The Biggest Loser’s Big Surprise?

Success and DietsThe internet is abuzz about an article by the New York Times called “After ‘The Biggest Loser’ Their Bodies Fought to Regain Weight.”  I’ve received requests from over 300 readers to write about it so here we go.

Before we get too far into this let’s be clear that whether or not people regain their weight, The Biggest Loser is an abomination of a show that uses threats about, and baseless promises of, health to convince fat people to be physically and mentally abused for profit.  They use the idea that they abuse fat people “for our own good to make us healthy” to help their audiences justify watching this physical and emotional abuse for entertainment. If the show were about dogs and not fat people their treatment would have been considered so inhumane that they would have been pulled off the air after one episode.  And that’s even if they really did help people lose weight.  Sadly, we now know, that’s not so much what they do.

The article starts by explaining how everyone is shocked to find that the contestants from The Biggest Loser gain back their weight: “13 of the 14 contestants studied regained weight in the six years after the competition. Four contestants are heavier now than before the competition.”

Basically, what the study found was that, among other factors, resting metabolisms of the contestants plummeted, and kept plummeting even after they left the show and started “maintenance.” Former contestant Danny Cahill was described as “One of the worst off” because he started with a typical metabolism, but now has to eat 800 calories a day less than a typical man his size just to maintain his weight.

Their experience shows that the body will fight back for years. And that, said Dr. Michael Schwartz, an obesity and diabetes researcher who is a professor of medicine at the University of Washington, is “new and important.”

“The key point is that you can be on TV, you can lose enormous amounts of weight, you can go on for six years, but you can’t get away from a basic biological reality,” said Dr. Schwartz, who was not involved in the study. “As long as you are below your initial weight, your body is going to try to get you back.”

What’s shocking is that every long-term study of attempted intentional weight loss has shown results like these, but somehow these so-called experts are just catching on now.

In the face of this evidence, of course The Biggest Loser’s official doctor, Robert Huizenga, was apologetic and recommended rethinking everything about the show.

Just kidding!  He “questioned whether the measurements six years later were accurate” and says he tells contestants to monitor their diet and exercise at least nine hours a week to keep the weight off. Of course, there’s absolutely no evidence to suggest that even if the contestants could make working out a part time job, that it would change the outcome, but why would that be important to the same doctor who oversaw this nonsense in the first place?

Among a number of really disturbing paragraphs in the article, this one stuck out at me (and at many of the people who asked me to write about this:)

Researchers are figuring out why being fat makes so many people develop diabetes and other medical conditions, and they are searching for new ways to block the poison in fat. They are starting to unravel the reasons bariatric surgery allows most people to lose significant amounts of weight when dieting so often fails. And they are looking afresh at medical care for obese people.

A huge part of the entrenchment of a weight-based model of health (the idea that we should focus on making every body fit the same ratio of weight and height as a path to health) despite the lack of evidence for its efficacy is our acceptance of “everybody knows” to substitute for, or even replace, actual evidence, and basic correlation vs causation errors being made constantly and with great confidence especially in the media.

Both mistakes are being made here.  Fat and health conditions are correlated, not causally related, researchers have no idea if being fat “makes people develop diabetes and other medical conditions” or if those medical conditions cause people to be fat, or if body size and those medical conditions are both affected by a third factor, or how much bias is involved (for example, if we test all fat people early and often for diabetes, and we fail to test thin people even when they have symptoms because healthcare providers mistakenly believe that it’s a fat persons’s disease, it wouldn’t be shocking if more fat people were diagnosed.)

The phrase “Block the poison in fat” is hyperbolic at best and has no place in a discussion about body size and health. Also while stomach amputation may reduce body size, it also has horrific life altering side effects, lots of people die, lots of people gain their weight back, and there are entire communities dedicated to people who would gladly have their weight, and their lives back and any discussion of weight loss surgery should include that information.

If they are looking afresh at medical care for fat people, might I suggest giving us actual medical care (you know, the interventions that thin people receive when they have the exact same health issues that we do) instead of keeping their gazed locked on finding ways to manipulate our body size.  There is a highly researched paper about this by Linda Bacon and Lucy Aphramor.

One of the most dangerous effects of our entrenchment in the (false) idea that manipulating body size is the only path to health (or a path to health at all,) is that it leads to doctors who put patients actual health at risk in an attempt to make them thin by any means necessary.

