was no smile.”
Other friends reached out to Prince over the weekend, concerned about what had happened to him on the plane. He had a resounding message: I’m O.K.
Knowing how much Prince, who didn’t use a cellphone but was constantly surfing his silver MacBook, valued his privacy, friends said they did not press him.
On Monday, April 18, Ms. Lawler-Freas, the Atlanta promoter, said that Prince’s representatives told her to hold off on confirming the eight tour dates she had arranged for him. He was going to take a break that week, and they would get back to her the next Monday, April 25, to confirm the concerts.
Prince seemed to lead a mundane life from there, stopping by a show at the Dakota Jazz Club in Minneapolis on Tuesday, April 19. The next day, police said, someone dropped him off at his compound at about 8 p.m. He was found dead the next morning, setting off the sweeping investigation.
“If we really want to be accurate and get it right, I think you have to pump the brakes,” said Deputy Kamerud of the Carver County Sheriff’s Office. “Some investigations are like 50-piece puzzles, some are like a 10,000-piece puzzle. This one is the latter.”
Mr. Freed, the blogger, said he could hardly believe reports of the painkiller dependency. Prince, he said, would help anyone in his band with a drug problem and even pay the cost of their recovery.
If you abused drugs, he said, “you weren’t going to work with him. You didn’t have a job.”
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Wednesday, May 4, 2016

Antibody infusions provide long-term defence against HIV-like infection

NATURE | NEWS


Specialized proteins can protect monkeys against the virus for months.

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Klaus Boller/Science Photo Library
Researchers tested antibody treatments with a chimeric virus containing fragments of HIV and simian immunodeficiency virus (SIV, shown here).
A single infusion of antibodies can protect monkeys from infection with a virus that is similar to HIV for nearly six months.
The finding provides further evidence that antibodies — specialized proteins that the body produces to fight infections — could one day be used as a method to prevent people from becoming infected with HIV.
“A caveat is that monkeys are not humans, but the model the authors use is about as good as it gets, and the results are a boost to HIV vaccine research and the use of passive antibodies as long-acting preventives,” said immunologist Dennis Burton of the Scripps Research Institute in La Jolla, California, who was not involved with the work.
Researchers have struggled to produce an effective vaccine against HIV, and the scientists behind this study say that administering periodic doses of antibodies might provide a stopgap measure while vaccine research continues. “This might turn out to be a seasonal alternative to a vaccine until we really know how to make one,” says HIV researcher Malcolm Martin of the US National Institute of Allergy and Infectious Diseases in Bethesda, Maryland, who led the work.

Long-term protection

Previous studies had found that antibodies derived from HIV-infected people can drastically reduce the amount of HIV in an infected person’s blood for short periods of time. Researchers have also found that antibodies given one or two days before monkeys were exposed to an HIV-like virus prevented them from becoming infected.
Martin and his colleagues wanted to test whether an antibody strategy could have a lasting effect, because in the real world, people might be exposed to HIV weeks or months after being dosed with protective antibodies.
Malcom Martin/NIH/NIAID
AIDS researchers at work at the National Institute of Allergy and Infectious Diseases.
His team found that, in the absence of any protection, monkeys exposed to a chimeric virus containing portions of both HIV and its monkey equivalent SIV became infected after two to six exposures. The researchers then gave four other groups of monkeys a single injection of antibodies: each group was given a different antibody. These monkeys were then exposed to the chimeric virus once per week until the scientists could detect the pathogen in the animals’ blood. To more closely mimic human HIV infection, the researchers exposed the animals to lower virus doses than had been used in previous studies, which gave deliberately high virus doses to make sure that animals became infected.
All of the treated animals became infected at between 12 and 23 weeks, depending on which antibody they were given at the start1. The probability of an animal becoming infected grew as the amount of antibody in its blood declined.
“Monkeys are not humans, but the model the authors use is about as good as it gets”
The results add to growing positivity about the potential use of antibodies as preventive tools against HIV. The practicality of the approach has been questioned because antibodies are expensive and it has not been clear how often they’d need to be used to prevent people from becoming infected. But the findings released today demonstrate that antibodies might provide reasonably long-term protection from a single dose. And Martin says that the antibodies might even last longer in people: the monkey immune system sees them as 'foreign' proteins, but that might be less of a problem in humans, he says.

