tag:theconversation.com,2011:/ca/topics/weight-loss-surgery-10240/articlesWeight loss surgery – The Conversation2018-06-02T12:34:50Ztag:theconversation.com,2011:article/960782018-06-02T12:34:50Z2018-06-02T12:34:50ZEating disorders are hard to overcome, but ditching diets is crucial<figure><img src="https://images.theconversation.com/files/221396/original/file-20180601-142075-o802a9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Eating disorders are very hard to treat, and those who have them often severely limit their food intake. </span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/thin-girl-sitting-on-sofa-empty-367721750?src=DNymoX69upd5ZTL3kiSrpw-1-51">VGstockstudio/Shutterstock.com </a></span></figcaption></figure><p>Eating disorders affect at least 30 million Americans and have the <a href="http://www.anad.org/education-and-awareness/about-eating-disorders/eating-disorders-statistics/">highest mortality rates</a> of any mental disorder. Those who survive eating disorders often have a long, difficult journey ahead of them. </p>
<p>Eating disorders are classified as mental illnesses characterized by <a href="https://www.nimh.nih.gov/health/topics/eating-disorders/index.shtml">severe disruptions in eating behaviors</a>. In our diet-focused culture, many people may not realize that eating disorders still take a huge toll. </p>
<p>As someone who has conducted extensive research and <a href="https://www.amazon.com/Putting-Together-Puzzle-Disorder-Recovery-ebook/dp/B07C4YMNLW/ref=sr_1_1?s=books&ie=UTF8&qid=1525542298&sr=1-1&keywords=full+eating+disorder+recovery">writing</a> in the field of eating disorder recovery, and who has ongoing personal experience in eating disorder recovery, I have found that although full recovery from an eating disorder is possible, it can take time and often requires much action. There can be many causes of eating disorders, including genetics, personality, trauma, or often a combination of causes. But by the time a person gets diagnosed by a doctor or therapist, the immediate causes are less relevant than how to recover. Consistent healthy habits are helpful in the recovery process.</p>
<h2>Ditch the diet</h2>
<p>The most important action that a person can take to recover from eating disorders is to stop dieting. Weight loss dieting is the <a href="https://www.frontiersin.org/articles/10.3389/fnut.2015.00034/full">number one cause of eating disorders</a>, binge eating, body dissatisfaction and low self-esteem. In contrast, weight-neutral self-care approaches – that is, focusing on maintaining one’s current weight – have been found to assist in eating disorder recovery.</p>
<p>But ditching the diet is only the first step. It is necessary to investigate and address <a href="https://onlinelibrary.wiley.com/doi/abs/10.1002/eat.22516">factors that maintain</a> eating disorders.</p>
<h2>Let go of safety behaviors</h2>
<p>Many people in partial recovery from eating disorders still rely on behaviors that help them feel safe, or less anxious, about their weight or appearance. These so-called <a href="https://www.ncbi.nlm.nih.gov/pubmed/23080085">safety behaviors</a> can vary but might include monitoring food intake, monitoring weight, double-checking nutritional values, being very careful about food ingredients, and avoiding eating in social situations.</p>
<p>The short-term anxiety-reducing benefits of safety behaviors are part of what makes them so <a href="http://jonabram.web.unc.edu/files/2012/07/Blakey-Abramowitz-2016-Safety-Behavior-Review.pdf">hard to eliminate</a>. Unfortunately, safety behaviors create a distraction and leave the eating disorder itself unchallenged.</p>
<p>In order to stop engaging in the safety behaviors that serve to maintain eating disorders, it is important to find alternate ways of thinking and acting around food, eating, body and weight. Strategies to reach full eating disorder recovery include letting go of safety behaviors and engaging in more self-trust and self-care.</p>
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<img alt="" src="https://images.theconversation.com/files/221398/original/file-20180601-142063-1k8b6jv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/221398/original/file-20180601-142063-1k8b6jv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/221398/original/file-20180601-142063-1k8b6jv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/221398/original/file-20180601-142063-1k8b6jv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/221398/original/file-20180601-142063-1k8b6jv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/221398/original/file-20180601-142063-1k8b6jv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/221398/original/file-20180601-142063-1k8b6jv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Weighing oneself often becomes a trap for those with eating disorders.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/feet-tied-measuring-tape-weight-scale-668247181?src=DNymoX69upd5ZTL3kiSrpw-1-1">Tero Vesalainen/Shutterstock.com</a></span>