There is always a weight a person’s body maintains without any effort. And while it is not known why that weight can change over the years — it may be an effect of aging — at any point, there is a weight that is easy to maintain, and that is the weight the body fights to defend. Finding a way to thwart these mechanisms is the goal scientists are striving for.

Why?  Why are they striving for this when studies like Matheson et. al, Wei et. al, the Cooper Institute Longitudinal Studies, and any study that actually looks at behaviors has found that (understanding that health is not an obligation, barometer of worthiness, entirely within our control, or guaranteed under any circumstances) behaviors are a much more accurate predictor of future health than body size.  The belief that making fat people thin will improve health outcomes and thus should be pursued by any means necessary is folly from a scientific perspective.  Let’s not forget that this is the approach that gave us diet pills that are dangerous, addictive, don’t help people lose very much weight, and are currently being prescribed anyway.

Another questionable bit of the article states:

While many of the contestants kept enough weight off to improve their health…

There is no evidence to show that any health improvements were the result of body size change, and not the result of a change of habits, is what led to better health.  In a piece for Huffington Post, researchers Mann, Tomiyama, and Ahlstrom explain that the suggestion that a certain percentage of weight loss will improve health is based on a series of failures leading to another “everybody knows” statistic that isn’t supported by evidence:

Eventually, the medical community settled on the current standard of losing just 5 percent of one’s starting weight, despite having no scientifically-supported medical reason for doing so.

The article goes on to talk about the ways that dieting screws up our hormones, and how doctors are looking at drugs and surgery to try to override our bodies tendencies.

Sadly, there’s no discussion of not screwing up our bodies with dieting in the first place. No discussion of what fat people’s health would look like if, instead of  a life of attempting to feed our bodies less than they need to live in the hopes that they will consume themselves and become smaller (despite a complete lack of evidence to suggest that will leave us thinner or healthier,) constant stigma, shaming, bullying, and oppression, and horrible, useless interactions with healthcare practitioners who fail to give us evidence-based interventions, we had the opportunity to spend our whole lives loving and appreciating our bodies, viewing them as worthy of care, and having the opportunity (though never the obligation) to focus on our actual health.

One of the key foundations of science is that you have to admit that you could be wrong, and in the face of overwhelming evidence that you have been fucking up you have to admit it.  This seems to be a principal that those involved in weight loss cannot, or will not, grasp. I’m sure it’s difficult to admit that you’ve been giving people terrible advice, and interventions that are most likely to lead to the opposite of the intended effect, but the alternative is to continue giving people terrible advice and interventions that are most likely to lead to the opposite of the intended effect. Sadly, that seems to be the path that The Biggest Loser, and medical science, are choosing for now.

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Published in: on May 6, 2016 at 8:42 am  Comments (40)  

40 CommentsLeave a comment

  1. Yes, yes, a thousand times yes, to all that you’ve said.

    And, additionally, I’m SHOCKED (not shocked at all) to see so much of the commentary is “Well, this doesn’t mean that fat people shouldn’t still try to lose weight! This doesn’t mean they can’t SUCCEED!”

    Um, no. That’s exactly what it means. Exactly.

    • I read the whole article. I couldn’t face the comments. I’m just as “shocked” as you are, O.C.

    • If it were for any other condition, there would be understanding and acceptance of the knowledge presented.

      But no, not for obesity. It’s like rape. There’s so many ways to blame the victim.

      Did you see the related article: How to Lose Weight- 9 Strategies to Try. It’s like they don’t even read the articles they post.

      • I’m not sure they even read the articles they write!

  2. Great response. I especially enjoyed the part where you said the show’s dr. apologized. LOL!

  3. Excellent post Ragen! I always love reading your insightful and intelligent blog.

  4. Irony is fully demonstrated in the 2700 replies to the Biggest Loser article. Just read the first 10 “Reader’s Picks.” Eight of those 10 (and hundreds below them) are still convinced that the article is wrong; that if only the weight loss was slower, the outcome would be different. Among the first 25 replies (with at least 300-500 agreeing with them) there are suggestions that Weight Watchers and Overeater’s Anonymous statistics must surely refute this article. Not to mention the responses from people who say they have maintained 100 pound losses over years. My favorite is: “I’m very hungry all day, every day. My battle plan to keep myself thin — and healthy — is this: Remove myself from food.”

    • You know what? Count me out. I’ve HAD it with being told that I must exercise thirty hours a day and learn to be contented with one peeled bean as a meal. How the hell are people supposed to accomplish anything (assuming that maintenance of weight loss isn’t their primary focus on life, and excluding people who do get satisfaction from this endeavor) when losing weight and maintaining the loss is more than a full-time job?

