In the music video, Taylor confronts her "nightmare scenarios and intrusive thoughts" in the form of sheeted ghosts and her glitzy alter-ego, who judges her every move. During a scene in the bathroom, the alter-ego disapprovingly shakes her head while Taylor weighs herself on a scale that reads "Fat.

While most people were turned off by the scene, others sympathized with Taylor, who has previously addressed her struggles with an eating disorder.

Another chimed in with another viewpoint regarding the mental impacts of eating disorders, writing, "It isn't bad to be fat, and her having the scale say 'fat' is a radical simplification of eating disorders, especially when fat people have EDs too.

TW: ED One criticism of Taylor Swift's music video is that you don't need to be fatphobic in your description of your body image. It isn't bad to be fat, and her having the scale say "fat" is a radical simplification of eating disorders, especially when fat people have EDs too.

Once the short clip was removed from the video, people had mixed reactions. Some praised the Grammy-winning singer and shared that the scene still got her point across.

As one fan put it, "This version does it without harming fat folk in the process. That would be an entirely different conversation. She removed a brief clip that many found hurtful.

IMO, the message remains. Others criticized Taylor, who has yet to publicly acknowledge the scene and the harm it may have caused. Taylor removed the image in the video on one single platform, but she's yet to address it verbally OR address the fact that millions of fans have [and] are still attacking fat people in her name," another person wrote.

In her documentary, Miss Americana , Taylor spoke about her personal experience with her body image as a public figure. A picture of me where I feel like I looked like my tummy was too big, or someone said that I looked pregnant At the time of this report, the scene is still included in the music video uploaded to Taylor Swift's YouTube channel and has yet to be removed or publicly addressed by the singer.

If you or a loved one are struggling, please contact the National Eating Disorders Hotline at or visit online.

How to Defrost Meat Safely and Quickly. The Best Pillows for Every Type of Sleeper. Shanahan faced a decision never before made in Super Bowl history, thanks to the new playoff overtime rules, and he proceeded to defer an advantage three possessions into the future against Patrick Mahomes.

What worked? What didn't? We're sizing up all the ads from the Super Bowl, right here. Recent advancements in technologies and metabolomics have helped our understanding of the mechanistic pathways and metabolites that are mediators of an increase in BMI and weight gain.

However, only five drug therapies have been approved for obesity treatment thus far. Presently, glucagon-like peptide-1 GLP-1 analogs are used as monotherapy, unimolecular agonists for gastric inhibitory peptide receptor GIP , GLP-1 receptor, or glucagon receptor are used to induce weight loss.

Furthermore, leptin analogs, ghrelin antagonists, amylin mimetics and melanocortin-4 receptor MC4R , and neuropeptide Y NPY antagonists that suppress appetite have demonstrated success in preclinical and clinical trials.

Recently blood metabolic signatures of adiposity associated with lifestyle factors have been identified. Hence, drug design and repurposing of drugs for weight management have taken a faster pace. The drugs used in the weight loss regime, such as selective inhibitors of pancreatic lipase, stimulators of noradrenaline release leading to the suppression of appetite m, combination drugs to enhance satiety by increasing energy expenditure, thus reducing food intake, have shown an overall success in weight management.

Metabolic pathways that play a significant role in weight regain or the maintenance of the lost weight can be divided into intrinsic and extrinsic factors.

Extrinsic factors span the lifestyle and psychosocial parameters, while intrinsic factors focus on energy balance and functional resistance to weight loss. Both the processes are interconnected through complex metabolic networks.

Accordingly, weight loss in individuals with high baseline fat mass progresses to steady maintenance of the lost weight. High-fat concentrations lead to loss of fat weight without stress to the adipocytes or reduction of fat-free mass.

Continued weight loss management requires effective regimes spanning both intrinsic and extrinsic factors, i. The final goal is to prevent weight regain by maintaining minimum cellular stress and accumulation of fat.

The primary weight gain and weight regain are different metabolic processes. Hence, preventing weight recidivism requires controlling a set of metabolic indices different from those targeted during initial weight loss.

