A recent report on the fate of “The Biggest Losers” participants showed that after 6 years, some of the most successful participants regained a substantial amount of their lost weight. Many clinicians (and non-clinicians) have expressed their opinions on this disappointing report. An overwhelming majority have commented on the change in metabolism of the participants, after 6 years, as indicated by the change in their basal metabolic rate (BMR). What many have failed to acknowledge is that overall, there was very little correlation between the BMR and the success or failure of maintaining the lost weight (several of the more successful participants at the 6-year point had the lowest BMR compared to the rest of the participants).
What also has been missing from the commentaries is the significance of the psychological aspect of obesity. There is no question that obesity is a complicated multifactorial chronic disease. There is also very little doubt that without addressing the underlying psychological aspects, all weight loss interventions, including most surgical procedures, will only have a temporary effect. As a strong believer in multidisciplinary approach to management of obesity, we strongly encourage our patients to seek long-term, often life-long, counseling to better address their pathological relationship with food. Unfortunately, the stigma associated with counseling and the hurdles imposed by third-party payers, often discourage our patients from following through.
So, what about the “biggest losers”? What went wrong after 6 years? Or better yet, what went right while participating in the show? The excitement of being a participant in a reality show (which included being under a microscope for a significant length of time) allowed most to temporarily overcome their demons when it came to their relationship with food. Six years later, having been left to their own devices, they stopped moving (change in caloric expenditure) and they went back to their abusive relationship with food, all of which translated into significant weight regain. As clinicians, we need to learn from this and many other similar stories and incorporate mental health strategies into our long-term management of our obese patients.