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RENEE MONTAGNE, HOST:

This is MORNING EDITION, from NPR News. I'm Renee Montagne.

STEVE INSKEEP, HOST:

And I'm Steve Inskeep. Good morning.

Today in "Your Health" on this Monday, we continue NPR's "Living Large" series. We look at fat and why it's so hard to keep off. We're in the second decade of an obesity epidemic, and it's still going strong.

MONTAGNE: The reasons range from bad eating habits to a sedentary lifestyle, something we all know. Then there are genetics and biology. And it turns out, your fat cells work against you. NPR's Patti Neighmond reports.

PATTI NEIGHMOND, BYLINE: If you are among the two-thirds of Americans who are overweight, chances are you've had people tell you to just use some self-control and stop eating so much. It does boil down to calories in, calories out. But as obesity specialist Dr. Donna Ryan says, it's really much more complicated than that.

DR. DONNA RYAN: It's really when you start to try to lose that the biology really kicks in and tries to resist the weight loss.

NEIGHMOND: And that's part of what creates the frustration many of us feel gaining, losing and gaining again. For Mary Grant, who's 56 years old, trying to lose weight has been part of her life since childhood. It started when her father called her fat, told her no one would date a fat girl, and embarrassed her in front of the entire family.

MARY GRANT: On the back of the door was my weight chart, and the scale stood in the kitchen. So every Saturday morning, first thing before anything else happened, I got weighed in front of everybody.

NEIGHMOND: During teenage years, Grant's father put her on diet after diet after diet.

GRANT: I did the have-a-half-a-grapefruit-before-every-meal diet. I did the early days of Weight Watchers, when you had to eat chicken livers. I did the tomato soup diet, the cabbage soup diet - you know, anything to get that weight off of me.

NEIGHMOND: Grant never did lose weight. She entered nursing school overweight. But soon after, she did a medically supervised fasting diet and lost a dramatic 100 pounds.

GRANT: I did it the same year Oprah did it. The day she showed up on her TV show in her size 10 jeans was the day I fit into my size 10 jeans. I remember it exactly.

NEIGHMOND: Grant kept the weight off for six years. But then she started to gain again. She never got as heavy as she'd been but still, she was overweight.

RYAN: Do you think it's easy to lose weight?

UNIDENTIFIED MAN #1: Yes.

UNIDENTIFIED MAN #2: Yes.

RYAN: Oh, we got some yeses.

NEIGHMOND: Twenty overweight people sit around Dr. Donna Ryan at the Pennington Bio Medical Research Center in Baton Rouge, Louisiana. They're part of a study looking at how weight loss affects obesity-related health problems like heart disease and diabetes.

RYAN: How many of you think it's easy to keep that lost weight off?

UNIDENTIFIED MAN #3: No.

RYAN: Is there anybody who thinks it's easy to keep it off? No, it's not easy to keep it off.

NEIGHMOND: And this is the heart of the matter: It's one thing to lose weight. It's another altogether to keep it off. And Ryan says this is where the biology takes over.

RYAN: There's a hormone that's called leptin. It's produced by your fat cells. When levels of it drop, it sends signals to your brain that your fat cells are reducing, that the amount of fat in your body is reducing.

NEIGHMOND: And then other biological signals get going. The brain basically perceives having less food as starvation. So the body shifts into automatic and begins to fight back. The brain tells the body, conserve energy. Metabolism drops. And here's the worst part: Brain chemicals send messages to the body that it's hungry - really hungry.

RYAN: So there are lots of brain peptides, brain hormones that kick in, that stimulate appetite and that drive you to be more hungry and to seek more food. It's the body's biology, resisting your attempts to achieve a negative energy balance and to lose weight, that really create the problems.

NEIGHMOND: So add hormones that stimulate appetite to hormones that decrease metabolism, and you have a double whammy stacked against your efforts to lose weight. Just ask Mary Grant.

GRANT: My feeling is that my cells have memories, and when they're thin and not full of fat, they're just not happy.