Sustaining weight loss underlies diverse homeostatic metabolic adaptations through the modulation of energy expenditure that improves metabolic efficiency. However, it leads to an increase in the signals for energy intake. The percentage of body fat lost during calorie restriction negatively correlates with the rate of weight regain, which depends on the baseline BMR.

Thus, higher initial BMR is usually helpful in successful weight maintenance after weight loss. Fat-free mass is highly involved in energy expenditure by physical activity. Hence, to increase the possibility of weight maintenance after weight loss, diets rich in protein and low glycemic index are advised together with physical activity.

Compared to a low-fat diet, a low glycemic index diet has a more pronounced effect in reducing hunger, minimizing postprandial insulin secretion, and maintaining insulin sensitivity. Other major regulators of weight maintenance after weight loss are metabolic hormones that modulate the feelings of hunger and satiety, such as leptin, insulin, ghrelin, etc.

This drop in the plasma leptin concentration creates a leptin deficiency signal in the brain that subsequently induces a high energy intake response.

An experimental observation indicated that injection of leptin in such individuals during the weight maintenance period was associated with a reversal of the deficiency symptoms in the brain areas dedicated to energy intake regulation.

Thus, there exists a direct link between leptin and the weight loss process. Leptin concentration changes over time throughout the weight loss regime and subsequently maintaining a healthy weight.

Besides leptin, reduction in the concentration of thyroid hormones, triiodothyronine T3 , and thyroxine T4 also substantiate weight loss. Notably, thyroid hormones are directly correlated to the leptin concentration throughout weight loss and maintenance.

Similarly, a higher baseline concentration of ghrelin hormone is also associated with improved weight loss. In addition, alteration in plasma ghrelin concentration is related to increased satiety. Finally, the hypothalamic-pituitary-thyroid axis seems to be the central modulator for weight maintenance through the influence of leptin as well as other regulatory metabolic hormones.

Other metabolic hormones, namely, peptide YY PYY , gastric inhibitory peptide, GLP1, amylin, pancreatic polypeptide, and cholecystokinin CCK , are sporadically shown to regulate hunger and satiety signals.

The plasma concentration of metabolites reflects the physiological activities of tissues and cells. Plasma concentration of some metabolites is observed to vary over time during and after the weight loss and maintenance process, indicating metabolic adaptation response.

After weight loss, the generation of negative energy balance alters the plasma concentration of metabolites, which is re-established when energy balance takes a new homeostatic position. Hence, the plasma metabolites concentration may reflect metabolic mechanisms that resist weight modulation.

Metabolite concentrations are modulated depending upon the amount of weight lost. However, the return effect of the plasma concentration of metabolites such as angiotensin I-converting enzyme ACE , insulin, and leptin to a threshold level are shown to reflect a possible weight regain.

The correlation of plasma leptin, baseline BMI, and initial fat mass with a risk for weight regain points to an active role of the adipocytes. After losing fat, adipocytes experience cellular stress.

The cells become smaller in size upon fat loss affecting the structure-function axis of adipocytes. The resultant change affirms sufficient fat supply to the adipose tissue. Adipocyte-based energy demands increase high-calorie intake and establish a risk of weight regain. Adipocytes regulated energy requirement also correlates with a drop in leptin concentrations.

Subsequently, many studies have supported that fast initial weight loss results in a more significant amount of lost weight but induces cellular stress and higher reversal.

However, a gradual initial weight loss substantiates metabolic adaptability of adipocytes and a greater prospect for long-term weight maintenance. Weight loss regimes usually depend on dietary modulations and calorie restrictions, exercise, and sometimes drug intervention or surgery.

However, it is concerning that most people are unable to maintain the lost weight, and many regain a significant part of the lost weight. Notably, there are individual differences observed in weight maintenance.

There is no standard effective regime developed thus far, and individual differences are observed in the manifestation of such regimes, and in some patients, it may not be successful.

These differences in the positive outcome of weight loss management programs may be due to lifestyle choices, eating habits, and individual metabolic variations, besides not complying with the healthy diet.

