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Chapter 24 — Further Reading
⚠️ A note first. Much of the popular writing on this topic is either cruel or falsely reassuring. The sources below were chosen because they are neither, and because their authors are visibly willing to state what they don't know.
⚠️ The two papers that carry the chapter
Sumithran P et al., "Long-Term Persistence of Hormonal Adaptations to Weight Loss," New England Journal of Medicine, 2011.
⚠️ This is §24.5, and it is the most important paper in the chapter. Read the hormone table and the twelve-month follow-up. It is short, it is free to find, and it is the single best answer to anyone who thinks weight regain is a character issue.
Fothergill E et al., "Persistent metabolic adaptation 6 years after 'The Biggest Loser' competition," Obesity, 2016.
⚠️ Read the methods before the result. Fourteen participants; an intervention involving very large deficits and several hours of daily exercise under competition conditions. Then read a critique — search "Biggest Loser metabolic adaptation critique generalizability" — and note that the study gets cited by people arguing dieting is futile AND by people arguing metabolic adaptation is a myth. Neither reading survives the methods section.**
On the trials that set expectations
The Diabetes Prevention Program — search "Diabetes Prevention Program lifestyle metformin outcomes." ⚠️ ~7% weight loss, ~58% reduction in progression to type 2 diabetes. Then read the DPP Outcomes Study**, the long-term follow-up, which is where the durability question is answered.
Look AHEAD — search "Look AHEAD trial cardiovascular outcomes type 2 diabetes." ⚠️ Read the primary paper AND the secondary outcome papers, because the story is genuinely two-sided and the coverage of it usually isn't.
On behavioural interventions generally: Cochrane and your national guideline body (NICE, USPSTF) both have free syntheses. ⚠️ Note the effect sizes and note how consistently they are reported as disappointing rather than as modest-but-real.
On the medications
Search the trial programmes by name: "STEP semaglutide obesity trial", "SURMOUNT tirzepatide", and ⚠️ "SELECT semaglutide cardiovascular outcomes" — the last is the one that changed the argument, because it is outcome evidence rather than weight evidence.
⚠️ Then find the discontinuation data: search "STEP 1 extension weight regain withdrawal semaglutide." This is the fact Case Study 2 is about and it is the one least often conveyed at the start of treatment.
On lean mass: search "lean mass loss GLP-1 receptor agonist body composition" and "resistance training protein during pharmacological weight loss." ⚠️ This is an active area and the practical guidance is ahead of the trial data — which is a reasonable place to be, given the downside of ignoring it.
On the wider context: ⚠️ search for coverage of compounded and grey-market GLP-1 products, which is Chapter 16 §16.2's adulteration problem in a far more dangerous setting. And on access and cost, your national formulary's position is worth reading in full rather than in summary.
On bariatric surgery
The Swedish Obese Subjects (SOS) study — search "Swedish Obese Subjects study long term outcomes." ⚠️ Decades of follow-up, which nothing else here has.
On the mechanism: search "gut hormone changes after Roux-en-Y gastric bypass GLP-1" — ⚠️ the finding that remission often precedes substantial weight loss is the one that reframes what the surgery is doing.
⚠️ On the harms, which deserve equal reading: search "micronutrient deficiency after bariatric surgery", "alcohol use disorder after gastric bypass", and "self-harm and suicide risk after bariatric surgery." These are established findings requiring long-term psychosocial and nutritional follow-up — and they are arguments for better care, not against the operation.
⚠️ On stigma
The Rudd Center for Food Policy and Health (uconnruddcenter.org) — ⚠️ free, well-sourced, and
the standard reference on weight stigma research.
On the prospective finding: search "weight discrimination subsequent weight gain prospective cohort." ⚠️ This is the result that should change clinical behaviour and largely hasn't.
On healthcare avoidance: search "weight stigma healthcare avoidance patients." ⚠️ If you are a clinician, read this one.
And read at least one first-person account, of which there are many published. ⚠️ The research tells you the effect sizes; it does not tell you what a consultation feels like from the other side, and that gap matters.
On the models, and the honest uncertainty
On set point vs settling point vs dual intervention point: search "dual intervention point model body weight Speakman" and read one exposition of each model. ⚠️ They are useful framings rather than established mechanisms, and reading all three is more informative than adopting one.
On genetics: search "heritability of BMI twin studies" and "GWAS obesity common variants." ⚠️ Then hold §24.1b's two-facts-at-once point deliberately, because almost everything written about obesity genetics is deployed to win one side of an argument.
On the energy gap: search "energy gap population weight gain" ⚠️ and read both the original calculation and the critiques of how it has been used.
Two books worth the time
Stephan Guyenet, The Hungry Brain — ⚠️ the best popular account of the appetite-regulation material in §24.5, and it is careful about what is and isn't established.
Giles Yeo, Why Calories Don't Count — ⚠️ read it as a corrective to naive calorie arithmetic, and note where it goes further than Chapter 4 would. He is a geneticist and §24.1b's material is his territory.
A note on what to be careful with
⚠️ This chapter has three failure modes and they pull in different directions.
1. ⚠️ The fatalistic one: "Most regain, so there's no point." §24.8's DPP result and §24.11's medications both refute it. Claim 4 was a defensible reading in 2015 and is not now.
2. ⚠️ The pharmacological one: "There's a drug, so the behavioural stuff is obsolete." Protein and resistance training are part of the treatment, not adjuncts (Case Study 2); the environment and the maintenance plan are what remain if the prescription stops; and access is not universal.
3. ⚠️ And the moralizing one, which this book has tried hardest to avoid: treating weight as a verdict on a person. §24.9 says that isn't merely unkind — it is associated with worse outcomes, healthcare avoidance and subsequent weight gain.
The honest position, stated once more:
⚠️ Weight loss is achievable and maintenance is genuinely hard, for measured physiological reasons. Modest loss produces disproportionate benefit in the right people. The right people are not everyone (§24.14b). And for the first time, there are interventions that act on the actual mechanism — which is progress, and which brings its own set of problems this book cannot solve.
⚠️ If you take one sentence: the difficulty is real, it has been measured, and it is not a statement about you.