The Science of Sustainable Weight Loss Past, Present, & Future · The Biggest Loser • The Biggest Loser is an eat less, exercise more reality TV show…to the extreme • Rapid

The Science of Sustainable Weight LossPast, Present, & Future

Spis Deg Fri 2-Year Book Launch AnniversaryOslo, Norway20 August 2019

Gratitude

Thank you, Irina Lee!

The Bright Line Eating Research Team:

• Jeanne Hurlbert, PhD

• Win Guan, PhD

All the Bright Lifers, Bright Liners, and

Norwegian health care professionals here

tonight ☺

More Gratitude

I. The Problem

II. The Past: Traditional Diets

III. The Present: Bright Line Eating

I. Research Findings

II. Goal Weight Gallery – Because It’s Fun ☺

IV. The Future: Where We Go from Here

Outline of Tonight’s Talk

Before We Begin

http://BrightLineEating.com/BookLaunchReferences

The Problem

We’re getting fatter

(Galka, M., 2016)

The Problem

We’re getting fatter

(Galka, M., 2016)

The Problem

Where this goes…

(Galka, M., 2016)

The Problem

So what?

• Our genes have stayed the same

• Our environment has changed

We’re Not Supposed to Be Heavy

“The real problem is not in losing the weight, but in

keeping it off for any meaningful length of time.

Numerous sources show that almost every lifestyle

intervention works for the first 3-6 months, but then

the weight comes rolling back.”

(Lustig, 2012)

But Science Says: Weight Loss is a Losing Game

12

Today’s Foods are Addictive

• 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 Toughest Drug to Quit

The Costs of Staying Heavy

Emotional issues DepressionLow self-esteem

Elevated risk for nearly all chronic diseases:• Diabetes• Cardiovascular disease• Osteoarthritis• Cancer

Musculoskeletal &Mobility problems;Pain

Poor memory and brain functioning

Alzheimer’s disease and other dementias

• The World Economic Forum estimates that by 2030 we’ll

spend $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

We Can’t Afford to Keep Going

• There is not a single peer-reviewed, scientific study showing any

intervention, surgery, or weight-loss program successfully helping

a cohort of overweight or obese people to get down to goal

weight and remain there

• Not one

• And by 2030, 50% of us will be obese

The Pickle We’re In

The Science of Sustainable Weight Loss

PAST

What’s been done about all of this so far?

Commercial Diets

Here’s a summary of what’s been shown in the scientific

literature so far:

• All diets show the same results – weight loss differences are small

to 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

Traditional Weight Loss Programs

Anything else?

1939 – 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)

12-Step Programs

Other options?

• Hugely popular – about 635,000 per year

• Types of programs

• Gastric Sleeve

• Roux-En-Y Gastric Bypass

• Reduce stomach volume and reduce digestion

• Generally prescribed when BMI > 40 or > 35

with comorbidity

• Success is defined as keeping off half the

excess weight needed to have a BMI of 25.

Bariatric Surgery

0%

10%

20%

30%

40%

50%

60%

2011 2012 2013 2014 2015

Per

cen

tage

of

Tota

l Su

rger

ies

Year

Bariatric Surgeries

RNY Band Sleeve BPD/DS Revisions Other

• Before surgery, the

average BMI is 43.9

• 5 years after surgery, the

average BMI is 32.3

• This is defined as success

✦ BMI less than 34.45

• 40% don’t even achieve

that after 5 years

Bariatric Surgery

Why so much weight regain?

The Biggest Loser

• The Biggest Loser is an eat less, exercise more reality TV

show…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 the

season

• 13/14 gained back most or all of the weight

• Not shocking, typical

• The shock was what happened to their resting metabolic rate

6 Years After “The Biggest Loser”

• The Biggest Loser contestants were burning 500 calories

per day fewer than would be expected for someone their

age, gender, and size

• 6 years later

• After they had already regained some or all of their weight

• The body remembers

But that’s not the only sustained physiological change

Hormone Where released What is does

Leptin Fat cellsacts in the hypothalamus to

reduce food intake and increase energy expenditure.

Ghrelingastrointestinal tract

and pancreasstimulates hunger

gastric inhibitory polypeptide

gastrointestinal tract and pancreas

promotes energy storage

peptide YY

gastrointestinal tract and pancreas

inhibits intake

GLP-1

cholecystokinin

pancreatic polypeptide

amylinSumithran, P., et al. (2011).

Hormonal Adaptations

Hormones affect our feelings of hunger and our desire for food

Their levels are affected by weight loss

On standard diets, after losing an average of 30 pounds, people are hungrier following meals and have a greater desire to eat than before the weight loss

This change persists at least one year after the weight loss

Hormonal Adaptations to Weight Loss

Sumithran, P., et al. (2011).

