Chubby lady looks to be less chubby

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For 15 years, Joseph Proietto has been helping people lose weight. When these obese patients arrive at his weight-loss clinic in Australia, they are determined to slim down. But then, almost without exception, the weight begins to creep back. In a matter of months or years, the entire effort has come undone, and the patient is fat again.

Anyone who has ever dieted knows that lost pounds often return, and most of us assume the reason is a lack of discipline or a failure of willpower. But Proietto suspected that there was more to it, and he decided to take a closer look at the biological state of the body after weight loss. Beginning inhe and his team recruited 50 obese men and women. The men weighed an average of pounds; the women weighed about pounds. Although some people dropped out of the study, most of the patients stuck with the extreme low-calorie diet, which consisted of special shakes called Optifast and two cups of low-starch vegetables, totaling just to calories a day for eight weeks.

Ten weeks in, the dieters lost an average of 30 pounds. At that point, the 34 patients who remained stopped dieting and began working to maintain the new lower weight. Nutritionists counseled them in person and by phone, promoting regular exercise and urging them to eat more vegetables and less fat. But despite the effort, they slowly began to put on weight. After a year, the patients already had regained an average of 11 of the pounds they struggled so hard to lose. They also reported feeling far more hungry and preoccupied with food than before they lost the weight.

A full year after ificant weight loss, these men and women remained in what could be described as a biologically altered state. Their still-plump bodies were acting as if they were starving and were working overtime to regain the pounds they lost. Another hormone Chubby lady looks to be less chubby with suppressing hunger, peptide YY, was also abnormally low. Levels of leptin, a hormone that suppresses hunger and increases metabolism, also remained lower than expected. A cocktail of other hormones associated with hunger and metabolism all remained ificantly changed compared to pre-dieting levels.

While the findings from Proietto and colleagues, published this fall in The New England Journal of Medicineare not conclusive — the study was small and the findings need to be replicated — the research has nonetheless caused a stir in the weight-loss community, adding to a growing body of evidence that challenges conventional thinking about obesity, weight loss and willpower.

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For years, the advice to the overweight and obese has been that we simply need to eat less and exercise more. While there is truth to this guidance, it fails to take into that the human body continues to fight against weight loss long after dieting has stopped. This translates into a sobering reality: once we become fat, most of us, despite our best efforts, will probably stay fat.

I have always felt perplexed about my inability to keep weight off. I exercise regularly — a few years ago, I even completed a marathon. Sometimes we ate healthful, balanced meals; on other days dinner consisted of a bucket of Kentucky Fried Chicken. As a high-school cross-country runner, I never worried about weight, but in college, when my regular training runs were squeezed out by studying and socializing, the s on the scale slowly began to move up.

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As adults, my three sisters and I all struggle with weight, as do many members of my extended family. My mother died of esophageal cancer six years ago. It was her great regret that in the days before she died, the closest medical school turned down her offer to donate her body because she was obese. Researchers know that obesity tends to run in families, and recent science suggests that even the desire to eat higher-calorie foods may be influenced by heredity.

But untangling how much is genetic and how much is learned through family eating habits is difficult. What is clear is that some people appear to be prone to accumulating extra fat while others seem to be protected against it. In a seminal series of experiments published in the s, the Canadian researchers Claude Bouchard and Angelo Tremblay studied 31 pairs of male twins ranging in age from 17 to 29, who were sometimes overfed and sometimes put on diets.

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None of the twin pairs were at risk for obesity based on their body mass or their family history. In one study, 12 sets of the twins were put under hour supervision in a college dormitory. Six days a week they ate 1, extra calories a day, and one day they were allowed to eat normally. They could read, play video games, play cards and watch television, but exercise was limited to one minute daily walk. Over the course of the day study, the twins consumed 84, extra calories beyond their basic needs.

That experimental binge should have translated into a weight gain of roughly 24 pounds based on 3, calories to a pound. But some gained less than 10 pounds, while others gained as much as 29 pounds. The amount of weight gained and how the fat was distributed around the body closely matched among brothers, but varied considerably among the different sets of twins.

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Some brothers gained three times as much fat around their abdomens as others, for instance. When the researchers conducted similar exercise studies with the twins, they saw the patterns in reverse, with some twin sets losing more pounds than others on the same exercise regimen. But while there is widespread agreement that at least some risk for obesity is inherited, identifying a specific genetic cause has been a challenge.

In Octoberthe journal Nature Genetics reported that researchers have so far confirmed 32 distinct genetic variations associated with obesity or body-mass index. One of the most common of these variations was identified in April by a British team studying the genetics of Type 2 diabetes. According to Timothy Frayling at the Institute of Biomedical and Clinical Science at the University of Exeter, people who carried a variant known as FTO faced a much higher risk of obesity — 30 percent higher if they had one copy of the variant; 60 percent if they had two.

This FTO variant is surprisingly common; about 65 percent of people of European or African descent and an estimated 27 to 44 percent of Asians are believed to carry at least one copy of it. In one study led by Colin Palmer of the University of Dundee in Scotland, Scottish schoolchildren were given snacks of orange drinks and muffins and then allowed to graze on a buffet of grapes, celery, potato chips and chocolate buttons.

All the food was carefully monitored so the researchers knew exactly what was consumed. Although all the children ate about the same amount of food, as weighed in grams, children with the FTO variant were more likely to eat foods with higher fat and calorie content. Those who had the gene variant had about four pounds more body fat than noncarriers. I have been tempted to send in my own saliva sample for a DNA test to find out if my family carries a genetic predisposition for obesity.

A positive result, telling people they are genetically inclined to stay fat, might be self-fulfilling. While knowing my genetic risk might satisfy my curiosity, I also know that heredity, at best, would explain only part of why I became overweight.