Weight lost through calorie restrictions poses a risk of bone mobilization or bone loss. A combination of calorie restriction and exercise does not necessarily prevent or attenuate bone loss. It requires a controlled weight-loss program design to pinpoint mechanisms adapted to support the quality and density of bone sites susceptible to bone loss.

Hence, besides the clinical regime of weight loss from the point when it is initiated to achieving a healthy weight, management of lost weight also requires clinical support. Weight loss through pharmacological and surgical interventions is becoming more appealing. Besides improving an individual's health and emotional status, they effectively reduce the risk factors for metabolic diseases.

Nonetheless, they are associated with significant age-specific side effects. Surgical interventions such as sleeve gastrectomy usually lead to swift weight loss but are accompanied by changes in hormones, bone density, and gastrointestinal problems. Weight regain after weight loss is also a frequent problem encountered in obesity.

This tendency is often due to the lack of compliance to exercise or dietary regimes. However, in many cases, it occurs due to physiological mechanisms and not due to high-calorie intake or lack of exercise.

Gut hormone secretions may lead to a reduced secretion of anorectic hormones and an enhanced orexigenic hormone affecting metabolic adaptation. This imbalance causes weight to be regained after weight loss has taken place. The BMI-induced metabolic shift may also lead to the weight regain process.

Hence, it concerns that many central metabolic and peripheral food craving, hunger sensation, and enjoyment of eating mechanisms can cause regain of weight. Maintaining weight loss after following a specific regime such as calorie restriction, exercise, drug treatment, or surgical intervention always requires a careful assessment at the individual level.

This should be followed by meticulous customization of weight management regimes to achieve a potent, sustained and healthy body weight. Metabolism plays a major role in the maintenance of a healthy weight after weight loss. Besides calorie restriction, exercise is a significant metabolism booster.

Exercise helps build lean muscle mass and increases the metabolic rate to utilize more energy in maintaining it.

Many health conditions are related to metabolic derangements. Specific illnesses such as insulin resistance, thyroid problems, etc. Some medications such as steroids, blood pressure reducers, antidepressants also induce slowing down of metabolism and hence pose risks of weight gain and regain after a healthy weight loss has been achieved.

From a clinical standpoint, metabolic derangements due to genetic predispositions, lifestyle, behavior, and medication or illness may prevent the maintenance of a healthy weight. Hence, regulation and maintenance of healthy metabolism are imperative to overcome unhealthy weight conditions such as obesity and other associated comorbidities.

Additionally, it leads to an overall reduction of fat and an increase in healthy muscle mass. Weight loss management is clinically recommended to prevent weight regain and affirm normal blood pressure, healthy triglycerides, and cholesterol levels, or reduce the risk for metabolic diseases.

Besides a general health index, maintaining a healthy weight has far-reaching benefits. Healthy weight loss reduction causes a general sense of well-being, more energy, reduction in stress levels and better sleep, improved immunity, better mental health, balanced hormones, and an overall enhancement in the quality of social life.

Unhealthy weight gain generally occurs through inducing and driving factors that perturb the metabolism, which may vary among individuals. Hence, the practitioners must recognize and evaluate the underlying causes and prescribe a regime for weight loss directed towards the specific causing and contributing factors to obtain desirable results.

Furthermore, weight recidivism is observed at a high rate and thus requires a customized regime spanning metabolic effectors to maintain lost weight.

This will involve a concerted effort from multidisciplinary staff such as physicians, nutritionists, exercise physiologists, and trainers to recognize the potential causes and target their treatment strategies accordingly. Besides, weight reduction and regeneration of healthy metabolism also depend on lifestyle, including healthy behavioral practices and eating habits.

Thorough counseling of patients will warrant better patient outcomes. Weight management becomes more complex when it is a therapeutic pathway for health conditions such as type2 diabetes, cardiovascular diseases, liver or kidney diseases, etc.

The outcomes of such therapeutic intervention may depend on a carefully directed approach that prevents adverse side effects.

However, to improve therapeutic outcomes, prompt consultation involving an interprofessional group of specialists is recommended. A nutritionist designs a diet regime in consultation with the physicians to understand the patient's metabolic level and identify comorbidities.

