The Biggest Losers: Extreme Obesity Poses a Challenge

(Jan. 25) -- It's not uncommon for participants on the NBC reality show "The Biggest Loser" to shed upwards of 15 pounds in a single week. But as the results of a long-term study show, even small weight reductions are a challenge for Americans struggling with extreme obesity.

Researchers heading up the two-year Louisiana Obese Subjects Study (LOSS) published their findings Monday in the Archives of Internal Medicine. In 2005, the study set out to determine whether physician-led weight-loss programs could help extremely obese individuals reach a healthy weight and maintain that loss.

A total of 391 participants, most of them women and all of them with a body mass index above 40 (a BMI under 25 is considered healthy), participated in the study. Half were offered an Internet-based healthy lifestyle guide at the Mayo Clinic's Web site, and the other half participated in a comprehensive, doctor-led diet and exercise initiative, which included counseling, a 12-week liquid diet and weight-loss medication.

Of those in the doctor-led program, 31 percent achieved a 5 percent or greater loss, and 7 percent attained a 20 percent weight loss. By comparison, those figures dropped to 9 percent and 1 percent among the participants using the online guide. Some metabolic metrics, like levels of HDL ("good") cholesterol and triglycerides, also improved among participants in the intensive program. But the positive results were short-lived: After one year, many participants started to regain weight and lost any improvement in cholesterol or insulin resistance.

Surgery is often described as the only solution to extreme obesity, which plagues 2.8 percent of men and 6.9 percent of women in the U.S. In fact, the National Institutes of Health says that "extremely obese persons often do not benefit from the more conservative treatments for weight loss and weight maintenance."

The study's authors hoped to prove that physician-led intervention could, in fact, work among the morbidly obese. In doing so, they wanted to encourage more funding for nonsurgical treatment and better training for physicians in treating extremely overweight patients. Weight-loss drugs, meal replacements and specialized counseling often aren't covered by health insurance, making them expensive deterrents to those facing dangerous weight problems.

Unfortunately, weight changes among the participants in both programs were small, and retention rates -- the number of those who stayed with the study through two years -- hovered around 50 percent. And the weight loss couldn't compare to that of bariatric surgery: One analysis of obesity surgery studies reports long-term weight loss of about 45 to 65 pounds.

That's the kind of significant weight reduction necessary to bring notable health benefits, like reduced blood pressure, healthier cholesterol, lower risk of diabetes and even longer lifespan. The impact of extreme obesity is so pronounced, according to studies, that it cuts more than a decade from life expectancy and increases individuals' medical bills by nearly $1,300 a year.