Dr Hall's fantastic talk 45 min you tube link
Scroll down when you go to the link to the picture below
It is great to hear Dr Hall finally put to bed this rule that many still talk about,
Gina Kolata explains this False Hope LINK
Dr Hall points out that if the 1,000 calorie deficit were correct on 2500 calories a day this man would lose all his weight in four years.
Dr Hall in this slide shows initial weight loss with 1,000 calorie deficit but that after about 9 months the plateau occurs.
This might be the most important slide in this talk.
A new way to predict weight loss.
Metabolic rate of participants before Biggest Loser
Dr Hall said in this study of the Biggest Loser that
muscle mass was maintained despite tremendous weight loss
due to increased protein
and intense aerobic and resistance training.
New information.
On Ranch contestants lost a pound a day.
At home contestants lost half a pound a day
Over a period of 7 months the average weight loss was 137 pounds
Dr Hall said in this study of the Biggest Loser that
muscle mass was maintained despite tremendous weight loss
due to increased protein
and intense aerobic and resistance training.
New information.
On Ranch contestants lost a pound a day.
At home contestants lost half a pound a day
Over a period of 7 months the average weight loss was 137 pounds
Average number of calories burned 3,700 cal/d before starting competition.
6 weeks into the competition the burning of calories increased by 1,000 calories/d to 4,700 calories/d
At end of competition the burning of calories had gone down to 3,000 calories
Contestants were sedentary before entering Biggest Loser.
In program they were doing 3.5 hours a day of vigorous exercise every day of the week.
After losing 130 pounds they require fewer calories to do the same amount of activity
because the amount of calories doses not depend on how strenuous your exercise is but depends on the weight bearing of your body during the early stage of the trial.
70% of total metabolism comes from resting metabolic rate.
In slide above the drop in RMR went down by 600 calories.
The organs are no longer as large and thus the RMR is less.
Range of RMR depending on amount of fat-free mass in contestants before competition above.
The model of calculation decrease in RMR was the red line as you lost weight before this new data at Biggest Loser.
The actual data shows a much bigger drop in the RMR with weight loss.
This is a very important slide with new unexpected data.
The greater than expected slowing of the RMR along the black line as the model predicted with weight loss in reality turned out to be much more as evidenced by all the individual line drop way below it .
This became called METABOLIC ADAPTATION as seen above.
On average the contestants regained 66% of their weight loss after 6 years.
Dr Hall believes average weight loss of 12% is amazing success for these contestants.
On average the people who had less exercise went back to their original weight
with some going 1% higher.
Important to discuss WATERFALL EFFECT of all diet trials. link
Dr Hall points out that the people who lowered their RMR were not the one who regained the most weight.
The people who maintained less exercise regained the most weight.
This was the big surprise to Dr Hall which he would never have predicted.
The resting metabolic rate remained low even after 6 years.
The metabolic rate was still 600 calories lower than at the beginning of the trial.
The contestants with the greatest decrease in resting metabolic rate did not have the greatest weight gain.
With weight regain the RMR should have increased.
It did not.
In fact the people with the lower RMR maintained the greatest weight loss
which Dr Hall points out is counter intuitive.
It is still a mystery to Dr. Hall as to why that is.
Bariatric patients lose weight more slowly
(they don't exercise as much as the Biggest loser group)
These surgical patients also show lower than expected RMR at 6 months but not at 12 months.
No one knows why this is?
In people who don't exercise much have less metabolic adaptation
The more you exercise the greater the metabolic adaptation
The greater the weight loss the greater the tension on Metabolic adaptation
Dr Hall says we don't know much about the physiology of hunger?
However with the DM drug Invokana we can draw off 90 g/d of glucose (400 calories)
without the patient changing their eating habit.
This is the first time their was a control to see on how increase in energy output with Invokana affected calorie intake due to increased appetite.
Dr Hall said the had never been a qualitative way to check on change of appetite.
On Invokana over a year people lost 4 kg.
Since they lose 400 calorie a day they should have lost 16 kg
Increase eating occurs with Invokana.
About 100 cal/d increase intake per Kg body weight loss
Thus there is 25 calorie loss per kg
While there is 100 calorie/d increase in calorie intake
Dr Hall believes this shows that weight regain in the reduced obese (he never uses this term) has less to do with calorie output (i.e exercise or Invokana) than with slowing increasing calorie intake.
Dr Hall calls this the Exponential decay of calorie adherence.
When the blue line crosses the orange line
is when the plateau occurs.
Dr Hall says he doesn't know why this occurs but he has some ideas.
Dr Hall says the more weight you lose the more your appetite goes up.