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Tuesday, May 3, 2016

Number of mumps cases at Harvard rises to 40


Harvard Yard a few days before students gathered for a demonstration.
–Jessica Rinaldi/Reuters
A mumps outbreak at Harvard University has affected 40 members of the school community over the last two months. Nearly a dozen students were in isolation as of Monday night, according to a university spokeswoman.
Harvard first announced two confirmed cases of mumps at the school in March. Despite investigations into the infection’s cause and efforts to isolate affected students, the number has continued to rise.
viral infection, mumps causes swelling in the salivary glands and cheeks. Its symptoms include fever, aching, headache, and a loss of appetite. Often, mumps spreads through direct physical contact with an infected person or an object or surface which someone with mumps has touched.
The Cambridge Public Health Department has been tracking the infection’s spread, interviewing those infected to determine with whom the students had contact, Susan Feinberg, a spokeswoman for the department, said. A month ago, thedepartment determined that all infected students to that point had received a mumps vaccine prior to contracting the infection, and that 99 percent of undergraduate students at the college had met the state’s immunization requirements.
To date, Feinberg had not yet heard of any confirmed cases in Cambridge that were unrelated to the Harvard community.
The university has promoted prevention tactics, university spokeswoman Lindsey Baker said. With the end of the academic year wrapping up, students are preparing for final exams and commencement, and the university is once again urging students to remain vigilant to avoid contracting the infection.
“It’s hard to predict how it will go and how much exposure there is,” Baker said. “It’s more just those events are coming up, so we just want people to take precautions.”
Harvard students aren’t alone — during the time of the school’s outbreak, Massachusetts had already confirmed 12 cases of mumps across the state this year, including UMass Boston two confirmed cases in March at UMass Boston and one case in February at Bentley University in Waltham.

After ‘The Biggest Loser,’ Their Bodies Fought to Regain Weight

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.


Danny Cahill stood, slightly dazed, in a blizzard of confetti as the audience screamed and his family ran on stage. He had won Season 8 of NBC’s reality television show “The Biggest Loser,” shedding more weight than anyone ever had on the program — an astonishing 239 pounds in seven months.
When he got on the scale for all to see that evening, Dec. 8, 2009, he weighed just 191 pounds, down from 430. Dressed in a T-shirt and knee-length shorts, he was lean, athletic and as handsome as a model.
“I’ve got my life back,” he declared. “I mean, I feel like a million bucks.”
Mr. Cahill left the show’s stage in Hollywood and flew directly to New York to start a triumphal tour of the talk shows, chatting with Jay Leno, Regis Philbin and Joy Behar. As he heard from fans all over the world, his elation knew no bounds.
But in the years since, more than 100 pounds have crept back onto his 5-foot-11 frame despite his best efforts. In fact, most of that season’s 16 contestants have regained much if not all the weight they lost so arduously. Some are even heavier now.
Yet their experiences, while a bitter personal disappointment, have been a gift to science. A study of Season 8’s contestants has yielded surprising new discoveries about the physiology of obesity that help explain why so many people struggle unsuccessfully to keep off the weight they lose.
Kevin Hall, a scientist at a federal research center who admits to a weakness for reality TV, had the idea to follow the “Biggest Loser” contestants for six years after that victorious night. The project was the first to measure what happened to people over as long as six years after they had lost large amounts of weight with intensive dieting andexercise.
Continue reading the main story
Continue reading the main story
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BEFORE and AT FINALECreditLeft: Chris Haston/NBC Universal via Getty; Right: Trae Patton/NBC Universal, via Getty
“I won’t be victim to this. It’s the hand I’ve been dealt.”

Danny Cahill

46, speaker, author, land surveyor and musician, Broken Arrow, Okla.
WEIGHT Before show, 430 pounds; at finale, 191 pounds; now, 295 pounds
METABOLIC RATE Now burns 800 fewer calories a day than would be expected for a man his size.
The results, the researchers said, were stunning. They showed just how hard the body fights back against weight loss.
“It is frightening and amazing,” said Dr. Hall, an expert on metabolism at the National Institute of Diabetes and Digestive and Kidney Diseases, which is part of the National Institutes of Health. “I am just blown away.”
It has to do with resting metabolism, which determines how many calories a person burns when at rest. When the show began, the contestants, though hugely overweight, had normal metabolisms for their size, meaning they were burning a normal number of calories for people of their weight. When it ended, their metabolisms had slowed radically and their bodies were not burning enough calories to maintain their thinner sizes.
Researchers knew that just about anyone who deliberately loses weight — even if they start at a normal weight or even underweight — will have a slower metabolism when the diet ends. So they were not surprised to see that “The Biggest Loser” contestants had slow metabolisms when the show ended.
What shocked the researchers was what happened next: As the years went by and the numbers on the scale climbed, the contestants’ metabolisms did not recover. They became even slower, and the pounds kept piling on. It was as if their bodies were intensifying their effort to pull the contestants back to their original weight.
Mr. Cahill was one of the worst off. As he regained more than 100 pounds, his metabolism slowed so much that, just to maintain his current weight of 295 pounds, he now has to eat 800 calories a day less than a typical man his size. Anything more turns to fat.

