How to Really Win at Being the Biggest Loser

As if losing weight weren't already daunting enough, recent research finding Season 8 contestants on " The Biggest Loser" reality show regained much of what they lost demonstrated just how hard it is to maintain.

"On average they gained 90 pounds ... back," says Kevin Hall, senior author of the National Institutes of Health study and a senior investigator at the National Institute of Diabetes and Digestive and Kidney Diseases, part of the NIH. The 14 contestants studied had lost 130 pounds, on average, six years prior. "They lost a huge amount of weight in the competition [and] they regained a substantial amount," Hall says.

Though some regained nearly all of the weight lost or more, the contestants studied lost and kept off, on average, about 12 percent, a clinically significant amount of weight. "Which is actually quite a bit better than you find with a lot of other lifestyle interventions. So there is some positive news here," Hall noted. That's the sunshine, anyhow, on the shade the study threw on the sometimes motivating and frequently dramatic weight loss featured on the popular TV show. The findings also reflect the seemingly extreme difficulty many obese individuals face -- whether on view for America to watch or living in obscurity -- to keep off pounds shed. "I think weight maintenance after weight loss is probably a bigger accomplishment than the weight loss itself," says Dr. Reed Berger-Fleishman, a bariatric doctor and physician nutrition specialist -- a doctor with training in nutrition -- at the Chicago-based University of Illinois Hospital & Health Sciences System.

[See: Debunking 5 Common Weight-Loss Myths.]

Hall notes study subjects saw a higher degree of metabolic rate slowing than anticipated in response to lifestyle changes, meaning they were burning even fewer calories than researchers expected. "In other words, the harder that you work to basically keep your weight below where it used to be, you will experience a proportional, but incomplete, pullback of the body. So it's sort of like a spring," he says. "The harder you tug on the spring, the greater it stretches out -- which is analogous to the weight loss -- but you're also experiencing a greater pullback."

Then -- boing -- you've ballooned back to your former weight -- or higher.

However, that needn't necessarily happen. "Biggest Loser" contestants studied varied widely in the weight they lost and regained; one lost even more weight post-competition, while some regained it all and more. Hall says the physiologic challenge mounted by the body is not your destiny. "You can fight it," he says. "You can change your weight permanently over a long period of time."

But, experts say, you need a plan.

Take a two-phase approach. The NIH developed a tool called the Body Weight Planner that people can use to negotiate both phases of weight loss: dropping pounds and keeping them off. Those using the tool plan for losing weight over a specific time period, and then what they have to do permanently to maintain it over time, Hall says. He adds that the online tool, which allows a person to make personalized calorie and physical activity plans to get down to a goal weight and stay there, should be used with the help of a physician or dietitian to target a goal weight and maintain that.

[See: 15 Best Weight-Loss Diets at a Glance.]

Consider intermittent fasting -- or not. In a recent interview on the "Today" show about the NIH study's findings, "Biggest Loser" host and personal trainer Bob Harper suggested intermittent fasting as a possible strategy to keep off weight lost. This approach might, for example, involve skipping dinner and fasting until breakfast a few times weekly, though definitions for intermittent fasting vary widely. Some studies have shown it's an effective way to reduce overall calorie intake and bolster health. However, research hasn't yet been done to prove this approach works for keeping off pounds, notes Stephen Anton, chief of the clinical research division at the Department of Aging and Geriatric Research at the University of Florida in Gainesville, an expert in intermittent fasting. "I can see the potential for it to work, but at this point in time there have not been any clinical trials to test the actual implementation of this in overweight individuals who have lost weight," he says.

Heed the winning ways of big losers who maintained. Check out the National Weight Control Registry, an investigation of long-term successful weight-loss management, to learn about what's worked for others to keep pounds off. That includes regularly weighing oneself as well as routinely recording food intake and exercising at a pretty high level -- approximately an hour a day of moderate intensity exercise. "If you look at just the people who are succeeding at this hard-to-reach goal [of maintaining significant weight loss], those are three of the key strategies that they're engaging in," Anton notes.

Don't neglect the mental health component. Research shows depression can both contribute to obesity and be a complication of it. That's in addition to the more obvious role some eating disorders, like binge-eating disorder, can play in weight gain. So if you're a new you on the outside, but your psyche is still weighed down, that could make it much more difficult to keep pounds off. Seek treatment for mental health issues to support permanent lifestyle changes.

Determine if surgery is a viable option. For some severely obese individuals, bariatric surgery may be the best approach to shed hazardous weight and move toward a new life at a smaller size. This is one approach that's known to be successful for some seeking to lose significant weight to keep it off over the long term, Hall says. In comparing bariatric patients with "Biggest Loser" contestants, it was found that the metabolism of bariatric patients studied eventually normalized after they literally had weight cut, such that they weren't having to continue working harder to burn calories, he says. Whereas, "Biggest Loser" contestants had a persistent slowing of metabolism, he says, six years after the competition and despite weight regain. Berger-Fleishman emphasizes that to keep from regaining weight, bariatric patients must still sustain permanent lifestyle changes, such as eating properly -- and less than they were -- and exercising regularly.

[See: 8 Weird Ways Obesity Makes You Sick.]

Forget "all or nothing." You're going to fail. You ate too much over a holiday -- or yesterday. You haven't exercised much of late. Lapses happen, and experts say it's OK to enjoy an occasional indulgence and then reset. "I see a lot of patients that do really well, and then they let one thing get them off track," Berger-Fleishman says. Instead of ill-advised attempts to say you'll never eat a particular food again or that you'll exercise every day without fail, she recommends easing into sustainable changes -- so that ultimately you can win at losing and keep the weight off for a lifetime.

Michael Schroeder is a health editor at U.S. News. You can follow him on Twitter or email him at mschroeder@usnews.com.