The Science Of Sustainable Weight Loss Past, Present, & Future

The Science ofSustainable Weight LossPast, Present, & FutureSpis Deg Fri2-Year Book Launch AnniversaryOslo, Norway20 August 2019

GratitudeThank you, Irina Lee!

More GratitudeThe Bright Line Eating Research Team: Jeanne Hurlbert, PhD Win Guan, PhDAll the Bright Lifers, Bright Liners, andNorwegian health care professionals heretonight

Outline of Tonight’s TalkI. The ProblemII. The Past: Traditional DietsIII. The Present: Bright Line EatingI.Research FindingsII.Goal Weight Gallery – Because It’s Fun IV. The Future: Where We Go from Here

Before We ces

The Problem

The ProblemWe’re gettingfatter(Galka, M., 2016)

The ProblemWe’re gettingfatter(Galka, M., 2016)

The ProblemWhere this goes (Galka, M., 2016)

So what?

We’re Not Supposedto Be Heavy Our genes have stayed the same Our environment has changed

But Science Says:Weight Loss is a Losing Game“The real problem is not in losing the weight, but inkeeping it off for any meaningful length of time.Numerous sources show that almost every lifestyleintervention works for the first 3-6 months, but thenthe weight comes rolling back.”(Lustig, 2012)

Today’s Foods are Addictive12

The Toughest Drug to Quit You need to eat 80% of the calories in the supermarket have added sugar The cues are everywhere Very strong social pressure Eating is synonymous with fun, celebration, recreation, leisure, and comfort It’s not an addiction that society takes seriously yet

The Costs of Staying HeavyEmotional issuesDepressionLow self-esteemElevated risk fornearly all chronicdiseases: DiabetesCardiovascular diseaseOsteoarthritisCancerMusculoskeletal &Mobility problems;PainPoor memory andbrain functioningAlzheimer’s diseaseand other dementias

We Can’t Afford to Keep Going The World Economic Forum estimates that by 2030 we’llspend 47 trillion on illnesses linked to obesity We can’t afford it personally, either An obese man spends 6,518 extra per year An obese woman spends 8,365 extra per year

The Pickle We’re In There is not a single peer-reviewed, scientific study showing anyintervention, surgery, or weight-loss program successfully helpinga cohort of overweight or obese people to get down to goalweight and remain there Not one And by 2030, 50% of us will be obese

The Science ofSustainable Weight LossPAST

What’s been done aboutall of this so far?

Commercial Diets

Traditional Weight Loss ProgramsHere’s a summary of what’s been shown in the scientificliterature so far: All diets show the same results – weight loss differences are smallto non-existent The diet that “works” is any diet that a patient will stick with Weight loss takes place in the first 6 months From 6-12 months plateau, then regain

Anything else?

12-Step Programs1939 – Alcoholics Anonymous (AA)1960 – Overeaters Anonymous (OA) Food Addicts Anonymous (FAA) (1987) Anorexics and Bulimics Anonymous (ABA) (1993) Compulsive Eaters Anonymous-HOW (CEA-HOW) (1996) Food Addicts in Recovery Anonymous (FA) (1998) Eating Disorders Anonymous (EDA) (2000) GreySheeters Anonymous (GSA) Recovery From Food Addiction, Inc. (RFA) Food Compulsions Anonymous (FCA)

Other options?

Bariatric SurgeryBariatric Surgeries60% Hugely popular – about 635,000 per yearTypes of programs Gastric Sleeve Roux-En-Y Gastric Bypass Reduce stomach volume and reduce digestion Generally prescribed when BMI 40 or 35with comorbidity 50%40%Percentage of Total Surgeries 30%20%10%Success is defined as keeping off half theexcess weight needed to have a BMI of onsOther2015

Bariatric Surgery Before surgery, theaverage BMI is 43.9 5 years after surgery, theaverage BMI is 32.3 This is defined as success BMI less than 34.4540% don’t even achievethat after 5 years

Why so muchweight regain?

