Michael Hebranko suffered from primary obesity caused by overeating. He is listed in the Guinness World Records, not because he reached a weight of 500 kg (in 1999), but because of his record weight loss, which took him from 411 kg to 90 kg in 19 months, a reduction of approximately 320 kg.
Hebranko’s record is even greater, although perhaps this particular record does not belong to him. Over the course of his life, he lost more than two tons through dieting, specifically 2,250 kg.
At the time of his record weight loss, Hebranko became a star in the diet industry. He gave lectures about his experience and promoted the method he had followed with his personal trainer. He also became a diet advocate, that is, a volunteer who works to guide and support obese people who intend to lose weight. Within seven years, he gradually went from the 90 kg he had reached back up to 453 kg, a high-risk condition that forced him to undergo treatment and hospitalization. His weight fell to just over 200 kg, only to gradually rise again to 250 kg in 2012. He died in 2013.
Hebranko is an example of the way the treatment of obesity and food addiction is currently conceived—and misconceived—that is, the phenomenon that leads to excessive food intake beyond the body’s ability to dispose of it, as a result of an alteration in the instinct to eat, despite awareness of the consequences, the desire to change one’s physical appearance, and even awareness of the possibility of succeeding.
Hebranko reached his maximum weight, in fact, during relapse, after his record weight loss. His various episodes of weight loss therefore did not lead, even in the absence of complete control, to an “intermediate” or compromise weight. In other words, through the various diets, his weight did not settle at somewhat lower levels; quite the opposite.
The weight loss occurred over 19 months, and therefore relatively rapidly (16 kg per month), whereas the subsequent increase in weight up to 453 kg occurred much more slowly (over seven years, or just over 4 kg per month). Control over relapse, even when relapse occurs gradually, is therefore ultimately poorer: the regain of weight is slow, but this does not make it easier to stop.
The obese person retains the ability to lose weight, even at a rapid rate, but does not regain the ability to prevent weight regain. This naturally becomes apparent over the years: for a certain period, the result obtained can be enjoyed, but not permanently. What is worse is that, over time, the ability to maintain the weight achieved through weight loss becomes weaker, and the ability to lose weight also declines, because of growing discouragement and awareness of the relative long-term futility of losing weight. Yet one of the characteristics of food addiction is precisely the continual search for weight-loss solutions, and looking in that direction for a solution.
His ability to lose weight, remarkable enough to earn him a Guinness record in 1990, remained considerable (more than 200 kg even around 2000, although less than before). His minimum weight, however, increased, including the minimum weight reached after subsequent weight-loss attempts. At the same time, his maximum weight increased, from 411 kg at the time of his record weight loss to 499 kg in 1999. He ultimately died at an intermediate weight of 250 kg, only slightly above the weight reached after his last intensive weight-loss attempt.
As with all addictions, the mistake lies in giving priority to the beginning of treatment and to the immediacy of a result, focusing on the “toxic” effect (in this case excess weight), rather than studying and verifying the possibility of reaching a new equilibrium—that is, spontaneous weight loss that can nevertheless be maintained over the long term.
A “maintenance diet” is in reality an idealized phase that is poorly compatible with the nature of the disorder, because the obese brain does not function in the same way and therefore experiences stronger and more urgent appetites, against which the brain is unable to deploy any particular counteracting function.
The brain is indeed predisposed to acquire food and extract calories from food; it is not predisposed to suppress appetite or prevent the absorption of the calories that have been consumed.
Today, important surgical solutions are available for the treatment of obesity. These can produce partial or complete weight loss and, in any case, establish a new equilibrium at different weight levels. The current limitation is that these procedures are indicated above a certain weight threshold, but at very high weights they may become inadvisable because the operative risk is unacceptable.
The best results are therefore obtained in younger obese patients, who are unfortunately often engaged in weight-loss attempts in which they invest hopes, expectations, and self-esteem. All of this can receive surprisingly powerful reinforcement from an immediate result, only to be dismantled during and after relapse.
It is important that these people be guided toward an understanding of the mechanisms underlying their disorder. At present, there are several surgical and medical treatments available, although the latter are more useful for improving certain metabolic parameters than for maintaining weight at much lower, that is, normal, levels.
The risk of progressing to obesity should also be assessed in young people who begin to develop problems with anorexia and bulimia, or in those who undertake diets in order to remain thin or become thinner for aesthetic reasons. It has been demonstrated that dieting today is associated with a lower weight tomorrow and a higher weight the day after tomorrow, compared with people who have not dieted.
Over time, therefore, dieting undertaken for psychological rather than medical reasons can worsen the relationship with food, with oneself in relation to food and weight, and often the ability to control weight itself. Those who move toward the bulimic side tend to follow a yo-yo pattern with progressive weight gain; those who move toward weight control may develop anorexia, anorexia-bulimia, or other similar conditions in which weight is maintained at the cost of toxic and risky behaviors involving deprivation, medication abuse, and psychological distress.