Increased physical activity was associated with less weight regain six years after “The Biggest Loser” competition

OBJECTIVE: To explore how physical activity (PA) and energy intake (EI) changes were related to weight loss and regain following the Biggest Loser competition. METHODS: At baseline, six weeks, 30 weeks, and six years after the competition we measured body composition via dual energy X-ray absorptiometry, resting energy expenditure using indirect calorimetry, and EI and PA using doubly labeled water. RESULTS: Six years after the competition, median weight loss in 14 Biggest Loser participants was 13%, with those maintaining greater weight loss (mean ± SE) of 24.9 ± 3.8% having increased PA by 160 ± 23% compared to a PA increase of 34 ± 25 % (p = 0.0033) in the weight regainers who were 1.1 ± 4.0% heavier than the pre-competition baseline. EI changes were similar between weight loss maintainers and regainers (−8.7 ± 5.6% vs −7.4± 2.7 %, respectively; p=0.83). Weight regain was inversely associated with absolute changes in PA (r= −0.82, p=0.0003) but not with changes in EI (r = −0.15, p=0.61). EI and PA changes explained 93% of the individual weight loss variability at six years. CONCLUSIONS: Consistent with previous reports, large persistent increases in physical activity may be required for long-term maintenance of lost weight.