Perceived effort goes down after plateau.
The perceived effort is fairly constant until 12 months despite the body increasing the appetite as shown by the blue dashed line.
Dr Hall says that what people report as their food intake at the beginning of a trial is reported as the same amount 12 months. They are inaccurate.
Dr. Hall thinks the patients report the same amount in of intake because they still have the perceived effort of trying so hard to maintain weight loss.
Problem is most people can't maintain high intensity stress exercise.
This is the main validation of my Sponge theory
Dr Hall says that most of the people (66%) in the Biggest trial regained their weight.
Overall after 6 years they still had maintained a 16% weight loss which he says has huge benefit for them.
Dr Hall saysDM prevention only requires maintaining 5% weight loss.
I agree with this except in 10 years probably 30% more will get back to their starting weight or if they are still extremely obese despite maintaining a 5% weight loss they will soon become Diabetic.
Diet medications need to be started as soon as people start to gain back some weight in order to maintain their weight loss.
Despite an hour of exercise a day people began to regain.
Dr Hall says this is due to increased appetite but he does not explain why.
He only shows that with more weight loss there is increased appetite.
I maintain this is due to The Sponge Syndrome,
which is when the reduced obese hit the plateau they still have the same number of fat cells.
They shrunken fat cells have very low leptin and cause decreased RMR and increased appetite.
Dr Hall never mentions that despite losing 230 pounds that person still has the same number of fat cells.
He discusses why people with bariatric surgery do better at maintaining weight.
His theory is that they lose the weight without such tremendous exercise and the fact that they don't have the drop in exercise from seven hours a day to one hour and day may offer an explanation.
He does say the people that maintained a very high level of exercise did better at maintaining their weight.
I write that you can't outrun your fork.
Even the high exercise achievers post trial gained some weight.
The winner of the biggest loser could not maintain this high intensity stress exercise due to injury.
I wish someone had put him on Qysmia earlier on during the regain curve.
With Post bariatric surgery I think the surgeons realize they need to start diet meds
when regain occurs.
Dr Hall recognizes that exercise is not the problem as much as appetite increase.
Scroll down when you go to the link to the picture below
Highly Acclaimed Educational Sessions from Past Conventions
It is great to hear Dr Hall finally put to bed this rule that many still talk about,
Gina Kolata explains this False Hope LINK
Dr Hall points out that if the 1,000 calorie deficit were correct on 2500 calories a day this man would lose all his weight in four years.
I was pleased to see that Dr Hall mentions leptin early in his lecture as a important factor
Dr Hall in this slide shows initial weight loss with 1,000 calorie deficit but that after about 9 months the plateau occurs.
This might be the most important slide in this talk.
A new way to predict weight loss.
Metabolic rate of participants before Biggest Loser
Dr Hall said in this study of the Biggest Loser that
muscle mass was maintained despite tremendous weight loss
due to increased protein
and intense aerobic and resistance training.
New information.
On Ranch contestants lost a pound a day.
At home contestants lost half a pound a day
Over a period of 7 months the average weight loss was 137 pounds
Dr Hall said in this study of the Biggest Loser that
muscle mass was maintained despite tremendous weight loss
due to increased protein
and intense aerobic and resistance training.
New information.
On Ranch contestants lost a pound a day.
At home contestants lost half a pound a day
Over a period of 7 months the average weight loss was 137 pounds
Average number of calories burned 3,700 cal/d before starting competition.
6 weeks into the competition the burning of calories increased by 1,000 calories/d to 4,700 calories/d
At end of competition the burning of calories had gone down to 3,000 calories
Contestants were sedentary before entering Biggest Loser.
In program they were doing 3.5 hours a day of vigorous exercise every day of the week.
After losing 130 pounds they require fewer calories to do the same amount of activity
because the amount of calories doses not depend on how strenuous your exercise is but depends on the weight bearing of your body during the early stage of the trial.
70% of total metabolism comes from resting metabolic rate.
In slide above the drop in RMR went down by 600 calories.
The organs are no longer as large and thus the RMR is less.
Range of RMR depending on amount of fat-free mass in contestants before competition above.
The model of calculation decrease in RMR was the red line as you lost weight before this new data at Biggest Loser.
The actual data shows a much bigger drop in the RMR with weight loss.
This is a very important slide with new unexpected data.
The greater than expected slowing of the RMR along the black line as the model predicted with weight loss in reality turned out to be much more as evidenced by all the individual line drop way below it .
This became called METABOLIC ADAPTATION as seen above.
On average the contestants regained 66% of their weight loss after 6 years.
