Counting calories. Reducing meal portions. Joining a gym. Eating small meals and lots of little snacks. Eliminating carbs, or sugar, or both. Starting a running regimen.
We vow to adopt new habits like these, especially around this time of year, in an effort to slim down. The truth is, most of us need it — 66 percent of adults, or 155 million Americans, are overweight or obese, according to the National Institutes of Health. Worldwide, the number of people considered overweight reached 1.9 billion in 2016, according to the World Health Organization.
And so, in an effort to stop ourselves from gaining weight, we vow to eat better and exercise more. Sometimes this is, ostensibly, for our health — extra weight has been linked to a number of health problems, including heart disease, Type 2 diabetes, increased risk of cancer or stroke, and overall increased mortality. For others, a diet might just be a way to look good. In any case, weight loss has become a $66 billion industry in the United States alone.
But most of us, to our dismay and frustration, fail to keep the pounds off. While 45 million Americans go on a diet each year, research has shown that 80 percent of people who do manage to lose weight regain it — usually at a rate of about 2 to 4 pounds per year.
Fortunately, scientists are on the case. Over the last few decades, researchers have worked to answer fundamental questions about human biology to understand why it’s difficult for people to lose weight, and why some people gain the weight back even when they’re diligently sticking to their diet and exercise program.
Last year, the NIH dedicated $931 million to weight loss research, which has already improved our understanding of the multiple facets that influence individual outcomes. As a result of this research, scientists have gained a bit of extra wisdom First, it’s not always your fault if you can’t lose weight. Second, despite some tech-heavy, and somewhat invasive, weight loss solutions, nothing can quite replace diet and exercise.
The Basics of Fat
From an evolutionary perspective, fat isn’t such a bad thing. It helps keep us warm, protects our internal organs, and stores unused energy from the food we eat in reserves that our body can drawn upon later.
In 2018, though, many of us have access to ample food sources that give us energy. And we don’t need to forage or hunt most of the day to get it. The result is an epidemic of obesity unprecedented in the history of humanity.
Most of us understand the basic idea behind gaining and losing weight. If we consistently eat more calories than we use, we gain weight. Eat fewer, and we lose it. However, what’s actually happening inside our bodies when we gain weight is more complex than it may seem. Yes, adipose tissue — the technical name for fat — stores energy and provides insulation. But it also stores a number of other things we may ingest (intentionally or otherwise) as we go about living: everything from vitamins to environmental pollutants. Fat also plays a key role in regulating hormones in the body, such as estrogen and insulin.
We’re born with more or less the same number of fat cells that we’re going to have for life. So when we gain or lose weight, it’s the size of the cells that changes depending on how much excess energy from the food we eat they need to accommodate.
Most recently, researchers learned that fat cells are not all created equal. While the fat cells (“white fat”) we usually think of as building up around our hips and bellies are good at storing energy, so-called brown fat cells are much better at keeping us warm. It’s long been known to be present in chubby babies and is important to their survival (as they aren’t yet strong enough to yank the blankets up if they get cold in the night). Then, in 2009, researchers at the National Institute of Diabetes and Digestive and Kidney Diseases discovered that adults also have brown fat. And that it’s a good fat to have.
One of the buzzwords related to weight loss is metabolism, which refers to the rate at which our body “burns” the energy we get from the food we eat, and which our body will store in fat cells if it’s not used. A person’s metabolic rate is influenced by a number of factors, such as age, sex, weight, and activity level. As such, one's metabolic rate is not necessarily the same throughout their life.
All this said, there’s nothing inherently bad about fat — in fact, we can’t survive without it. But we also can’t survive with too much of it. The same is true for other creatures, though their bodies work a bit differently than ours. Mice, according to one study, have an “internal scale” that quells hunger cues when they get heavy. Humans have no such instinct, at least, not that we know of. Other animals, like shrews, adjust their entire body size — organs and skeleton and all — as their weight fluctuates in response to seasonal changes.
Until we as a species find ourselves able to make changes like these, we’ll have to find other ways to hack our bodies to keep our weight in check But given the quirks of our biology that keep the weight on, this might be easier said than done.
The tried-and-true way to lose weight — good old diet and exercise — is, as most people can tell you, not much fun. It’s difficult to stick with, and progress is slow. So researchers have come up with a number of interventions that can speed up the process, or generate the same results with less effort.
Some techniques hijack the body’s natural mechanisms to get it to lose weight. People who are overweight may blame a slow metabolism, the rate at which the body uses the energy from food. But it’s really our muscles that burn those calories. What if they could do so more efficiently? Researchers found that, when injected with a compound called morpholino, mice’s muscles burned more energy without working harder, according to a 2015 study.
