I’ve been doing a lot of research into the effectiveness of Weight Loss Surgery – and in particular, the long term benefits it has to offer.  All the data I have encountered (Swedish Obesity Study, US Veterans Study) highlights the significant advantages of weight loss surgery over traditional weight loss strategies (diet, exercise, counselling, support).  It is largely this data which convinced me that the risk of not doing anything was much higher than the risk of the surgical option.

But I started to wonder what type of research there was about the long term effects of non-surgical weight loss strategies.

The Biggest Loser

The Biggest Loser was (once) a very popular reality TV program which followed the progress of severely obese contestants to see who could lose the most weight (for a significant prize).  It started out in the USA in 2004 and ran for 17 seasons over a 12 year period.  The show came to Australia in 2006 and ran for 11 seasons to 2017.

This program provides a very public glimpse into spectacular weight loss results achieved in a relatively short period, by very motivated people with lots of support, assistance and motivation.  It demonstrates that massive weight loss can certainly be achieved in the short term, but offers no indication as to the long term benefits of this type of weight loss regime… In fact when you look into it a little deeper any information about long term results is noticeable by its absence.  Apart form a few “guest appearences” from past contestants (usually from the previous season), there is next to no mention of how the rest are getting on.

In 2016, a study published in Obesity Journal examined the current situation of 14 contestants, 6 years after they appeared as contestants on The Biggest Loser.  The focus of this study was primarily to look at long term changes in their metabolic rate.

Researchers studied 14 contestants who participated in the 30-week competition, which involves intensive diet and exercise training. They started at an average weight of 149 kg and ended at an average weight of  91 kg. Six years later, when the six men and eight women went to the National Institutes of Health for follow-up measurements :

  • weight, on average, was back up to 131 kg. Only one participant hadn’t regained any weight.
  • percent body fat started at an average of 49 percent, dipped to 28 percent and returned to 45 percent over time.
All but one subject regained some of the weight lost during the competition and five subjects were within 1% of their original weight or above.  On average, the group regained much of their weight but did maintain about 12 percent weight loss even after six years, had better cholesterol profiles, and none had developed diabetes during follow-up.


While most subjects experienced substantial weight regain in the years since “The Biggest Loser” competition, the mean weight loss was 11.9% compared with their original baseline weight and 57% of the participants maintained at least 10% weight loss. In comparison :
  • 20% of overweight individuals maintain at least 10% weight loss after 1 year of a weight loss program (Wing RR, Phelan S. Long-term weight loss maintenance. Am J Clin Nutr 2005;82:222S-225S.)
  • 37% of the lifestyle intervention arm of the Diabetes Prevention Program maintained at least 7% weight loss after 3 years (Wing RR, Hamman RF, Bray GA, et al. Achieving weight and activity goals among diabetes prevention program lifestyle participants. Obes Res 2004;12:1426-1434.),
  • 27% of the intensive lifestyle intervention arm of the Look AHEAD trial maintained 10% weight loss after 8 years (Look ARG. Eight-year weight losses with an intensive lifestyle intervention: the look AHEAD study. Obesity (Silver Spring) 2014;22:5-13.).


The 2016 study found that only one of the 14 Biggest Loser contestants examined weighed less than when the competition completed, with four of them now heavier than their starting weight,  and nine returning to within 10% of their previous weights. Whereas according to the Journal of Obesity outcomes for patients undergoing gastric bypass surgery are far superior, with patients losing 60-70 per cent of excess weight after a year with approximately 50 per cent of this access weight loss maintained after 15 years.