‘A Basic Biological Reality’

The struggles the contestants went through help explain why it has been so hard to make headway against the nation’s obesity problem, whichafflicts more than a third of American adults. Despite spending billions of dollars on weight-loss drugs and dieting programs, even the most motivated are working against their own biology.

...
Dina Mercado at home with one of her sons, Jericho, in Commerce, Calif. CreditEmily Berl for The New York Times
Photo
BEFORE and AT FINALECreditLeft: Chris Haston/NBC Universal via Getty; Right: Trae Patton/NBC Universal via Getty
“It’s hard. The cravings are there.”

Dina Mercado

35, maintenance worker for Commerce, Calif.
WEIGHT Before show, 248 pounds; at finale, 173.5 pounds; now, 205.9 pounds
METABOLIC RATE Now burns 437.9 fewer calories per day than would be expected for a woman her size.

...
Slimmer and Hungrier
Some scientists say weight maintenance has to be treated as an issue separate from weight loss. Only when that challenge is solved, they say, can progress truly be made against obesity.
...
Sean Algaier taking communion at Providence Road Church of Christ in Charlotte, N.C., where he is a pastor.CreditGeorge Etheredge for The New York Times
Photo
BEFORE and AT FINALECreditLeft: Chris Haston/NBC Universal via Getty; Right: Trae Patton/NBC Universal via Getty
“It’s not as dramatic as being told you have a disease, but it’s along those lines.”

Sean Algaier

36, worship pastor, Charlotte, N.C.
WEIGHT Before show, 444 pounds; at finale, 289 pounds; now, 450 pounds
METABOLIC RATE Now burns 458 fewer calories a day than would be expected for a man his size.

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Armanda Arlauskas walking her dog, Jax, in her neighborhood in Raleigh, N.C. CreditGeorge Etheredge for The New York Times
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BEFORE and AT FINALECreditLeft: Chris Haston/NBC Universal via Getty; Right: Trae Patton/NBC Universal via Getty
“I could tell something wasn’t right with my body. I just knew it was an issue with my metabolism.”

Amanda Arlauskas

26, wellness coach and social media consultant, Raleigh, N.C.
WEIGHT Before show, 250 pounds; at finale, 163 pounds; now, 176 pounds
METABOLIC RATE Now burns 591.1 fewer calories per day than would be expected for a woman her size.
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Rudy Pauls and his wife, Beth, disinfecting a newborn lamb on their farm in Belchertown, Mass.CreditNathaniel Brooks for The New York Times
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BEFORE and AT FINALECreditLeft: Chris Haston/NBC Universal via Getty; Right: Trae Patton/NBC Universal via Getty
“‘The Biggest Loser’ did change my life, but not in a way that most would think. It opened my eyes to the fact that obesity is not simply a food addiction. It is a disability of a malfunctioning metabolic system.”

Rudy Pauls

37, electrical engineer, Belchertown, Mass.
WEIGHT Before show, 442 pounds; at finale, 234 pounds; in 2014, 390 pounds; now, after bariatric surgery, 265 pounds
METABOLIC RATE Now burns 516 fewer calories a day than would be expected for a man his size.

Tracey Yukich walks regularly at Lake Johnson Park in Raleigh, N.C. CreditGeorge Etheredge for The New York Times
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BEFORE and AT FINALECreditLeft: Chris Haston/NBC Universal via Getty; Right: Trae Patton/NBC Universal via Getty
“I eat very clean and stay away from sugar, and I take supplements. I want to know what do we do now, because I am a doer.”

Tracey Yukich

44, exercise physiologist, Raleigh, N.C.
WEIGHT Before show, 250 pounds; at finale, 132 pounds; now, 178 pounds
METABOLIC RATE Now burns 211.7 fewer calories per day than would be expected for a woman her size.