What happens after the happily-ever-after of a show’s finale? Researchers followed 14 of the original 16 The Biggest Loser Season 8 contestants for 6 years to find out, and their findings made quite a splash.

It was disappointing but hardly surprising to find that after 6 years most of these very successful dieters regained a significant amount of what they lost, and 5 of the 14 in the study were right were they started, or even above their initial pre-show weight. Nevertheless, about 60 percent of Biggest Loser contestants in the study maintained at least 10 percent of their weight loss. As dismal as this sounds, these results, published in the journal Obesity, are better than the incorrect belief that no one -- ever --achieves permanent weight loss, and better than results usually seen in other diet programs: It’s estimated that 20 percent of dieters maintain 10 percent of the weight loss a year after the diet ended.

What was unforeseen was that even after 6 years, even after the participants regained weight, their metabolic rate was significantly lower than expected – hundreds of calories lower than the caloric expenditure of people of the same size and activity level. It’s well known that the body adapts to weight loss in a way that makes weight gain really easy – the body becomes very efficient with energy, and starts doing more with less, practically needing fewer calories for its usual maintenance. That even 6 years and after losing weight, and even after weight regain this metabolic adaptation was still in action was a new, quite shocking finding.

And the metabolic rate issue is, of course, only one aspect of the fight to keep weight off after weight-loss diet. There are also psychological, hormonal and social factors that might be even more important determinants of weight regain.

The reality of weight loss and weight stigma

Overweight people face bias and discrimination every day – despite being the majority in the US and many other countries. The gigantic, ever-present weight loss industry makes it seem that weight loss is totally controllable and that it’s within each individual’s power to change. The Biggest Loser shows that with enough willpower and hard work one can reach weight loss extreme makeovers.

This kind of portrayal is not only unrealistic; it might also fuel greater negative attitudes and bias toward obese people.

Another study in Obesity examined how a 40-minute episode of The Biggest Loser affected viewers' anti-fat attitudes. Undergraduate students were randomly assigned to watch an episode of The Biggest Loser or a nature film, while being told that the purpose of the study is to test the effect of media consumption on processing speed. Watching The Biggest Loser did not improve attitudes towards obese people. It made them worse. The participants who watched The Biggest Loser reported greater dislike of obese people and greater belief that weight is controllable.

Despite the attention this recent study got, I doubt any network is proposing a reality show about the trials and tribulation of keeping lost weight off – it just doesn’t make for good TV.

And neither, I’m afraid, does the message of prevention.

Curing grave illness, last-minute rescues and extreme weight loss inspire the imagination. Preventing disease, avoiding risk and evading weight gain have no compelling visuals to attract our short attention spans.

Yet when one looks at what weight loss really looks like it is clear that the best strategy, as a society, is to avoid weight gain. We, as a society, have not changed genetically in the last 30 years. Our food has. Unless we move towards a culture that makes eating sensibly easier, many of us who want a healthy weight will have to continue to struggle with losing weight and then – forever -- with keeping it off.

It’s becoming clear that the keeping-lost-weight-off part is at least just as hard as shedding those pounds.

Dr. Ayala