      I’m a sculptor, a writer, and a musician, and I have a day job, a granddaughter, stepdaughter, a husband and friends to keep up with. Screw being ravenous. Screw missing out on life because I have to spend six hours at a gym instead of at a birthday party.

      I have a casual friend who lost a lot of weight,magazines it back, berated herself for being a “food addict,” went vegan and became a full-time fitness instructor, teaching four hours a day of Afro-Haitian dance an Zumba to maintain her weight loss.

      That was two years ago. The weight is coming back. She is, I’m sure, extremely fit, but that’s not GOOD enough.

      Seriously, let me out of this goddamned madhouse!

      • That “magazines it back” was obviously supposed to read “gained it back,” thanks, autocorrect.

  5. I kept seeing comments from folks about how the reason the Biggest Loser folks gained weight back and their metabolisms slowed was that they tried to lose too much too fast and that going slow and steady was the way.

    Hard to keep from typing random swear words in comment replies… I have shared your post in hopes of addressing that drivel…

    • I’ve read some statements attributing this phenomenon to reverting back to old eating habits. So it’s the same stupid; just different words.

      Just once I’d like to see someone who utters this kind of stupid demonstrate how to subsist on less calories than the charts indicate one should consume. Have them explain how to deal with the constant cravings, growling stomach, shakes, feelings of weakness, etc. one has to endure to maintain the lower calorie consumption after losing a great deal of weight.

      • I’d like to see “someone who utters this kind of stupid” explain how people who are currently DIETING, manage to plateau and even gain weight, while they are still doing all the calorie-cutting, working out, and dealing with “the constant cravings, growling stomach, shakes, feelings of weakness, etc. one has to endure” to lose weight in the first place.

        Oh, yeah. If you’re on a diet, and not losing, then you must be lying. It can’t possibly be your body actively trying to save itself.

  6. I’ve been reading these articles (and the ones that are saying that diabetes is caused by, god forbid, a myriad of factors such as genetics) and thinking to myself, “really? This is news? Haven’t we known this for years and yet you are presenting it as a shocking scientific breakthrough?”

    It’s amazing how entrenched the idea of weight loss as simple calories in/out and “fat as the root of all evil” are, despite possibly decades of scientific evidence. In fact, it’s so entrenched I routinely struggle with it myself, despite reading this great blog regularly and others. We humans are a funny lot.

  7. I’ve been surprised by how upsetting I’ve found the discussion around this article. Many, many (thin) friends have posted links to the story with words like “fascinating” to describe it. It’s only fascinating if it’s not your life, friend. If you didn’t start dieting at seven years old, thus destroying your metabolism before you even knew what the hell it was. If you didn’t follow to the letter the low-fat, high-carb diets of the 1980s and suffer the health effects of having done that. If you didn’t spend 3/4 of your years on this planet hating your body and the other 1/4 trying to get over that hate. Fascinating?!! Um, no. I’m going with “infuriating”, thanks.

    • I’m with you, I’ve seen the article a few times and I skipped it, because I assumed it would be ripe with fat hate. Sure, they gain back the weight, but it wouldn’t be like something Ragen posts with all the facts and now how about we love ourselves, I assumed it would be full of they didn’t try hard enough and we can make the weight stay off. I didn’t read it and I didn’t share it.
      I’m sorry you spent so much of your life dieting and being miserable, that’s the one thing I didn’t do, I think I’ve been too much of a rebel.
      I never dieted, but I never really loved myself either. Before finding Regan, and Jes Baker, and Marilyn Wann, I just accepted myself, but kind of apologized for being okay with myself at the same time. Now I know it’s okay to like myself, and I’m working on it. This is also the first time I have learned the fallacy of “try hard enough and you can be thinner”. I assumed it was true like so many others, I just wasn’t willing to be that miserable.

  8. This is a gladiator show. It’s the modern version of the ancient practice of throwing people that society (in general) doesn’t like into a pit, and either having them be forced to kill each other, or else adding in wild animals, or the like, to kill them for society’s pleasure.

    When I first heard about the show “Survivor,” I knew enough about humanity to be horrified, and think that it really was a gladiator show. Fortunately, they don’t kill off people on that show. However, they do torture them, for the viewers’ pleasure. It’s the same thing, really, but they don’t claim to be doing it “for their own good.” Survivor, then, becomes a viewer’s “guilty pleasure,” while Biggest Loser becomes “inspirational.”

