Why do I always regain the weight I lost?

Something very important happened last week. I’m sorry I haven’t gotten this note out sooner:

The New England Journal of Medicine published an article (10/25/11) on an excellent piece of research.  The study was designed to look at hormones and other factors involved in metabolism, sensations of hunger, and fullness in people who lost 10% of their body weight.  They gathered data before dieting, after the loss, and after 1 year of maintaining the weight loss.

The results show that after weight loss, people were more interested in food, hungrier, and felt less full after eating than before the diet started.  Measurements of hormones involved in hunger and fullness all changed in the directions expected and probably caused these differences in sensations.  Thyroid hormones were not measured.  However, leptin, a hormone involved in regulating metabolism, decreased.  For those of you who know something about thyroid: a decrease in leptin causes a decrease in free T3 (which speeds metabolism) and an increase in reverse T3, changes which slows metabolism according to many of us in the field.

And here’s the shocking result: These changes were still found when the testing was rerun one year later!  Let me say that louder: These changes were still found when the testing was rerun one year later!

Some of the things they measured were heading back toward normal, but they were still more similar to values right after weight loss than they were to the starting values.

On its face, it looks like horrible information to hear.  People trying to lose weight and keep it off are going to think this is terrible.  But I think it’s wonderful and let me tell you why. Because it’s about time the world looked at this differently.  Some of us who listen respectfully to our patients and understand the biology could have predicted these results – and it’s nice to see the truth put out there.  I’ve never seen a study with these measures carried out a year later.  That’s an important piece of what they have done. You have to know the enemy to fight it.  Your body is biologically designed to save your life when there hasn’t been enough food coming in.  You are consciously smart enough to know that losing weight is a healthy thing to do.  But your primitive body says, “Oh my!  I haven’t gotten enough to eat lately.  If I don’t grab everything in sight whenever food is available, I’m going to die.  Also, since there was a time of limited food in the past, you never know when it’s going to happen again, so I’d better store extra calories.”  Plus, your metabolism has decreased, causing you to burn fewer calories than before weight loss whether you are sitting or weight-lifting.  Our primitive body is pretty hard to fight.

So I think this is good news.  If you struggle with weight, you’ve been carrying around a lot of guilt with the extra weight.  Now you don’t have to feel guilty about the fact that the chips or cupcakes or whatever are calling to you in a louder voice after you’ve lost some weight.

So many people say, “You shouldn’t take medications to lose weight.”  I think this work strongly shows that, for some people, medications are part of the answer.  Not the whole answer, but part of it.

This article shows the reasons why I believe in prescribing a variety of medications to help decrease appetite, increasing fullness, and maintain normal metabolism both during the weight loss attempt and, if needed, while working to maintain weight loss.

Here’s a link to the New York Times with an article that describes the research findings: Click here for Article

Keep up the good work.