By Alexandra Sifferlin

Biggest Loser winner Rachel Frederickson shocked audiences Tuesday when she revealed she had dropped 155 pounds, nearly 60% of her starting weight. Earlier this week a Saudi man also made headlines for losing an astronomical 700 pounds, shedding 50% of his original weight. With the success of shows like The Biggest Loser, Extreme Makeover, and My 600-lb Life, extreme weight loss has become somewhat of a gawking pastime among American audiences. But while audiences can witness these people’s external changes in appearance, what’s happening internally when a body shrinks to half its size?

Obesity is typically measured by body mass index (BMI), with a BMI of 30 and above considered obese, and BMI of 40 and above considered severely obese. For people with a BMI above 40 to reach a healthier weight and actually maintain it, weight-loss surgery is usually the only option. For a 5’10? man, that’s about 280 pounds, and for 5’5? woman, approximately 240 pounds.

Once the pounds start shedding, people’s perception of their own size remains skewed while they internalize their new bodies. As they adjust, they continue to make a lot of space for themselves, like selecting large spaces to sit. ”Internally, people still think they are large. They swing their arms further out from their body like a helicopter, thinking their hips are still as wide as they used to be, even though they aren’t,” says Dr. Roxanne Sukol, a preventive medicine specialist at Cleveland Clinic.

The first 25 to 30 pounds are the easiest to drop, and usually accompanied by immediate improvements in blood pressure, blood sugar, and breathing. It becomes harder to lose the pounds after that initial period, but with each additional pound lost, physicians notice improvements in virtually every organ system.

However, if an individual’s weight has caused significant health problems, like heart issues or diabetes, such problems don’t go away so easily. Even when a person recovers, ailments developed along the way can remain. “We see blood pressure and sugar improve rapidly, but if your obesity caused you to have a dilated heart, that might take longer to heal–if it ever heals,” Dr. Sukol says. Excess skin can also remain after weight is dropped, but it usually adapts to the body after a period of time.

Physical therapy is nearly always needed to continue the healing process. If an individual has not been mobile for years, their muscle and skeletal systems are likely damaged. Our knees and lower extremities aren’t meant to hold the amount of weight severely obese individuals carry, and that weight can interfere with blood flow to the heart, which is one of the reasons obese people experience bloating. The good news, according to Dr. Sukol, is that, with every five pounds lost, an enormous amount of pressure on the knee caps is relieved.

Appetite can also change. When individuals replace foods like white breads and potato chips with intact carbohydrates like beans, vegetables, fruits, and whole grains, they tend to lose weight and feel more satiated from eating more nutritious food.

Lastly, the mental health effects that come from significant weight loss are immeasurable. From a biological level, neurotransmitters in the brain work better when a person is on a healthy diet. But socially, the effect of weight loss is just as great. “Being obese is such a stigma in our society, that I think the stress of being obese and having to cope with how people look at you is something impossible to relate to,” says  Dr. Sukol. And that’s a considerable weight off someone’s shoulders.

The American Heart Association outlined Thursday its first ever guidelines for primary care provider sand OBGYNs developed specifically to prevent women’s strokes, the third leading cause of death for U.S. women, and the fifth leading cause for men.Stroke risk factors for both men and women include high blood pressure, high cholesterol, and smoking, but certain hormonal changes can reportedly increase a woman’s risk.

“If you are a woman…your risk is also influenced by hormones, reproductive health, pregnancy, childbirth and other sex-related factors,” said Cheryl Bushnell, M.D., M.H.S., author of the new scientific statement published in the American Heart Association journal Stroke.

According to the guidelines, women with a history of high blood pressure before pregnancy are at risk for preeclampsia, a blood pressure disorder that occurs during pregnancy. Preeclampsia doubles the risk for stroke and increases the risk for high blood pressure four-fold, according to the guidelines.

The combination of high blood pressure and birth control use can also raise a woman’s risk for stroke. Migraines with aura, diabetes, depression, and emotional stress, which occur more frequently among women, are also contributing factors.

Many of us in the healthcare field have preached for decades that people should not rely on vitamins in pill form to meet the recommended doses of vitamin intake. Instead, we’ve urged our patients to get their nutrients from the foods we eat.

Now, however, a certain population of women may have an important reason to take multivitamins. New research data, which were extracted from the Women’s Health Initiative Clinical Trials and the Women’s Health Observational Study, show that older women with invasive breast cancer—cancer that has spread outside of the breast duct—may gain a new advantage from taking a multivitamin each day; in fact, these vitamins may reduce the risk that their breast cancer will recur.

Wow.

That’s right. This research, recently published in the journal Breast Cancer Research and Treatment, suggests that multivitamin/mineral supplements may help older women who develop breast cancer to survive their disease.

Multivitamin/mineral supplements are the most commonly consumed dietary supplements among adults in the U.S. They usually contain small amounts of 20 to 30 vitamins and minerals, often at levels reaching 100 percent of U.S Recommended Dietary Allowances or less. The manufacturers of these products recommend that people take one pill daily.

A comparison of those who took a multivitamin and those who didn’t

Fortunately, these two studies were large enough so that the results of this new vitamin-and-mineral research were valid.

During the extensive study period, 385 of the women diagnosed with breast cancer during the study were using supplements. The vast majority of these had been taking the supplements prior to being diagnosed. A comparison of mortality rates revealed that the women with invasive breast cancer who took multivitamins/mineral supplements were 30 percent less likely to die from their cancers than were the women with invasive breast cancers who hadn’t taken any supplements.

Could merely taking these supplements explain the difference in these statistics? Well, the researchers then also looked at all the other potential possibilities such as smoking history, race, ethnicity, age, depression, diet, alcohol use, physical activities, age at diagnosis of breast cancer, and diabetes. And after considering all these other factors with due diligence, the scientists concluded that the supplement usage was what made the difference in the mortality rates.

But you still must eat nutritious foods!

Now, here comes my regular caveat: Please don’t interpret these research results to mean that you can stop eating a healthy diet and rely solely on a supplement pill to assure that you are getting the nutrients you need. Instead, consider clipping a coupon for a multivitamin from the Sunday paper this week and start taking one, especially if you are over age 50, have had breast cancer, and have a chance of recurrence.

There isn’t research yet to determine if taking this pill prevents breast cancer in those not diagnosed, but research is certainly underway to try to decipher this as well.

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