I developed the idea of the Sponge Syndrome explaining why the reduced obese could not maintain weight loss when I was at the Mall of America in 2011 and saw a statue of Square Pants Sponge Bob.
My 6.5 minute video
Christopher N Ochner
Adam G Tsai
Robert F Kushner
Thomas A Wadden
and The Lancet Diabetes and Endocrinology publication.
Ochner et al article Feb 11, 2015 link
"Many clinicians are not adequately aware of the reasons that individuals with obesity struggle to achieve and maintain weight loss,1 and this poor awareness precludes the provision of effective intervention.2
Irrespective of starting weight, caloric restriction triggers several biological adaptations designed to prevent starvation.3
These adaptations might be potent enough to undermine the long-term effectiveness of lifestyle modification in most individuals with obesity, particularly in an environment that promotes energy overconsumption.
However, they are not the only biological pressures that must be overcome for successful treatment.
Additional biological adaptations occur with the development of obesity and these function to preserve, or even increase, an individual's highest sustained lifetime bodyweight.For example, preadipocyte proliferation occurs, increasing fat storage capacity."
In addition, habituation to rewarding neural dopamine signalling develops with the chronic overconsumption of palatable foods, leading to a perceived reward deficit and compensatory increases in consumption.4
Importantly, these latter adaptations are not typically observed in individuals who are overweight, but occur only after obesity has been maintained for some time.3
Thus, improved lifestyle choices might be sufficient for lasting reductions in body weight prior to sustained obesity.
Once obesity is established, however, body weight seems to become biologically stamped in and defended.
Therefore, the mere recommendation to avoid calorically dense foods might be no more effective for the typical patient seeking weight reduction than would be a recommendation to avoid sharp objects for someone bleeding profusely.
Evidence suggests that these biological adaptations often persist indefinitely, even when a person re-attains a healthy BMI via behaviourally induced weight loss.3
Further evidence indicates that biological pressure to restore body weight to the highest-sustained lifetime level gets stronger as weight loss increases.5
Thus, we suggest that few individuals ever truly recover from obesity; individuals who formerly had obesity but are able to re-attain a healthy body weight via diet and exercise still have ‘obesity in remission’ and are biologically very different from individuals of the same age, sex, and body weight who never had obesity.3, 5
For most individuals, these biological adaptations need to be addressed for weight loss to be sustained long-term.
We believe these mechanisms largely explain the poor long-term success rates of lifestyle modification, and obligate clinicians to go beyond mere recommendations to eat less and move more.