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<p>Self-weighing is a safety behavior that maintains the overvaluation of weight, which is part of the <a href="https://www.psychiatry.org/patients-families/eating-disorders/what-are-eating-disorders">American Psychiatric Association’s</a> definition of eating disorders. Continued <a href="http://europepmc.org/abstract/MED/12898556">concern with weight or shape</a> at the end of treatment has been found to be a strong predictor of relapse back into an eating disorder. A powerful strategy to reduce overvaluation of weight is to consider a personal 30-day <a href="https://www.amazon.com/Putting-Together-Puzzle-Disorder-Recovery-ebook/dp/B07C4YMNLW/ref=sr_1_1?s=books&ie=UTF8&qid=1525542298&sr=1-1&keywords=full+eating+disorder+recovery,">“no weigh”</a> experiment. </p>
<p>Other <a href="https://www.tandfonline.com/doi/abs/10.1080/00223980.2013.842141">safety behaviors</a> that aim at gaining information about one’s shape or size – such as mirror checking, pinching the fat on one’s torso, feeling muscles or bone, engaging in social size comparison, and seeking reassurance from others about one’s body – all have to be considered for elimination. Each one of these examples can be a safety behavior that serves to maintain undue concern with one’s weight and shape, and in turn, keeps the eating disorder alive.</p>
<h2>Practice self-trust</h2>
<p>Practicing self-trust around eating means giving oneself unconditional permission to eat when hungry, whatever foods are desired, in the amount desired. Research has shown that <a href="http://psycnet.apa.org/record/2006-12809-009">unconditional permission to eat</a> is the exact opposite of an eating disorder. It can be anxiety-producing to give oneself unconditional permission to eat, but it turns out that any kind of food rules, including limits on when, what and how much to eat, led research <a href="http://psycnet.apa.org/record/2006-12809-009">participants</a> to be more preoccupied with food. Food rules prompted participants to have a much higher tendency to overindulge, especially when they broke one of their food rules. On the other hand, research participants who allowed themselves to eat when hungry and to choose foods and amounts they desired had a lower tendency to overindulge or engage in binge eating. </p>
<p>Trusting one’s body to direct eating choices is one aspect of self-trust. Self-trust also extends to many other self-care practices.</p>
<h2>Engage in self-care</h2>
<p>A person’s individual relationship with their own body is the <a href="https://www.tandfonline.com/doi/abs/10.1080/10640266.2015.1118954?journalCode=uedi20.">“doorway to pathology”</a>, meaning if that relationship is not a positive one, a person is at risk of developing an eating disorder. In order to fully recover from an eating disorder, this doorway must be filled with positive self-care practices. People in recovery can learn to engage in self-care practices that do not contain any elements of self-harm. </p>
<p>Overindulgence in food contains both elements of self-care and self-harm. Self-care involves tuning in and listening to body signals and responding in helpful ways. For instance, being “tired” could elicit telling yourself to “rest a bit” or “turn off the light and go to sleep now.” The feeling of being “very uncomfortable” could signal it’s “time to change this situation,” and the feeling of being “overwhelmed” could mean it’s “time to take a break” or “time to make a list,” depending on the situation.</p>
<p>These responses are all dependent on the assumption of self-trust. One has to trust that the body does not lie. Our bodies tell us what we need to know and responding to their messages can help us to fully recover from eating disorders</p>
<h2>Take some risks</h2>
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<img alt="" src="https://images.theconversation.com/files/221400/original/file-20180601-142098-12onos1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/221400/original/file-20180601-142098-12onos1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/221400/original/file-20180601-142098-12onos1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/221400/original/file-20180601-142098-12onos1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/221400/original/file-20180601-142098-12onos1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/221400/original/file-20180601-142098-12onos1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/221400/original/file-20180601-142098-12onos1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=504&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Self-confidence and self-trust can help people who struggle with eating disorders.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/smiling-young-businesswoman-using-laptop-happy-692205346?src=hDWfySaE3aC_E1W5C2CaSA-1-25">fizkes/Shutterstock.com</a></span>
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<p>It can feel scary to let go of safety behaviors and to replace them with self-care based on self-trust. Change is inherently risky. But for positive change to occur, it is necessary to take some risks. And it is worth it, because full recovery involves more than just letting go of eating disorder and safety behaviors. It also involves feeling better about oneself.</p>