Hormonal Adaptations to Weight Loss

Why?

Hormone levels change during weight loss; a portion of that change persists even a year later

Sumithran, P., et al. (2011).

Isn’t ANYONE successful?

Established 1994 (25 years ago)

• Rena Wing, Ph.D. Brown Medical School

• James Hill, Ph.D. University of Colorado

Tracking 10,000 people who have succeeded in sustaining their weight loss

• What’s 10,000 / 108,000,000 ?

• .0000925

National Weight Control Registry

35

• 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 average

BMI is 25.1

• 38% are Overweight

• 13% are Obese

But Here’s the Thing:

36

There is no "one size fits all strategy" for successful

weight loss maintenance, but long-term weight-loss

maintenance is possible and requires sustained

behavior change

NWCR Key Takeaway

37


PRESENT

38

January 26th

2014

Birth of Bright Line Eating

39

• First online Boot Camp – October 2014

• From then until now: 22,000+ participants

• From more than 100 countries

History of BLE Boot Camps (BC)

40

• 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 Track

Other BLE Programs

41

• 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

BLE Research (Oct 2015)

Here is what we’ve learned from

the Boot Camp Research program

Boot Camp Research

Participants lose an average of

7.8% of their total weight during

the Boot Camp (an average of

15.7 pounds or 7.1 kilos)

Boot Camp Research

Boot Camp Weight Loss

0

1

2

3

4

5

6

7

8

9

10

20-29 30-39 40-49 50-59 60-69 70 and over

Wei

ght

Loss

(lb

s)

Age Group

Weight Loss (lbs) by Age Group

Boot Camp Weight Loss

0

2

4

6

8

10

Normal Overweight Class 1 Obesity Class 2 Obesity Class 3 Obesity

Pe

rce

nt

We

igh

t Lo

ss

Baseline Weight Status

-6

-4

-2

0

Normal Overweight Class 1 Obesity Class 2 Obesity Class 3 Obesity

Ch

ange

in B

MI

Baseline Weight Status

Weight Loss & Dietary Preferences

Dietary preferences before BLE compared with weight loss during the Boot Camp

0 1 2 3 4 5 6 7 8 9

Paelo

Whote Foods Plant-Based

Vegan

Vegetarian

Omnivore (fish only)

Omnivore (no red meat)

Omnivore

Weight Loss (kg)

Weight Loss (kg) by Dietary Preference

Weight Loss & Frequency of Exercise

Amount of exercise compared with weight loss during the Boot Camp

6

6.5

7

7.5

8

8.5

Sedentary Lightly Active Moderately Active Very Active

Wei

ght

Loss

(kg

)

Level of Exercise

Weight Loss (kg) by Exercise Level

Changes in Cravings, Hunger, and Distress

0

0.5

1

1.5

2

2.5

3

Week 1 Week 2 Week 3 Week 4 Week 5 Week 6 Week 7 Week 8

Leve

lsCraving, Hunger, and Distress during BLE:BC

Hunger Craving Distress

Confidence in Reaching & Maintaining Goals

54%32%

11%

3%

Extremely confident/Very confident Confident/Somewhat confident

Uncertain/Somewhat uncertain Not confident/Very uncertain

Peace & Serenity with Food

88%

5%

7%

Increased Decreased Stayed the Same

Medical Changes

22%

28%

38%

48%

12%

28%

26%

20%

22%

15%

0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50%

Heart disease

High Blood Pressure

Type I Diabetes

Type II Diabetes

Thyroid Disorder

Cancer

Anxiety or Panic Disorder

Bipolar Disorder

Depression

Sleep Apnea

Decreased or Eliminated Medications Since Starting BLE

• Began June 2016

• Open to all past Boot Campers

• Over 5,600 participants thus far

• Monthly surveys, ongoing

Follow-Up Research

1. Bright Lines matter

2. Being a Bright Lifer matters

3. “Goal weight” can be renegotiated downward

Key Takeaways

For each Bright Line:• Scale: 1=daily breaks & 4=total abstinence,

• Perfect adherence to all 4 BL would score 16

The Impact of the Bright Lines

-15

-10

-5

0

5

10

15

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24

Ch

ange

in W

eig

ht

(kg)

Months After Boot Camp

<11 11-12 13-14 15-16

Non-Bright Lifers

The Impact of Bright Lifers

-20

-15

-10

-5

0

5

10

15

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24

Ch

ange

in W

eig

ht

(kg)

Months After Boot Camp

<11 11-12 13-14 15-16

0

5

10

15

20

25

30

Post-intervention 1 Month 6 Month 12 Month 18 Month 24 Month

Percent Weight Loss by Bright Lifer Enrollment

Non-Bright Lifer Bright Lifer

-12

-10

-8

-6

-4

-2

0Post-intervention 1 Month 6 Month 12 Month 18 Month 24 Month

Change in BMI by Bright Lifer Enrollment

Non-Bright Lifer Bright Lifer

• After the Boot Camp ends, 89% of people in the follow-up research program maintain their weight loss or continue to lose

