The concept of weight loss has typically been seen as a short-term plan and solution. Until recently, many people believed in a short-term modification of eating less and exercising as a solution for weight loss. We now understand that obesity is a multi-factorial chronic disease that requires long-term management for success at not only long-term weight loss, but also for weight gain prevention.
In 2011, Sumithran published a paper in the New England Journal of Medicine looking at the compensatory changes that happen in a person trying to lose weight, and keep it off (1). He found that body weight is centrally regulated, with multiple hormonal signals affecting food intake and energy expenditure. He also discovered that after successful weight loss, there was a disproportionate reduction in energy expenditure that persisted well after the weight was lost, resulting in increased risk for weight regain. There were also alterations in the body hormones that increased hunger, lessened satiety or fullness, and increased the risk for weight regain.
More recently, in 2016, Fothergill et al published a paper in Obesity looking at the persistent metabolic adaptations six years after “The Biggest Loser” competition (2). They discovered that weight regain happened years later after the initial weight loss due to decreases in the resting metabolic rate.
Evidence now shows that weight management is a long-term commitment and process. It may take as long as two years for the body to “adapt” to weight loss, as seen from the prospective investigative data tracking of more than 10,000 individuals who succeeded at long-term weight loss.
With 1.5 billion people worldwide struggling with this disease, changing our treatment and therapeutic goals to long-term weight management will only enhance our success and reduce the co-morbidities associated with obesity.