<p>Research participants who had reached full eating disorder recovery had <a href="https://guilfordjournals.com/doi/10.1521/jscp.2010.29.7.821">positive self-concepts</a>. Those who were fully recovered from eating disorders showed higher levels of self-esteem, <a href="http://positivepsychology.org.uk/self-efficacy-definition-bandura-meaning/">self-efficacy</a>, or a person’s belief in his or her ability to succeed at a task, and self-directedness than those who were not in recovery or those who were in partial recovery. Another research study showed that the more positive ways that participants were able to think about themselves, the less likely they were to drop out of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3107987/">eating disorder treatment</a>.</p>
<p>Taking risks to trust one’s body and to engage in responsive self-care are almost guaranteed to lead to an improved self-concept. Taking these risks can be anxiety-producing in the short run but worth it, to reach full eating disorder recovery.</p><img src="https://counter.theconversation.com/content/96078/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Catherine Gillespie does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>In a diet-obsessed culture, eating disorders pose a severe threat. While the reasons for the disorders are varied, a consistent approach in treatment can help people stop dieting and feel safe.Catherine Gillespie, Associate Dean, School of Education, Drake UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/884632017-12-26T14:37:01Z2017-12-26T14:37:01ZNew medical advances marking the end of a long reign for ‘diet wizards’<figure><img src="https://images.theconversation.com/files/199767/original/file-20171218-27607-p7u70a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The Wizard of Oz promised results he could not deliver but was convincing in his presentation. Diet wizards have done the same for decades. </span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/tom-margie/">Insomnia Cured Here/Flickr.com</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>For many years, the long-term success rates for those who attempt to lose excess body weight have hovered around <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4990387/">5-10 percent</a>. </p>
<p>In what other disease condition would we accept these numbers and continue on with the same approach? How does this situation sustain itself?</p>
<p>It goes on because the diet industry has generated <a href="http://www.sciencedirect.com/science/article/pii/S014067361461744X#cesec80">marketing fodder</a> that obscures scientific evidence, much as the Wizard of Oz hid the truth from Dorothy and her pals. There is a gap between what is true and what sells (remember the <a href="https://www.npr.org/sections/thesalt/2015/05/28/410313446/why-a-journalist-scammed-the-media-into-spreading-bad-chocolate-science">chocolate diet</a>?). And, what sells more often dominates the message for consumers, much as the wizard’s sound and light production succeeded in misleading the truth-seekers in the Emerald City.</p>
<p>As a result, the public is often directed to attractive, short-cut weight loss options created for the purposes of making money, while scientists and doctors document facts that are steamrolled into the shadows. </p>
<p>We are living in a special time, though – the era of <a href="https://www.nature.com/articles/nrgastro.2013.119">metabolic surgeries and bariatric procedures</a>. As a result of these weight loss procedures, doctors have a much better understanding of the biological underpinnings responsible for the failure to lose weight. These discoveries will upend the current paradigms around weight loss, as soon as we figure out how to pull back the curtain.</p>
<p>As a dual board-certified, interventional obesity medicine specialist, I have witnessed the experience of successful weight loss over and over again – clinically, as part of interventional trials and in my personal life. The road to sustained transformation is not the same in 2018 as it was in 2008, 1998 or 1970. The medical community has identified the barriers to successful weight loss, and we can now address them. </p>
<h2>The body fights back</h2>
<p>For many years, the diet and fitness industry has supplied folks with an unlimited number of different weight loss programs – seemingly a new solution every month. Most of these programs, on paper, should indeed lead to weight loss. At the same time, <a href="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(02)08397-6/abstract">the incidence of obesity continues to rise at alarming rates</a>. Why? Because people cannot do the programs. </p>
<p>First, overweight and obese patients do not have the calorie-burning capacity to exercise their way to sustainable weight loss. What’s more, the same amount of exercise for an overweight patient is <a href="https://www.nature.com/articles/0803052">much harder</a> than for those who do not have excess body weight. An obese patient simply cannot exercise enough to lose weight by burning calories.</p>