• Within one year, 32% have made it down to goal weight and many more are still losing

• Of those who get to goal weight, 84% are maintaining it

To Date

• On average, of those who still need to lose weight after the Boot Camp ends, those who choose to become Bright Lifers continue to lose, and those who don’t, stall out

• As a group, they stall out because 40% of them aren’t following the Bright Lines anymore

To Date

The Bright Line Eating Goal Weight Gallery

BLE Goal Weight Gallery

Lisa Phillips

• 4’11”

• Lost 25.1 pounds (11.4 kg)

• Weight Loss: 6 months

• Maintenance: 3 years

Susan Cook

• 5’0”

• Lost 70 pounds (32 kg)



• Off all supplements and prescriptions incl.

high cholesterol drugs of over 20 years.

“I love weighing the same I did as a high

school athlete.”


Riva Danzig

• Bronx, New York, USA

• Age 68

• 5’ 7”





Khosi Ferris

• South Africa & Thailand





Khosi Ferris

“I am so in love with my right size body. I did not

believe it was possible to organically loose weight

and reach my ideal goal weight but today I can

attest that it’s so possible…!”

“BRIGHT LINE EATING ROCKS MY WORLD!!!”


Ed Rafferty

• 6’

• Age: 70





Ed Rafferty

“In 35 years of recovery in another 12

step fellowship, I could arrest other

symptoms of my addiction, but I stayed

fat no matter what I did.”

“I am completely off all heart medication

and insulin.”


Irina Lee

• Oslo, Norway

• 5’ 7”


• Weight Loss: 200 days

• Maintenance: 40 months


Irina Lee

“[Because of BLE,] I've …decided to

change the direction of my career. I

bought the Norwegian rights for the

Bright Line Eating book …to spread this

message to a broader audience.”

“I have finally found peace. Nothing

beats the feeling of waking up with

integrity and self-worth.”


Deb Leeson

• 4’ 11”


• Maintenance: 3.5 years


Deb Leeson

“I have had health challenges in the past related

to fibromyalgia and chronic fatigue. Since

beginning BLE my energy levels have risen, my

thinking is a lot clearer and physically I am

stronger and more active.”


Sherry Balthazor

• 5’ 4”


• Weight Loss: 1 year, 11 days



Sherry Balthazor“I was so sick from depression, anemia, vitamin deficiency,

diabetes, high blood pressure, fibromyalgia, IBS, migraines,

neuropathy, osteoarthritis, osteopenia, acid reflux, chronic

pain, asthma, sleep apnea, and insomnia…and I was taking

medication for all of it.”

“Now I am only taking a small dose of blood pressure

medication and I’m about to complete wean off of it.”


Patricia Smith

• San Miguel, Mexico

• Age 66

• 5’ 3.5”



• Maintenance: 1 year


Patricia Smith“I do not use food for entertainment, for emotional

reasons, for boredom or as a reward. Food has become

nourishment for my body.”

“I am off all medications for high blood pressure,

cholesterol, and Type 2 Diabetes.”


Sandy Engbretson

• Began BLE January 2017



• Off her heart medication after 6

months

• Maintenance: 1 year


Jackie Stapleton

• Jerusalem, Israel

• Age 80

• 5’ 7”



• Maintenance: 3.5 years


Jackie Stapleton

“I love my body and feel alive and better

physically than I have in years. And I

reached goal weight before age 80.”


Tammy Palmer

• Age 59

• 5’ 3”

• Went from 330 lb to 150 lb


• Maintenance: 1 year, 5 months


Tammy Palmer“When I started Bright Line Eating, I was on two

different blood pressure medications and was having

trouble keeping my blood pressure at 140/90. I am now

off all blood pressure medication and my blood pressure

is staying around 120/78.”

“Before I was constantly thinking about food. Now I

plan my meals and don’t think about them again until

mealtime.”


