Battle of the bulge tougher than ever imagined

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“The Biggest Loser” is an NBC TV reality show in which people compete to lose the most weight.

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The more we understand, the less we judge.

Alcoholics once were “alkies.” Homeless people were “bums.” Overweight people were “fatties.”

But the more society learns about the complex medical, biological and social factors behind such scourges as alcoholism, drug abuse, mental illness and obesity, the more compassionate we grow in our responses — and the more effective our cures become.

A powerful example of the ability of science to question old notions of character weakness can be found in a study published this week in the medical journal Obesity. The study, which tracked former contestants on the TV reality show “The Biggest Loser,” offers strong evidence that, yes, losing weight is hard to do, but keeping it off might be harder still — and not for lack of trying.

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All but one of 14 contestants from Season 8 of the TV show gained back most or all of their lost weight in the following six years, the study found, typically despite determined efforts to keep it off through diet and exercise. Several of the former contestants got even heavier.

When people lose a lot of weight, their metabolism slows dramatically, meaning they burn calories more slowly and — here’s the surprising part — that slow metabolism doesn’t necessarily pick up steam again. As one contestant explained to the New York Times, which reported on the study Monday, this would explain why all his friends can drink beer without gaining weight, but if he drinks a beer “there goes another 20 pounds.”

Adding to the problem, levels of the hormone leptin plummeted as the reality show’s contestants dropped weight, which was expected, but returned to only half of normal levels in the years that followed, which was not expected. Leptin controls hunger. A person who has a low level of leptin feels a constant urge to eat.

When we lose weight and try to keep it off, our body fights back hard.

All this suggests a couple of things: Obesity, a condition with which a third of all Americans struggle, should be viewed and treated as a disease, not a personal failing. And the cure is more complicated than a reality show prescription of crash dieting and extreme exercising.

“Keeping weight off requires education, knowledge and the right tools to combat all the aspects that lead to weight gain and therefore to weight loss,” Dr. Bipan Chand, head of the multidisciplinary weight loss program at Loyola University Medical Center, told us. “There is no one right solution for all individuals.”

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