The Biggest Loser The Biggest Loser is an eat less, exercise more reality TVshow to the extreme Rapid Weight Loss (330 to 200 lbs in five months)A recent article garnered huge attention by publishing a“where are they now?” piece, 6 years after the end of theseason 13/14 gained back most or all of the weight Not shocking, typicalThe shock was what happened to their resting metabolic rate

6 Years After “The Biggest Loser” The Biggest Loser contestants were burning 500 caloriesper day fewer than would be expected for someone theirage, gender, and size 6 years later After they had already regained some or all of their weight The body remembers

But that’s not theonly sustainedphysiologicalchange

Hormonal AdaptationsHormoneHormones affect ourfeelings of hunger andour desire for foodTheir levels are affectedby weight lossWhere releasedWhat is doesLeptinFat cellsacts in the hypothalamus toreduce food intake and increaseenergy expenditure.Ghrelingastrointestinal tractand pancreasstimulates hungergastric inhibitorypolypeptidegastrointestinal tractand pancreaspromotes energy storagegastrointestinal tractand pancreasinhibits intakepeptide an, P., et al. (2011).amylin

Hormonal Adaptations to Weight LossOn standard diets, after losing an average of30 pounds, people are hungrier followingmeals and have a greater desire to eat thanbefore the weight lossThis change persists at least one year afterthe weight lossSumithran, P., et al. (2011).

Hormonal Adaptations to Weight LossWhy?Hormone levelschange during weightloss; a portion of thatchange persists evena year laterSumithran, P., et al. (2011).

Isn’t ANYONEsuccessful?

National Weight Control RegistryEstablished 1994 (25 years ago) Rena Wing, Ph.D. Brown Medical School James Hill, Ph.D. University of ColoradoTracking 10,000 people who have succeeded in sustaining their weight loss What’s 10,000 / 108,000,000 ? .000092535

But Here’s the Thing: To Register Lose at least 30 pounds (13.6 kg) Keep it off for at least one year Studies of the NWCR population (2012—2016) show averageBMI is 25.1 38% are Overweight13% are Obese36

NWCR Key TakeawayThere is no "one size fits all strategy" for successfulweight loss maintenance, but long-term weight-lossmaintenance is possible and requires sustainedbehavior change37

The Science ofSustainable Weight LossPRESENT38

Birth of Bright Line Eatingth26January201439

History of BLE Boot Camps (BC) First online Boot Camp – October 2014 From then until now: 22,000 participants From more than 100 countries40

Other BLE Programs Bright Lifers – 5,000 Active Members 14 Day Challenge – 52,000 Participants Bright Line Mind – Positive Psychology Bright Line Freedom – Parts Work Reboot Rezoom – Getting Back on Track41

BLE Research(Oct 2015) 72% fill out at least 1 survey Surveys track: Demographics & personal stats Weekly weight & daily Bright Lines Habits & tool usage Changes in cravings, hunger, and medications Celebrations & struggles Attitudes & effort

Boot Camp ResearchHere is what we’ve learned fromthe Boot Camp Research program

Boot Camp ResearchParticipants lose an average of7.8% of their total weight duringthe Boot Camp (an average of15.7 pounds or 7.1 kilos)

Boot Camp Weight LossWeight Loss (lbs) by Age Group1098Weight Loss (lbs)7654321020-2930-3940-4950-59Age Group60-6970 and over

Boot Camp Weight LossNormalOverweightClass 1 Obesity Class 2 Obesity Class 3 Obesity10Percent Weight LossChange in BMI0-2-486420Normal-6OverweightClass 1 Obesity Class 2 Obesity Class 3 ObesityBaseline Weight StatusBaseline Weight Status

Weight Loss & Dietary PreferencesWeight Loss (kg) by Dietary PreferenceDietarypreferencesbefore BLEcompared withweight loss duringthe Boot CampOmnivoreOmnivore (no red meat)Omnivore (fish only)VegetarianVeganWhote Foods Plant-BasedPaelo012345Weight Loss (kg)6789

Weight Loss & Frequency of ExerciseWeight Loss (kg) by Exercise Level8.58Weight Loss (kg)Amount ofexercisecompared withweight lossduring the BootCamp7.576.56SedentaryLightly ActiveModerately ActiveLevel of ExerciseVery Active

Changes in Cravings, Hunger, and DistressCraving, Hunger, and Distress during BLE:BC32.5Levels21.510.50Week 1Week 2Week 3Week 4Week 5Hunger Craving DistressWeek 6Week 7Week 8

Confidence in Reaching & Maintaining Goals3%11%54%32%Extremely confident/Very confidentConfident/Somewhat confidentUncertain/Somewhat uncertainNot confident/Very uncertain