Other methods find ways to alter our relationship to hunger: either biochemically, by halting those signals from the brain, or addressing the more emotionally-charged experience of our discomfort associated with hunger. Researchers have found that people often give up on diets because that they struggle to quiet the feeling of hunger. But hunger, we’re realizing, isn’t just a biological signal that our bodies need nutrients — humans eat for emotional reasons and for social reasons. All of this makes it harder to lose weight.
Perhaps drugs could quell our hunger. Last fall, a California-based pharma company called Amgen created an injection intended to do just that. The drug contains a protein called GDF5, bolstered with antibodies so the body wouldn’t break it down too quickly to be effective. In experiments, researchers found that monkeys that received the injection ate less, lost weight, and were less likely to develop Type 2 diabetes. The drug had not yet been tested in humans, however, who could experience side effects that may make the drug unappealing (if it works at all).
Amgen’s offering is the most recent in a long line of drugs developed over the past decade. To date, the others didn’t stand up to the scrutiny of clinical trials. Axokine was one such drug; it failed its first clinical trial when two-thirds of the patients developed antibodies to it, meaning it stopped working. Another, called Rimonabant, made it to market in Europe only to be quickly pulled from the shelves when patients began experiencing major psychiatric side effects such as depression and mood changes (it was never approved in the U.S.).
Other methods have proven effective, but with a significant caveat: They are much more invasive. Gastric bypass, which surgically reduces the size of the stomach or shortens the intestinal tract, has been around for more than thirty years. While it’s often successful, it’s still a major surgery and comes with risks, such as infection or blood clots.
So researchers have sought to create devices that are as effective as a bypass but are less invasive and come with less risk. In 2015, the FDA approved the first “anti-obesity” electronic implant, which blocks signals along the vagus nerve — the way our stomachs tell our brains we’re hungry.
Another device, called AspireAssist — essentially allowed patients to empty some of their stomach contents after a meal. The FDA approved the device in 2016, but it was met with controversy. The most widespread criticism was that such a device was more or less physician-approved bulimia. Its manufacturers clarified that the device was equipped with a safety mechanism that prevented it from being used more than three times a day for a six-week period.
One of the biggest challenges is, in truth, facing the emotional challenges weight loss presents. It is a journey fraught with frustration, trial and error, small successes, and feelings of monumental failure. The weight loss industry tends to entice folks who are looking for quick and easy fixes. In extremes, the diet and exercise regimens they tout often do lead to weight loss — often rapidly. While that may, at first, be reinforcement to keep someone motivated, what nutritionists know, and pharmaceutical executives perhaps do not care to acknowledged, is that keeping weight off requires more than dropping one kind of food. It requires a lifestyle change, often one that people are reluctant to make even if they know it would improve their health.
“If there would be something — the next great invention — [it would be something] that would keep people really engaged,” Becca Krukowski, an associate professor of preventive medicine at the University of Tennessee Health Science Center, told Futurism. “What I see so far is that there's some sort of personal component, that nonspecific something, that keeps people going.”
Data — on people’s activity, on what they eat — might do just that. Wearables like Fitbits or apps like Apple Health are still not available to everyone, but they are increasingly ubiquitous. But because this data is often tracked passively, it doesn’t always engage people (and produce the results they crave) as some might hope.
People seem to need emotional support above all else. Krukowski notes that, even when people track their data, what they really want is to have others to talk to about it. The internet, then, might be one of the best weight loss tools out there, if it’s used to connect people, help them access information, and build networks of support.
The Future of Weight Loss Comes In All Sizes
In an era in which everything is personalized and customizable, in which we seem on the cusp of altering treatment to match a person’s individual genome, it seems unlikely that the people of the future will lose weight with a one-size-fits-all approach. There’s no one diet, one exercise program, one device, or one surgery that will work for everyone. Often, those who succeed long-term have tried many techniques and strategies, and the one that eventually helps them keep the weight off might change over time.
It seems far more likely that a more individualized approach will be truly transformative for those seeking to lose weight.
For now, it seems, nothing can beat diet and exercise in terms of efficacy and safety. But technology could game-ify the process of losing weight, make it more appealing and less like drudgery. “In terms of technology, the big thing that I would love to see is ways to make it more fun,” Krukowski said. “I feel like if we could get, somehow, either through the process in these programs or help people recognize the changes they would enjoy in themselves, that this would be an easier, more fun, more sustainable process.”
Directing people’s attention to the changes they’re making in their lives could help them stay motivated and engaged. But it could have a happy side effect, for which we all have a renewed hunger: joy.