Comment Re:Pills Won't Stop Your Sin (Score 1) 181
The overlapping physiological changes that occur with weight loss help explain the near-ubiquitous weight loss time course: early rapid weight loss that stalls after several months, followed by progressive weight regain32. Different interventions result in varying degrees of weight loss and regain, but the overall time courses are similar. As people progressively lose more and more weight, they fight an increasing battle against the biological responses that oppose further weight loss.
Appetite changes likely play a more important role than slowing metabolism in explaining the weight loss plateau since the feedback circuit controlling long-term calorie intake has greater overall strength than the feedback circuit controlling calorie expenditure. Specifically, it has been estimated that for each kilogram of lost weight, calorie expenditure decreases by about 20–30 kcal/d whereas appetite increases by about 100 kcal/d above the baseline level prior to weight loss31. Despite these predictable physiologic phenomena, the typical response of the patient is to blame themselves as lazy or lacking in willpower, sentiments that are often reinforced by healthcare providers, as in the example of Robert, above.
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