<p>Second, the body will not let us restrict calories to such a degree that long-term weight loss is realized. The body fights back with <a href="http://mannlab.psych.umn.edu/">survival-based biological responses</a>. When a person limits calories, the body slows baseline metabolism to offset the calorie restriction, because it interprets this situation as a threat to survival. If there is less to eat, we’d better conserve our fat and energy stores so we don’t die. At the same time, also in the name of survival, the body sends out surges of hunger hormones that induce food-seeking behavior – creating a real, measurable resistance to this perceived threat of starvation. </p>
<p>Third, <a href="https://www.scientificamerican.com/article/how-gut-bacteria-help-make-us-fat-and-thin/">the microbiota in our guts are different</a>, such that “a calorie is a calorie” no longer holds true. Different gut microbiota pull different amounts of calories from the same food in different people. So, when our overweight or obese colleague claims that she is sure she could eat the same amount of food as her lean counterpart, and still gain weight – we should believe her. </p>
<h2>Lots of shame, little understanding</h2>
<p>Importantly, the lean population does not feel the same overwhelming urge to eat and quit exercising as obese patients do when exposed to the same weight loss programs, because they start at a different point. </p>
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<span class="caption">French fries and chocolate milkshakes affect people differently. Some are tempted by them, and others are not.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/chocolate-ice-cream-glass-cup-whipped-346034765?src=2d7C-LrAcTRnSveGXLCSDA-2-48">Sheila Fitzgerald/Shutterstock.com</a></span>
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<p>Over time, this situation has led to stigmatizing and prejudicial fat-shaming, based on lack of knowledge. Those who fat-shame most often have never felt the biological backlash present in overweight and obese folks, and so conclude that those who are unable to follow their programs fail because of some inherent weakness or difference, a classic setup for discrimination.</p>
<p>The truth is, the people failing these weight loss attempts fail because they face a formidable entry barrier related to their disadvantaged starting point. The only way an overweight or obese person can be successful with regard to sustainable weight loss, is to directly address the biological entry barrier which has turned so many back.</p>
<h2>Removing the barrier</h2>
<p>There are three ways to minimize the barrier. The objective is to attenuate the body’s response to new calorie restriction and/or exercise, and thereby even up the starting points. </p>
<p>First, surgeries and interventional procedures work for many obese patients. They help by minimizing the biological barrier that would otherwise obstruct patients who try to lose weight. These procedures alter the hormone levels and metabolism changes that make up the entry barrier. They lead to weight loss by directly addressing and changing the biological response responsible for <a href="https://www.nature.com/articles/nrgastro.2013.119">historical failures</a>. This is critical because it allows us to dispense with the antiquated “mind over matter” approach. These are not “willpower implantation” surgeries, they are metabolic surgeries. </p>
<p>Second, medications play a role. The FDA has approved <a href="https://www.medscape.com/viewarticle/876411">five new drugs</a> that target the body’s hormonal resistance. These medications work by directly attenuating the body’s survival response. Also, stopping medications often works to minimize the weight loss barrier. Common medications like antihistamines and antidepressants are often <a href="https://academic.oup.com/jcem/article/100/2/342/2813109">significant contributors to weight gain</a>. Obesity medicine physicians can best advise you on which medications or combinations are contributing to weight gain, or inability to lose weight. </p>
<p>Third, increasing <a href="https://www.ncbi.nlm.nih.gov/books/NBK404/">exercise capacity</a>, or the maximum amount of exercise a person can sustain, works. Specifically, it changes the body so that the survival response is lessened. A person can increase capacity by attending to recovery, the time in between exercise bouts. Recovery interventions, such as food supplements and sleep, lead to increasing capacity and decreasing resistance from the body by reorganizing the biological signaling mechanisms – a process known as retrograde neuroplasticity.</p>
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<span class="caption">Strength conditioning builds muscle mass, which can help increase capacity.</span>
<span class="attribution"><a class="source" href="http://www.uconnruddcenter.org/_tools/imageViewer.cfm?id=180&c=2&r=0">Rudd Center for Food Policy and Obesity</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
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<p>Lee Kaplan, director of the Harvard Medical School’s Massachusetts Weight Center, captured this last point during a recent lecture by saying, “We need to stop thinking about the Twinkie diet and start thinking about physiology. Exercise alters food preferences toward healthy foods … and healthy muscle trains the fat to burn more calories.” </p>