NEIGHMOND: Unhappy fat cells? Well, says Dr. Ryan, that's pretty much on target.

RYAN: The reduced person has to eat fewer calories to maintain that weight as compared to a person who's exactly the same weight, but is not reduced.

NEIGHMOND: Say you weigh 230 pounds. You lose 30 pounds. You're down to 200. Your friend is also 200 pounds, and has always been 200 pounds. You have to eat less than your friend to maintain the very same weight.

DR. CYNTHIA FERRIER: Well, hi, Linda.

LINDA TEUFEL: Hi.

FERRIER: How are you doing?

TEUFEL: Well, I'm doing OK. I'm just really disappointed that I've gained weight again lately. And...

FERRIER: Oh. What do you think happened?

NEIGHMOND: At the Greenfield Health Clinic in Portland, Oregon, Dr. Cynthia Ferrier talks with her patient, 61-year-old Linda Teufel. Last year, Teufel lost 100 pounds, but now she's devastated that she's gained it back.

TEUFEL: Three hundred and twenty-five pounds, and I was down last year - last fall to 235.

NEIGHMOND: And here's the real rub: The more weight you lose, the more difficult it is to maintain the weight loss. So the biggest losers have the hardest time. For people like Linda Teufel, metabolism grinds down lower and lower as more and more pounds come off, and going to the doctor often becomes a dismal chore.

TEUFEL: Because it's just too hard for me to keep coming in and, you know, gaining. Once I start losing, I'll come in again.

(SOUNDBITE OF LAUGHTER)

NEIGHMOND: You could think of it this way, says Dr. Ryan: Overweight people have a caloric handicap. Depending on how much weight they've lost, they have to eat 300, 400 or even 500 calories less every day if they want to continue losing. And Ryan says as far as we know, it appears this lower metabolism lasts a lifetime.

FERRIER: Once you've gained the weight, you can never go back to your old habits and expect that the weight is going to stay off, because it'll go right back to where it was.

NEIGHMOND: Before you get too demoralized, the fact is, you can fight back. For starters, you have to figure out a good, healthy diet you can be on for the rest of your life. No more grapefruit or cabbage soup diets. You're unlikely to stay on those forever. You can also kick up your metabolism. You just have to do it every day.

Take the findings of this study, says Ryan, that looked at people who were successful in keeping their weight down over a number of years.

FERRIER: For the men and women in that study, their usual physical activity is about one hour of moderate physical activity, six days a week. It's expending about 450 or so calories a day.

NEIGHMOND: A bonus to help battle that lower metabolism. And the hour of physical activity doesn't have to be vigorous, like jogging. It can be moderate, like brisk walking, swimming or biking. Research now shows that even modest weight loss can make a big difference in health. In Dr. Ryan's study, the average participant lost only 5 percent of their initial weight. But their blood sugar and cholesterol went down, and many people were able to get off diabetes and blood pressure medications.

FERRIER: So this modest weight loss that they've achieved has really translated into substantial benefits.

(SOUNDBITE OF DOG BARKING)

GRANT: Is the FedEx guy coming? Oh, she does not like the FedEx guy.

NEIGHMOND: At home, Mary Grant's dogs, Coco and Bandit, help her stay active. She knows well she has to remain vigilant if she's to lose that last 20 pounds.

GRANT: And I'll do it. My husband always says, you know, you put your mind to it, you can do it. But the important thing is not to beat yourself up. We spend way too much time doing that. I weigh once a week, you know. I keep a food diary. I do all the things I know I'm supposed to do.

NEIGHMOND: And if her weight climbs, Grant knows she has to cut back what she's eating, and increase her exercise. Federal health officials recommend 30 minutes a day of moderate exercise to reduce the risk of heart disease. But you need twice that amount - an hour a day - if you want to lose, or maintain weight loss. Patti Neighmond, NPR News.

(SOUNDBITE OF MUSIC)

MONTAGNE: You're listening to MORNING EDITION, from NPR News.

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