Peace & Serenity with Food7%5%88%IncreasedDecreasedStayed the Same

Medical ChangesDecreased or Eliminated Medications Since Starting BLESleep Apnea15%Depression22%Bipolar Disorder20%Anxiety or Panic Disorder26%Cancer28%Thyroid Disorder12%Type II Diabetes48%Type I Diabetes38%High Blood Pressure28%Heart disease22%0%5%10%15%20%25%30%35%40%45%50%

Follow-Up Research Began June 2016 Open to all past Boot Campers Over 5,600 participants thus far Monthly surveys, ongoing

Key Takeaways1. Bright Lines matter2. Being a Bright Lifer matters3. “Goal weight” can be renegotiated downward

The Impact of the Bright Lines15For each Bright Line: Scale: 1 daily breaks & 4 total abstinence,Perfect adherence to all 4 BL would score 16Change in Weight (kg)1050-5-10-1512345678 11910 11 12 13 14 15 16 17 18 19 20 21 22 23 24Months After Boot Camp11-1213-1415-16

The Impact of Bright Lifers15Non-Bright Lifers10Change in Weight (kg)50-5-10-15-20123456789 111011 12 13 14 15Months After Boot Camp11-1213-1415-16161718192021222324

Change in BMI by Bright Lifer EnrollmentPost-intervention1 Month6 Month12 Month018 MonthPercent Weight Loss by Bright Lifer Enrollment24 n-Bright LiferBright Lifer1 Month6 Month12 MonthNon-Bright LiferBright Lifer18 Month24 Month

To Date After the Boot Camp ends, 89% of people in thefollow-up research program maintain their weightloss or continue to lose Within one year, 32% have made it down to goalweight and many more are still losing Of those who get to goal weight, 84% aremaintaining it

To Date On average, of those who still need to loseweight after the Boot Camp ends, those whochoose to become Bright Lifers continue to lose,and those who don’t, stall out As a group, they stall out because 40% of themaren’t following the Bright Lines anymore

The Bright Line EatingGoal Weight Gallery

BLE Goal Weight GalleryLisa Phillips 4’11” Lost 25.1 pounds (11.4 kg) Weight Loss: 6 months Maintenance: 3 years

BLE Goal Weight GallerySusan Cook 5’0” Lost 70 pounds (32 kg) Weight Loss: 10 months Maintenance: 3 years Off all supplements and prescriptions incl.high cholesterol drugs of over 20 years.“I love weighing the same I did as a highschool athlete.”

BLE Goal Weight GalleryRiva Danzig Bronx, New York, USA Age 68 5’ 7” Lost 65 pounds (30 kg) Weight Loss: 6 months Maintenance: 3 years

BLE Goal Weight GalleryKhosi Ferris South Africa & Thailand Lost 20 pounds (9 kg) Weight Loss: 7 months Maintenance: 3 years

BLE Goal Weight GalleryKhosi Ferris“I am so in love with my right size body. I did notbelieve it was possible to organically loose weightand reach my ideal goal weight but today I canattest that it’s so possible !”“BRIGHT LINE EATING ROCKS MY WORLD!!!”

BLE Goal Weight GalleryEd Rafferty 6’ Age: 70 Lost 36 pounds (16 kg) Weight Loss: 6 months Maintenance: 2 years

BLE Goal Weight GalleryEd Rafferty“In 35 years of recovery in another 12step fellowship, I could arrest othersymptoms of my addiction, but I stayedfat no matter what I did.”“I am completely off all heart medicationand insulin.”

BLE Goal Weight GalleryIrina Lee Oslo, Norway 5’ 7” Lost 40 pounds (18 kg) Weight Loss: 200 days Maintenance: 40 months

BLE Goal Weight GalleryIrina Lee“[Because of BLE,] I've decided tochange the direction of my career. Ibought the Norwegian rights for theBright Line Eating book to spread thismessage to a broader audience.”“I have finally found peace. Nothingbeats the feeling of waking up withintegrity and self-worth.”

BLE Goal Weight GalleryDeb Leeson 4’ 11” Lost 50 pounds (23 kg) Maintenance: 3.5 years

BLE Goal Weight GalleryDeb Leeson“I have had health challenges in the past relatedto fibromyalgia and chronic fatigue. Sincebeginning BLE my energy levels have risen, mythinking is a lot clearer and physically I amstronger and more active.”