<p>The bottom line is, obese and overweight patients are exceedingly unlikely to be successful with weight loss attempts that utilize mainstream diet and exercise products. These products are generated with the intent to sell, and the marketing efforts behind them are comparable to the well-known distractions generated by the Wizard of Oz. The reality is, the body fights against calorie restriction and new exercise. This resistance from the body can be lessened using medical procedures, by new medications or by increasing one’s exercise capacity to a critical point. </p>
<p>Remember, do not start or stop medications on your own. Consult with your doctor first.</p><img src="https://counter.theconversation.com/content/88463/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>David Prologo is the founder and CEO of The Catching Point, LLC (<a href="http://www.catchingpoint.com">www.catchingpoint.com</a>). </span></em></p>Dieting fads have been around for more than a century, but none of them has been shown to curb obesity long-term. The good news is that scientific evidence is revealing treatments that do work.J. David Prologo, Associate Professor, Department of Radiology and Imaging Sciences, Emory UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/650952016-11-24T20:13:31Z2016-11-24T20:13:31ZWhy so many people regain weight after dieting<figure><img src="https://images.theconversation.com/files/147281/original/image-20161124-19692-1ff4f8w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Metabolism can change after weight loss. </span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-205314421/stock-photo-close-up-of-overweight-woman-measuring-waist.html?src=O1kd_mdiOEyWzTY9_Xq8mw-1-17">Women measuring waist image via www.shutterstock.com.</a></span></figcaption></figure><p>Anyone who has tried to lose weight and keep it off knows how difficult the task can be. It seems like it should be simple: Just exercise to burn more calories and reduce your calorie intake. But <a href="http://ajcn.nutrition.org/content/74/5/579.long">many studies</a> have shown that this simple strategy doesn’t work very well for the vast majority of people. </p>
<p>A dramatic example of the challenges of maintaining weight loss comes from a recent National Institutes of Health study. The researchers followed 14 contestants who had participated in the “World’s Biggest Loser” reality show. During the 30 weeks of the show, the contestants lost an average of over 125 pounds per person. But in the six years after the show, all but one <a href="http://dx.doi.org/10.1002/oby.21538">gained back most of their lost weight</a>, despite continuing to diet and exercise.</p>
<p>Why is it so hard to lose weight and keep it off? Weight loss often leads to declines in our resting metabolic rate – how many calories we burn at rest, which makes it hard to keep the weight off. So why does weight loss make resting metabolism go down, and is there a way to maintain a normal resting metabolic rate after weight loss? As someone who studies musculo-skeletal physiology, I will try to answer these questions.</p>
<p>Activating muscles deep in the leg that help keep blood and fluid moving through our bodies is essential to maintaining resting metabolic rate when we are sitting or standing quietly. The function of these muscles, called soleus muscles, is a major research focus for us in the Clinical Science and Engineering Research Center at Binghamton University. Commonly called “secondary hearts,” these muscles pump blood back to our heart, allowing us to maintain our normal rate of metabolic activity during sedentary activities.</p>
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<img alt="" src="https://images.theconversation.com/files/146439/original/image-20161117-18142-ardzey.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/146439/original/image-20161117-18142-ardzey.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/146439/original/image-20161117-18142-ardzey.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/146439/original/image-20161117-18142-ardzey.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/146439/original/image-20161117-18142-ardzey.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/146439/original/image-20161117-18142-ardzey.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/146439/original/image-20161117-18142-ardzey.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Why is it hard to maintain weight loss?</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-95021029/stock-photo-analog-weight-scale-isolated.html?src=QF-v5dT4HLNLZWITlXHL0w-1-8">Weight scale image via www.shutterstock.com.</a></span>
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<h2>Resting metabolism and weight maintenance</h2>
<p>Resting metabolic rate (RMR) refers to all of the biochemical activity going on in your body when you are not physically active. It is this metabolic activity that keeps you alive and breathing, and very importantly, warm.</p>