This requires the involvement of an interprofessional team that includes physicians, nutritionists, and laboratory technologists. Once the physician and laboratory technologist help diagnose the comorbidity or metabolic causes, nutritionists can help devise an effective calorie restriction regime for weight management.

Routine moderate to intense physical activities are effective in preventing weight regain. For a successful weight maintenance program, well-directed physical training is recommended.

However, it depends on personal behavior, dedication, and an effective exercise plan. Initially, this was only considered a domain for physical trainers; however, it is realized that only exercise could not lead to healthy outcomes. Thus it is crucial to obtain assistance from experts from other fields.

Hence to derive a good outcome, a physician must incorporate assistance from specialists, pharmacists, lab technologists, and nurses to achieve a better outcome from drug therapy when dietary regimes or physical training has not been successful.

This also requires complete information about the dietary and exercise regimes to be obtained by the physician. Hence, an interdisciplinary approach is helpful to achieve successful and sustained therapeutic results. Bariatric or metabolic surgical interventions are a procedure for treating excessive weight gain and for individuals with weight regain.

These operations are also carried out to treat diabetes, high blood pressure, sleep apnea, and high cholesterol. These operations modify the stomach and intestines to treat obesity and comorbid conditions.

The operation is intended to constrict the stomach size in addition to bypassing a stretch of the intestine. This changes food intake and absorption of food resulting in less hunger and a feeling of fullness.

Surgical intervention poses a risk factor for the patients; hence assistance for interdisciplinary teams constituting surgeons, nurses, pharmacists are mandatory for assessment, post-operative patient care, monitoring, and follow-up.

Furthermore, better outcomes can be enhanced by counseling and informing the patients about the goals and objectives of the bariatric surgery a priori. All these surgical procedures are usually aggressive, and hence reversal is not easy. Reversal may usually result in complications and risks.

After a sleeve gastrectomy, the procedure can never be reversed. Excessive and unhealthy weight gain generally progresses through inducing and driving factors that perturb the metabolism and vary among individuals.

Long-term management of overweight conditions and maintenance of lost weight requires ongoing clinical attention. A weight management regime follows a sequential metabolic adaptation towards establishing sustained homeostasis.

An interprofessional staff involving physicians, surgeons, nurses, pharmacists, nutritionists, exercise physiologists, and trainers who can determine the underlying causes and devise regimes can provide a holistic and integrated approach towards weight maintenance.

The basic indices that define metabolic derangements as key culprits for weight regain must be evaluated before determining a therapeutic regime. Hence, the essential role of diagnostic laboratory professionals cannot be undermined. A collaborative effort in decision making and patient counseling are key elements for a good outcome in weight management to prevent recidivism.

The interprofessional care of the patient must follow integrated care management combined with an evidence-based method to planning and evaluating all activities. A thorough understanding of signs and symptoms can lead to implementing a more successful regime and better outcomes.

Disclosure: Aisha Farhana declares no relevant financial relationships with ineligible companies. Disclosure: Anis Rehman declares no relevant financial relationships with ineligible companies.

This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4. You are not required to obtain permission to distribute this article, provided that you credit the author and journal.

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Search term. Metabolic Consequences of Weight Reduction Aisha Farhana ; Anis Rehman. Author Information and Affiliations Authors Aisha Farhana 1 ; Anis Rehman 2.

Affiliations 1 College of Applied Medical Sciences, Jouf University. Continuing Education Activity Obesity and overweight are considered significant health problems and have become a global challenge due to their high prevalence in almost all countries.

Introduction Metabolism is a dedicated network of enzyme and metabolite-derived mechanisms that is a hallmark of life activities. Function Metabolism is a group of processes through which food is converted into energy to help maintain bodily function. BMI below Issues of Concern Weight loss regimes usually depend on dietary modulations and calorie restrictions, exercise, and sometimes drug intervention or surgery.

Clinical Significance Metabolism plays a major role in the maintenance of a healthy weight after weight loss. Enhancing Healthcare Team Outcomes Weight Loss and Metabolic Consequences Unhealthy weight gain generally occurs through inducing and driving factors that perturb the metabolism, which may vary among individuals.

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