The National Weight Control Registry tracks 10, people who have lost weight and have kept it off. Wing says that she agrees that physiological changes probably do occur that make permanent weight loss difficult, but she says the larger problem is environmental, and that people struggle to keep weight off because they are surrounded by food, inundated with food messages and Chubby lady looks to be less chubby presented with opportunities to eat.

There is no consistent pattern to how people in the registry lost weight — some did it on Weight Watchers, others with Jenny Craig, some by cutting carbs on the Atkins diet and a very small lost weight through surgery. But their eating and exercise habits appear to reflect what researchers find in the lab: to lose weight and keep it off, a person must eat fewer calories and exercise far more than a person who maintains the same weight naturally.

Registry members exercise about an hour or more each day — the average weight-loser puts in the equivalent of a four-mile daily walk, seven days a week. They get on a scale every day in order to keep their weight within a narrow range. They eat breakfast regularly. Most watch less than half as much television as the overall population. They also appear to eat less than most people, with estimates ranging from 50 to fewer daily calories.

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Kelly Brownell, director of the Rudd Center for Food Policy and Obesity at Yale University, says that while the 10, people tracked in the registry are a useful resource, they also represent a tiny percentage of the tens of millions of people who have tried unsuccessfully to lose weight.

Years later they are paying attention to every calorie, spending an hour a day on exercise. Janice Bridge, a registry member who has successfully maintained a pound weight loss for about five years, is a perfect example. Bridge, who is 66 and lives in Davis, Calif. At the time, her slow pace of weight loss prompted her doctor to accuse her of cheating. Friends told her she must not be paying attention to what she was eating.

After peaking at pounds inshe tried again to lose weight. She managed to drop 30 pounds, but then her weight loss stalled. Inat age 60, she ed a medically supervised weight-loss program with her husband, Adam, who weighed pounds.

After nine months on an calorie diet, she slimmed down to pounds. Adam lost about pounds and now weighs about During the first years after her weight loss, Bridge tried to test the limits of how much she could eat.

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She used exercise to justify eating more. The death of her mother in consumed her attention; she lost focus and slowly regained 30 Chubby lady looks to be less chubby. She has decided to try to maintain this higher weight ofwhich is still pounds fewer than her heaviest weight. But my body would put on weight almost instantaneously if I ever let up. So she never lets up. Since October she has weighed herself every morning and recorded the result in a weight diary. She even carries a scale with her when she travels.

In the past six years, she made only one exception to this routine: a two-week, no-weigh vacation in Hawaii. She also weighs everything in the kitchen. She knows that lettuce is about 5 calories a cup, while flour is about If she goes out to dinner, she conducts a Web search first to look at the menu and calculate calories to help her decide what to order.

She has also found that drinking copious amounts of water seems to help; she carries a ounce water bottle and fills it five times a day. She writes down everything she eats. At night, she transfers all the information to an electronic record.

Adam also keeps track but prefers to keep his record with pencil and paper. I do a little bit of self-analysis every night. Bridge and her husband each sought the help of therapists, and in her sessions, Janice learned that she had a tendency to eat when she was bored or stressed. Bridge supports her careful diet with an equally rigorous regimen of physical activity.

She exercises from to minutes a day, six or seven days a week, often by riding her bicycle to the gym, where she takes a water-aerobics class. Janice Bridge has used years of her exercise and diet data to calculate her own personal fuel efficiency. She knows that her body burns about three calories a minute during gardening, about four calories a minute on the recumbent bike and during water aerobics and about five a minute when she zips around town on her regular bike.

Based on metabolism data she collected from the weight-loss clinic and her own calculations, she has discovered that to keep her current weight of pounds, she can eat 2, calories a day as long as she burns calories in exercise. She avoids junk food, bread and pasta and many dairy products and tries to make sure nearly a third of her calories come from protein. Because she knows errors can creep in, either because a rainy day cuts exercise short or a mismeasured snack portion adds hidden calories, she allows herself only 1, daily calories of food.

The average estimate for a similarly active woman of her age and size is about 2, calories. Just talking to Bridge about the effort required to maintain her weight is exhausting. I find her story inspiring, but it also makes me wonder whether I have what it takes to be thin.

And while I enjoy exercising for or minute stretches, I also learned from six months of marathon training that devoting one to two hours a day to exercise takes an impossible toll on my family life. Bridge concedes that having grown children and being retired make it easier to focus on her weight. But the alternative is to not keep the weight off. For 25 years, they have meticulously tracked about individuals for six months or longer at a stretch. The subjects reside at their research clinic where every aspect of their bodies is measured.

Body fat is determined by bone-scan machines. A special hood monitors oxygen consumption and carbon-dioxide output to precisely measure metabolism. Calories burned during digestion are tracked. Exercise tests measure maximum heart rate, while blood tests measure hormones and brain chemicals.

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Muscle biopsies are taken to analyze their metabolic efficiency. Early in the research, even stool samples were collected and tested to make sure no calories went uned for. Eventually, the Columbia subjects are placed on liquid diets of calories a day until they lose 10 percent of their body weight. Once they reach the goal, they are subjected to another round of intensive testing as they try to maintain the new weight.

The data generated by these experiments suggest that once a person loses about 10 percent of body weight, he or she is metabolically different than a similar-size person who is naturally the same weight. The research shows that the changes that occur after weight loss translate to a huge caloric disadvantage of about to calories. For instance, one woman who entered the Columbia studies at pounds was eating about 3, calories to maintain that weight.

Once she dropped to pounds, losing 17 percent of her body weight, metabolic studies determined that she needed about 2, daily calories to maintain the new lower weight.

Chubby lady looks to be less chubby

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