by Barbara Berkeley, MD
Imagine I had a magic pill.
And imagine I told every overweight person in America that this pill could keep each one of them at the lowest weight he or she could achieve. All each had to do was diet down to that low weight and this wondrous little pill would prevent regain forever.
I believe that if I could promise such a pill, pretty much every overweight person would be able to achieve a very significant weight loss.
The reason is that dieting for weight loss is simply a process of prolonged low level starvation and that is an uncomfortable and difficult proposition As a result, the successful dieter must be very, very motivated. The magic pill would be a powerful motivator indeed. Imagine!
But if my supposition is true, what does this say about the amount of attention we pay to dieting strategies? Do we really need thousands of how to books, websites, print articles, counselors, diet programs.....or do we really just need a big dose of motivation and more importantly.....a permanent way to make weight loss stick?
At a recent obesity conference at the Cleveland Clinic I was heartened to hear a talk by highly respected researcher Dr. Rudolph Leibel. Dr. Leibel's work at Columbia University has centered around obesity genetics and metabolism. His talk focused on what he believes to be incontrovertible fact: that the body's regulation of fat mass work in only one direction---protection of weight. This means that it's difficult to lose weight (the body is trying to protect the current weight) and very, very difficult to maintain weight loss (the body is trying to return to the original weight). While we can force ourselves to overcome the body's protection mechanism for awhile---(during a diet, for example)---it's hard to do it forever. This is a fact that is obvious to obesity specialists and undoubtedly to each one of you reading this.
What gave me hope was that Dr. Leibel began talking about research he is currently doing with the hormone leptin. Leptin is a hormone which is produced by fat cells and which, in normal circumstances, shuts down appetite. When fat cells are full up, we make leptin which reaches the brain and tells the appetite centers to quiet down. We don't need to eat because we are sufficiently fat.
Unfortunately, the obese state messes with the normal state of affairs. The obese body becomes resistant to leptin's message and so, even with high levels of leptin production, the brain does not shut down appetite. At one time, researchers thought that injecting obese people with high levels of leptin might override this problem but it simply didn't work. The resistance to the message remained.
When fat cells are relatively empty, on the other hand, they don't produce leptin. Under normal circumstances, this encourages appetite and promotes regain. But this begs the question: what happens if a reduced person gets treated with leptin? They would then get the "don't eat" signal. Might that shut down the mechanism that causes weight to be reaccumlated? Dr. Leibel's early research holds out some hope for this. I have included a link to one of his studies here.
Leptin is unlikely to be the magic pill. For starters, it currently is administered by injection twice a day. But the fact that researchers are honing in on maintenance should hearten us all. Science will eventually provide help with weight regain.
Until then, we must rely on the tried and true. Significantly lower your carb intake to decrease the production of fat-storing insulin, exercise vigorously and frequently, make use of meal replacements to avoid the three-big-meal per day eating style, learn about your own weight regain formula by keeping notes and by weighing daily and...when all else fails....have a strong strategy for reversing small regains. The best way to stave off weight regain is to expect it and be ready for it.