Sonja Waters

• Began BLE May 2017

• Started at 315 pounds with Type 2

diabetes and high cholesterol





Valerie ConnerReleased 50 lbs (23 kg)Weight Loss: 130 daysMaintenance: 3.5 years

Julia CarolReleased 86 lbs (39 kg)Weight Loss: 8 monthsMaintenance: 3 years

Linden Morris DelrioReleased 64 lb (29 kg)Weight Loss: 6 monthsMaintenance: 4 years & 3 months


Lynda HahnReleased 114 lb (52 kg)Weight Loss: 10 monthsMaintenance: 3.5 years

Colleen EganReleased 31 lb (14 kg)Weight Loss: 5 monthsMaintenance: 4 years

Jenny HazeltonReleased 70 lb (32 kg)Weight Loss: 14 monthsMaintenance: 3 years


Beth KerrickReleased 37 lb (17 kg)Weight Loss: 7 monthsMaintenance: 15 months

Donna MontgomeryReleased 62 lb (28 kg)Weight Loss: 8 monthsMaintenance: 18 months


LynnReleased 151 lb (69 kg)Went from size 3x to 6 in one yearStarted BLE 11/19/18

Scott SteinhorstReleased 15 lb (7 kg)Weight Loss: 5 weeksMaintenance: 3.5 years

85

Tami OrenReleased 64 lb (29 kg)Weight Loss: 15 monthsMaintenance: 16 months

Willie DavisStarted Feb 2018 at 380 lbReleased 141 lb (64 kg)


Laura BurnettStarted BLE May 2017Released 140 lbs (64 kg)Went from size 22 to 2Maintenance: 6 months 86

Don DeFlavisReleased 55 lbs (25 kg) Weight Loss: 21 weeksMaintenance: 1 year

GeniLost over 100 lbs (46 kg)Weight Loss: 1 yearMaintenance: 2 years



FUTURE

87

• Continue collecting data

• Analyze, write up, and publish the data

• Collaborate with scientists, physicians, and health care professionals

• Start some new, very important projects

The Job Ahead

• Can the weight loss be sustained?

• Five years, ten years, twenty, thirty?

• What factors make some people, and not others, successful?

• Can we make the program more accessible?

• How do the brain and body change?

Questions

• Bright Line Eating data were first published in 2017.

• 1 April, 2017, “Bright Line Eating: A Novel Web-Based Weight Loss

Program.” The FASEB Journal. Vol. 31, No. 1 supplement.

• Live presentation at the Experimental Biology conference in Chicago

at the session on Energy Balance, Macronutrients, and Weight

Management.

And It’s Begun

• The first publication in a peer-reviewed scientific journal:

• The Journal of Nutrition and Weight Loss

✦ Vol 3 (2), 114-121

✦ https://www.longdom.org/open-access/evaluation-of-a-commercial-

telehealth-weight-loss-and-managementprogram.pdf

Then in 2018…

https://www.longdom.org/open-access/evaluation-of-a-commercial-telehealth-weight-loss-and-managementprogram.pdf

• Publication of two additional abstracts, with

corresponding conference presentations:

✦Bright Line Eating: An Effective, Online Program for Sustained

Weight Loss. American Society for Nutrition, Boston, MA

✦Bright Line Eating: Initial Phase Results from a Novel Telehealth

Weight Management Program. Obesity Week, Nashville, TN

Also in 2018:

• Bright Line Eating: Two-year Follow-up

Evaluation of a Commercial Telehealth Weight

Loss and Management Program

✦ In preparation

✦Estimated submission: 2019

Additional Journal Articles in Preparation:

• Huger and Craving Levels after Eliminating Sugar

✦ In preparation

✦Estimated submission early 2020

Additional Journal Articles in Preparation:

• Kathryn Lively, Ph.D., Professor and Dean

• Dartmouth College

• Identity changes in sustained weight loss

Ongoing Partnership

• 2016 – Adjunct Associate Professor of

Brain and Cognitive Sciences

• Opportunities for research partnerships

University of Rochester

Reversing Dopamine Downregulation

• Metabolic and hormonal changes accompanying achievement

and maintenance of goal weight after significant weight loss

• Leptin, ghrelin, gastric inhibitory polypeptide, peptide YY, GLP-1,

cholecystokinin, pancreatic polypeptide, amylin

• Will require collaboration with primary care physicians

Another Future Study:

• Randomized Controlled Clinical Trial

✦Recruit a large number of participants

✦Randomly assign them to control condition (wait list) versus:

➢ Bright Line Eating

➢ Weight Watchers

➢ Other…

And Finally:

The time is now.

We’re standing at the cusp of something huge.

Never before, in all of human history, has

there been a scientifically verified process by

which someone who is overweight or obese

can naturally get down into a right-sized

body and stay there.

Now there is.

• Scientific grounding

• Deep understanding of addiction

• Bright lines

• → Freedom

• Focus on being unstoppable—not necessarily perfect

• Simply Rezoom

The Missing Pieces that Make BLE Work

• Focus on habits & automaticity

• Exercise later, not now

• Abundance of whole foods, with large quantities of produce

• Soothing to brain & body

• Ongoing community & support

106

The Missing Pieces that Make BLE Work

And the journey continues.

Any questions?

Documents

The Science of Sustainable Weight Loss Past, Present, & Future · The Biggest Loser • The Biggest Loser is an eat less, exercise more reality TV show…to the extreme • Rapid