Dr Hall believes average weight loss of 12% is amazing success for these contestants.
On average the people who had less exercise went back to their original weight
with some going 1% higher.
Important to discuss WATERFALL EFFECT of all diet trials. link
Dr Hall points out that the people who lowered their RMR were not the one who regained the most weight.
The people who maintained less exercise regained the most weight.
This was the big surprise to Dr Hall which he would never have predicted.
The resting metabolic rate remained low even after 6 years.
The metabolic rate was still 600 calories lower than at the beginning of the trial.
The contestants with the greatest decrease in resting metabolic rate did not have the greatest weight gain.
With weight regain the RMR should have increased.
It did not.
In fact the people with the lower RMR maintained the greatest weight loss
which Dr Hall points out is counter intuitive.
It is still a mystery to Dr. Hall as to why that is.
Bariatric patients lose weight more slowly
(they don't exercise as much as the Biggest loser group)
These surgical patients also show lower than expected RMR at 6 months but not at 12 months.
No one knows why this is?
In people who don't exercise much have less metabolic adaptation
The more you exercise the greater the metabolic adaptation
The greater the weight loss the greater the tension on Metabolic adaptation
Dr Hall says we don't know much about the physiology of hunger?
However with the DM drug Invokana we can draw off 90 g/d of glucose (400 calories)
without the patient changing their eating habit.
This is the first time their was a control to see on how increase in energy output with Invokana affected calorie intake due to increased appetite.
Dr Hall said the had never been a qualitative way to check on change of appetite.
On Invokana over a year people lost 4 kg.
Since they lose 400 calorie a day they should have lost 16 kg
Increase eating occurs with Invokana.
About 100 cal/d increase intake per Kg body weight loss
Thus there is 25 calorie loss per kg
While there is 100 calorie/d increase in calorie intake
Dr Hall believes this shows that weight regain in the reduced obese (he never uses this term) has less to do with calorie output (i.e exercise or Invokana) than with slowing increasing calorie intake.
Dr Hall states that this is the typical weight loss curve for any diet.
The plateau occurs at 8-9 months then regain.
He think this due to increased appetite and increased food intake without the patient realizing it.
Dr Hall calls this the Exponential decay of calorie adherence.
When the blue line crosses the orange line
is when the plateau occurs.
Dr Hall says he doesn't know why this occurs but he has some ideas.
Dr Hall says the more weight you lose the more your appetite goes up.
Perceived effort goes down after plateau.
The perceived effort is fairly constant until 12 months despite the body increasing the appetite as shown by the blue dashed line.
Dr Hall says that what people report as their food intake at the beginning of a trial is reported as the same amount 12 months. They are inaccurate.
Dr. Hall thinks the patients report the same amount in of intake because they still have the perceived effort of trying so hard to maintain weight loss.
Problem is most people can't maintain high intensity stress exercise.
This is the main validation of my Sponge theoryDr Hall says that most of the people (66%) in the Biggest trial regained their weight.
Overall after 6 years they still had maintained a 16% weight loss which he says has huge benefit for them.
Dr Hall saysDM prevention only requires maintaining 5% weight loss.
I agree with this except in 10 years probably 30% more will get back to their starting weight or if they are still extremely obese despite maintaining a 5% weight loss they will soon become Diabetic.
Diet medications need to be started as soon as people start to gain back some weight in order to maintain their weight loss.
Despite an hour of exercise a day people began to regain.
Dr Hall says this is due to increased appetite but he does not explain why.
He only shows that with more weight loss there is increased appetite.
I maintain this is due to The Sponge Syndrome,
which is when the reduced obese hit the plateau they still have the same number of fat cells.
They shrunken fat cells have very low leptin and cause decreased RMR and increased appetite.
Dr Hall never mentions that despite losing 230 pounds that person still has the same number of fat cells.
He discusses why people with bariatric surgery do better at maintaining weight.
His theory is that they lose the weight without such tremendous exercise and the fact that they don't have the drop in exercise from seven hours a day to one hour and day may offer an explanation.
He does say the people that maintained a very high level of exercise did better at maintaining their weight.
I write that you can't outrun your fork.
Even the high exercise achievers post trial gained some weight.
The winner of the biggest loser could not maintain this high intensity stress exercise due to injury.
I wish someone had put him on Qysmia earlier on during the regain curve.
With Post bariatric surgery I think the surgeons realize they need to start diet meds
when regain occurs.
Dr Hall recognizes that exercise is not the problem as much as appetite increase.
Very insightful. Have you read Dr Jenkinson's book Why we eat (too much)
ReplyDelete