The current theme of metabolic research seems to have settled on physiological changes, post-weight-loss in the obese, that set the person up for almost assured failure and regain. It has been reported that the super-obese (usually a term for BMI>40) tend to have REEs that are higher than would be predicted by standard, generally accepted models such as Harris-Benedict or Mifflin-St.Jeor. This is both what was seen in the Biggest Losers "before" weight loss, and was reported in comments on this blog by Dr. Yoni Freedhoff, who measures REE in the obese he treats.
In order for a super-obese person to fully reverse their obesity, they will need to lose large amounts of weight -- 100, 200 or more pounds. To do so, most will need to dramatically cut calories to lose at a rate that is motivating enough to sustain a fairly lengthy time period. Even "fast" weight loss, reported by many, and especially gastric bypass patients, occurs over several months to a year ... or more.
It is well documented that REE will decline in most, and it will decline more precipitously in response to more drastic cuts in intake. The individual variation in this response is often glossed over. It has also been well documented that REE returns to normal levels once maintenance calories are consumed. This is something that has now been replaced by the results after 6 years for 14 former contestants on The Biggest Loser. The abysmal media reporting on that study has now placed a *fact* into the general discourse that the reason obesity is so difficult to reverse is a physiological one -- as the New York Times blared, "Their Bodies Fought to Regain Weight". This was followed by an editorial by a neuroscientist, cautioning in the subtitle "The problem isn't willpower. It's neuroscience. Why you can't -- and shouldn't -- fight back. ".
In this blog, I will discuss how what Kevin Hall actually says about the Biggest Loser study clashes with interpretations, and where we agree. I will then address where we disagree. His bottom line appears to be that metabolic adaptation is defined as measuring REE when obese and then calculating what it should be at 100, 150, 200, etc. lbs lighter. He focuses on change in REE being greater than would be predicted for the individual based on their super-obese metabolic starting point. I disagree that this is an appropriate measure, and especially how this interpretation has been portrayed in the media. As it turns out, the "after" subjects did not have depressed REEs when compared to others at that weight!
I propose a "what if it's all been a big fat super-obese lie" question. What if -- instead of the body fighting to maintain some re-set super-obese setpoint by "adapting" to calorie restriction and weight loss with a depressed metabolic rate ... What if it is the super-obese who are exhibiting a metabolic adaptation to their chronically overfed state?