<p>Quiet sitting at room temperature is the standard RMR reference point; this is referred to as one metabolic equivalent, or MET. A slow walk is about two MET, bicycling four MET, and jogging seven MET. While we need to move around a bit to complete the tasks of daily living, in modern life we tend not to move very much. Thus, for most people, <a href="http://www.vox.com/2016/4/28/11518804/weight-loss-exercise-myth-burn-calories">80 percent</a> of the calories we expend each day are due to RMR. </p>
<p>When you lose weight, your RMR should fall a small amount, as you are losing some muscle tissue. But when most of the weight loss is fat, we would expect to see only a small drop in RMR, as fat is not metabolically very active. What is surprising is that relatively large <a href="http://ajcn.nutrition.org/content/97/5/990.long">drops in RMR</a> are quite common among individuals who lose body fat through diet or exercise.</p>
<p>The “World’s Biggest Loser” contestants, for example, experienced a drop in their <a href="http://dx.doi.org/10.1002/oby.21538">resting metabolic rate of almost 30 percent</a> even though 80 percent of their weight loss was due to fat loss. A simple calculation shows that making up for such a large drop in RMR would require almost two hours a day of brisk walking, seven days a week, on top of a person’s normal daily activities. Most people cannot fit this activity level into their lifestyle.</p>
<p>There’s no question that eating a balanced diet and regular exercise are good for you, but from a weight management perspective, increasing your resting metabolic rate may be the more effective strategy for losing weight and maintaining that lost weight. </p>
<h2>The connection between RMR and your heart</h2>
<p>Metabolic activity is dependent on oxygen delivery to the tissues of the body. This occurs through blood flow. As a result, cardiac output is a primary determinant of metabolic activity.</p>
<p>The adult body contains about four to five liters of blood, and all of this blood should circulate throughout the body every minute or so. However, the amount of blood the heart can pump out with each beat is dependent on how much blood is returned to the heart between beats.</p>
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<img alt="" src="https://images.theconversation.com/files/146438/original/image-20161117-18128-mpa757.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/146438/original/image-20161117-18128-mpa757.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/146438/original/image-20161117-18128-mpa757.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/146438/original/image-20161117-18128-mpa757.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/146438/original/image-20161117-18128-mpa757.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/146438/original/image-20161117-18128-mpa757.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/146438/original/image-20161117-18128-mpa757.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Cardiac output controls resting metabolic rate.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-163113980/stock-vector-human-heart-vector-illustration.html?src=jJvpa7IeSOBvFYliMZbtaA-1-3">Human heart image via www.shutterstock.com.</a></span>
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<p>If the “plumbing” of our body, our veins in particular, was made of rigid pipes, and the skin of our legs was tough like that of bird legs, cardiac outflow would always equal cardiac inflow, but this is not the case. The veins in our body are are quite flexible and can expand many times their resting size, and our soft skin also allows lower body volume expansion.</p>
<p>As a result, when we are sitting quietly, blood and interstitial fluid (the fluid which surrounds all the cells in our body) pools in the lower parts of the body. This pooling significantly reduces the amount of fluid returning to the heart, and correspondingly, reduces how much fluid the heart can pump out during each contraction. This reduces cardiac output, which dictates a reduced RMR.</p>
<p>Our research has shown that for typical middle-aged women, cardiac output will drop about <a href="http://ajpregu.physiology.org/content/288/3/R623.long">20 percent when sitting quietly</a>. For individuals who have recently lost weight, the fluid pooling situation can be greater because their skin is now much looser, providing <a href="https://www.ncbi.nlm.nih.gov/pubmed/6467809">much more space for fluids to pool</a>. This is especially the case for people experiencing rapid weight loss, as their skin has not had time to contract.</p>
<h2>Raising metabolic activity</h2>
<p>For young, healthy individuals, this pooling of fluid when sitting is limited because specialized muscles in the calves of the legs – the soleus muscles – pump blood and interstitial fluid back up to heart. This is why soleus muscles are often referred to as our “secondary hearts.” However, our modern, sedentary lifestyles mean that our secondary hearts tend to weaken, which permits excessive fluid pooling into the lower body. This situation is now commonly referred to as <a href="http://www.mayoclinic.org/healthy-lifestyle/adult-health/expert-answers/sitting/faq-20058005">“sitting disease.”</a> </p>
