Two news article landed in my inbox recently that aren’t directly related to each other, but ought to be. The first was about a company that’s going to start charging “unhealthy” employees more for health insurance:
Like a lot of companies, Veridian Credit Union wants its employees to be healthier. In January, the Waterloo, Iowa-company rolled out a wellness program and voluntary screenings. It also gave workers a mandate – quit smoking, curb obesity, or you’ll be paying higher healthcare costs in 2013. It doesn’t yet know by how much, but one thing’s for certain – the unhealthy will pay more.
In recent years, a growing number of companies have been encouraging workers to voluntarily improve their health to control escalating insurance costs. And while workers mostly like to see an employer offer smoking cessation classes and weight loss programs, too few are signing up or showing signs of improvement.
So now more employers are trying a different strategy – they’re replacing the carrot with a stick and raising costs for workers who can’t seem to lower their cholesterol or tackle obesity. They’re also coming down hard on smokers. For example, discount store giant Wal-Mart says that starting in 2012 it will charge tobacco users higher premiums but also offer free smoking cessation programs.
I’m sure MeMe Roth would love the idea of punishing fat people for not being born naturally skinny like she was, but I don’t like seeing smoking and obesity lumped together.
Yes, quitting smoking is notoriously difficult, but people do it all the time. Once the dangers of smoking were well-known and well-publicized, the rate of smoking in the U.S. dropped by half over the next decade or so. Both of my parents – neither known for their iron wills – quit smoking in middle age. That’s because, difficult as it was, they knew exactly what to do: stop putting cigarettes in their mouths and lighting up. (Like most people who quit, they quit cold turkey.)
You don’t quit smoking cigarettes only to find that two packs per day of Marlboro smoke is somehow finding its way into your lungs anyway. But people go on calorie-restricted diets all the time and find (much to their chagrin) that they can’t seem to lose more than a few pounds … which brings me to the second article:
For years, studies of obesity have found that soon after fat people lost weight, their metabolism slowed and they experienced hormonal changes that increased their appetites. Scientists hypothesized that these biological changes could explain why most obese dieters quickly gained back much of what they had so painfully lost.
But now a group of Australian researchers have taken those investigations a step further to see if the changes persist over a longer time frame. They recruited healthy people who were either overweight or obese and put them on a highly restricted diet that led them to lose at least 10 percent of their body weight. They then kept them on a diet to maintain that weight loss. A year later, the researchers found that the participants’ metabolism and hormone levels had not returned to the levels before the study started.
Wait, you mean losing weight isn’t just a simple matter of cutting 3500 calories from your diet to lose a pound of fat?
No, of course it isn’t. The body adjusts to try to become fatter again. Hormones drive people to accumulate body fat in the first place, and hormones drive them to regain the weight they lose. Look at what happened to the people in this study:
In the study, Joseph Proietto and his colleagues at the University of Melbourne recruited people who weighed an average of 209 pounds. At the start of the study, his team measured the participants’ hormone levels and assessed their hunger and appetites after they ate a boiled egg, toast, margarine, orange juice and crackers for breakfast. The dieters then spent 10 weeks on a very low calorie regimen of 500 to 550 calories a day intended to makes them lose 10 percent of their body weight. In fact, their weight loss averaged 14 percent, or 29 pounds. As expected, their hormone levels changed in a way that increased their appetites, and indeed they were hungrier than when they started the study.
Okay, no big deal so far, right? They were eating less than before, so we’d expect them to be hungry. But by gosh, if they’d just stick to that maintenance diet …
They were then given diets intended to maintain their weight loss. A year after the subjects had lost the weight, the researchers repeated their measurements. The subjects were gaining the weight back despite the maintenance diet — on average, gaining back half of what they had lost [emphasis mine].
That’s not character at work. It’s biochemistry. Their bodies were slowing their metabolisms in an attempt to regain the weight and reacquire a state of energy balance.
One hormone, leptin, which tells the brain how much body fat is present, fell by two-thirds immediately after the subjects lost weight. When leptin falls, appetite increases and metabolism slows. A year after the weight loss diet, leptin levels were still one-third lower than they were at the start of the study, and leptin levels increased as subjects regained their weight.
Other hormones that stimulate hunger, in particular ghrelin, whose levels increased, and peptide YY, whose levels decreased, were also changed a year later in a way that made the subjects’ appetites stronger than at the start of the study.
Your body doesn’t kick up your appetite because it wants to torture you. It kicks your appetite because it senses a fuel shortage at the cellular level.
The results show, once again, Dr. Leibel said, that losing weight “is not a neutral event,” and that it is no accident that more than 90 percent of people who lose a lot of weight gain it back. “You are putting your body into a circumstance it will resist,” he said. “You are, in a sense, more metabolically normal when you are at a higher body weight.”
Bingo. It’s like I said in my Big Fat Fiasco speech: from a biochemical standpoint, you’re as fat as you need to be. Your body defends a higher fat mass as long as it needs that fat mass to supply your cells with fatty acids for fuel. To lose weight and keep it off, you need to be able to tap your stored body fat more efficiently – and that requires a change in your hormonal balance. It’s not just a matter of cutting calories.
Months ago, I bookmarked an article on similar study that looked at the biochemical changes among former contestants on The Biggest Loser. Here’s what the researchers found:
In an abstract presented at the most recent Obesity Society Annual Scientific Assembly, Darcy Johannsen and friends reported that by week 6 participants had lost 13% of their body weight and by week 30, 39%. More interestingly they reported that by week 6 participants metabolisms had slowed by 244 more calories per day than would have been expected by their weight loss and by week 30, by 504 more calories
That’s basically a meal’s worth of calories a day that Biggest Loser contestants no longer burn as a consequence of their involvement. Effectively that means they’re eating an extra meal a day.
Is it any surprise that so many contestants from The Biggest Loser – including the season two overall winner – have gained back all the weight? All the “eat less, move more” theory did for them in practice was slow their metabolisms – again, beyond what the weight loss alone would predict.
I’m sure the companies threatening fat employees with higher insurance rates expect those employees to become motivated, eat less, and lose weight. Without understanding of what drives fat accumulation, I think it’s more likely those employees will become motivated, go on a diet, lose a few pounds, stall, regain, give up … and end up paying the higher insurance rates.
If the bigwigs at these companies knew better and truly wanted to encourage (or coerce, to be more accurate) their employees into making positive changes, they’d base their insurance premiums on their fasting glucose levels – then teach them how to bring those levels down. If I’m looking at a fat guy with normal blood sugar and a skinny guy with high blood sugar and had to bet which one will run up more in future medical expenses, I’d pick the skinny guy to cost me more every time.