Relapse in obesity treatment: biology or behavior?

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Abstract
Despite substantial efforts directed toward obesity treatment, our long-term success rate remains poor (1, 2). Although many obese individuals can lose weight, most cannot maintain the weight loss for periods longer than a few months to a year (1, 2). A major point of controversy among obesity experts is whether the high degree of recidivism after weight loss is due to biological or behavioral factors. Some investigators conclude that weight regain is inevitable as a result of strong biological pressures to return the subject to an obese body weight (3). Others believe that the inability to maintain substantial lifestyle changes over time is the main culprit in weight regain (4). The results of the meta-analysis published by Astrup et al (5) are directly relevant to this debate. These authors suggest that a low resting metabolic rate (RMR) may contribute to weight regain in some formerly obese subjects.