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<img alt="" src="https://images.theconversation.com/files/146435/original/image-20161117-18123-158scnu.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/146435/original/image-20161117-18123-158scnu.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=1929&fit=crop&dpr=1 600w, https://images.theconversation.com/files/146435/original/image-20161117-18123-158scnu.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=1929&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/146435/original/image-20161117-18123-158scnu.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=1929&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/146435/original/image-20161117-18123-158scnu.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=2424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/146435/original/image-20161117-18123-158scnu.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=2424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/146435/original/image-20161117-18123-158scnu.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=2424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The soleus muscles keep blood from pooling in the legs.</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File%3AGray438.png">Henry Vandyke Carter, via Wikimedia Commons</a></span>
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</figure>
<p>Moreover, excessive fluid pooling can create a vicious cycle. Fluid pooling reduces RMR, and reduced RMR means less body heat generation, which results in a further drop in body temperature; people with low RMR often have persistently cold hands and feet. As metabolic activity is strongly dependent on tissue temperature, RMR will therefore fall even more. Just <a href="https://books.google.com/books?id=BN2PJSajgSIC&pg=PA150#v=onepage&q&f=fals">a 1 degree Fahrenheit</a> drop in body temperature can produce a <a href="https://en.wikipedia.org/wiki/Abnormal_basal_metabolic_rate">7 percent drop in RMR</a>. </p>
<p>One logical, though expensive, approach to reduce fluid pooling after weight loss would be to undergo cosmetic surgery to remove excess skin to eliminate the fluid pooling space created by the weight loss. Indeed, a recent <a href="http://www.sciencedirect.com/science/article/pii/S1748681516302133">study</a> has confirmed that people who had body contouring surgery after losing large amounts of weight due to gastric banding surgery had better long-term control of their body mass index than people who did not have body contouring surgery.</p>
<h2>What can you do?</h2>
<p>A much more convenient approach to maintaining RMR during and after weight loss is to train up your secondary hearts, or soleus muscles. The soleus muscles are deep postural muscles and so require training of long duration and low intensity. </p>
<p>Tai chi, for instance, is an effective approach to accomplish <a href="http://link.springer.com/article/10.1007%2Fs00421-011-2182-y">this</a>. However, we’ve observed that many people find the exercises onerous. </p>
<p>Over the last several years, investigators in the Clinical Science and Engineering Research Lab at Binghamton University have worked to develop a more practical approach for retraining the soleus muscles. We have created a device, which is now commercially available through a <a href="http://www.sonostics.com/">university spin-off company</a>, that uses a specific mechanical vibration to activate receptors on the sole of the foot, which in turn makes the soleus muscles undergo a reflex contraction.</p>
<p>In a <a href="https://dx.doi.org/10.1097/01.HCR.0000320067.58599.ac">study</a> of 54 women between the ages of 18 and 65 years, we found that 24 had secondary heart insufficiency leading to excessive fluid pooling in the legs, and for those women, soleus muscle stimulation led to a reversal of this fluid pooling. The ability to prevent or reverse fluid pooling, allowing individuals to maintain cardiac output, should, in theory, help these individuals maintain RMR while performing sedentary activities. </p>
<p>This premise has been confirmed, in part, by recent studies undertaken by our spin-off venture. These unpublished studies show that by reversing fluid pooling, cardiac output can be raised back to <a href="http://www.sonostics.com/energy-issues/">normal levels</a>. Study results also indicate that by raising cardiac output back to normal resting levels, RMR returns to normal levels while individuals are sitting quietly. While these data are preliminary, a larger clinical trial is currently underway.</p><img src="https://counter.theconversation.com/content/65095/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kenneth McLeod is an inventor of the secondary heart stimulation technology, he owns shares in, and consults for, Sonostics, Inc. which has licensed this technology for commercial development.</span></em></p>Weight loss often leads to declines in our resting metabolic rate – how many calories we burn at rest – which makes it hard to keep the weight off. So why does weight loss make resting metabolism go down?Kenneth McLeod, Entrepreneur in Residence & Director - Clinical Science and Engineering Research Laboratory, Binghamton University, State University of New YorkLicensed as Creative Commons – attribution, no derivatives.