    It’s ALL gladiator cruelty!

    I read that whole article, with a growing disgust, as they pointed out time and again how long-term weight loss does not work, and not ONCE did they suggest that we should accept fat people. It was all about, “Yes, so how do we MAKE it work? How do we make all these fat people thin and acceptable?” Hand-wringing over how to justify continued torture of a hated group, because otherwise, they might just feel guilty.

    • EXACTLY!!! Gladiator!!!

  9. My dad just feel victim to the cause/correlation fallacy. He is a super active, slender man, so his physician just took his history, but never did any blood or stress tests for 3 years.

    Welp, at the beginning of April, he had a series of serious heart attacks, narrowly avoided open heart surgery, and was diagnosed with type 2 diabetes. Doctor was surprised! Basically said that he shouldn’t have any of these things because he wasn’t overweight. Way to excuse your poor medical care, doc.

    I just don’t get how difficult it is for doctors to see past body size, I just don’t! It is harming *everyone*.

    (I fully acknowledge that fat people bear the brunt of this horrific state of affairs, and my mother has been the victim of the opposite situation – surely losing weight and more exercise well mend your broken feet! This example is at the top of my mind right now for some reason!)

    • Here’s a big ol’ internet hug, if you want it, zardeenah!

    • Oh, man! Sure sorry about your Dad’s situation. I would think that thin folks, treated in the manner that your Dad has been, would be just as irate as fat folks being mistreated by the docs.

      I recently went to the doc for sore joints in my hands. So the doc ordered blood & urine tests. And I got a lecture on losing weight (“you don’t want to take blood pressure pills, do you?”).

      Okay… but what about my hands?

      And what does an A1C test and urine glucose level have to do with sore joints in my hands anyways? And cholesterol levels plus triglyceride levels? Yeah, we know what she was gunning for. All came back normal – though I am low in Vitamin D.

      Okay… but what about my hands?

      According to the doc, there’s nothing I can do. It’s from getting old. Take ibuprofen. I don’t have a medical degree and I knew to do that.

      And, since I have a large insurance deductible, I have to pay for all those lab tests she ordered. Thanks, doc.

      • Amazing… you could have the beginnings of carpal tunnel from repetitive motion–typing or other uses of your hands in work or in your hobbies, etc. Pain and swelling of the hands does not necessarily mean arthritis.

        • Yeah, good point- carpal tunnel is a distinct possibility. I’ll do what I can to avoid it-like find another doc.

          But on the bright side, I got prescription strength vitamin D. Get this: 50,000 units per capsule. I’ve never seen such a huge amount in one dose before! (taken once per week).

          • If you think you might have carpal tunnel syndrome, look up the symptoms on a few different medical sites, online, to confirm. If the symptoms match, then go to a medical supply store and get a wrist brace, or two. My doctor prescribed them for me, but I didn’t actually need the prescription, at the store.

            It can’t hurt (really, all it does is hold your hand in position, nothing potentially harmful, at all), and it might do the job.

            It worked for me. I wore it every night, and much of the day, for a month, then just at night for a couple of weeks, and now I only wear it when I feel symptoms coming back.

            I love my braces! If you don’t see improvement within 6 weeks, it’s probably something else, or else so severe that you’ll need surgery. When my doctor mentioned surgery, you’d better believe I kept wearing those braces! Fortunately, mine wasn’t severe enough to need it. You could log your wearing of the braces, and take that information to your doctor, so he knows you’ve already tried that treatment.

            Pro-tip – wear long sleeves, or long gloves, or wrap something around your wrist, because the velcro closure will snag on your sheets, as you sleep, if left uncovered.

            Good luck, and I hope you feel better, soon! Also, I hope you find a good doctor, soon.

      • Reminds me of the time my OB practice obsessively tested me for GD while telling me that my lower back pain, constant urge to urinate combined with strangury, etc., were just me being fat and old while pregnant, despite my biweekly urine samples being visibly cloudy and orange. The single non-fat-phobic member of my prenatal care team, who happened to be my midwife, who had sent me to the OBs for shadow care, finally used some old strips to check my pee herself, then told me to demand testing for a UTI. The OB practice caught it right before my chances of premature labor were due to go through the roof. And then took all the credit for saving me. Riiiiiiight.

        • Oh, and I have never had even a borderline positive GD test.

      • My husband went to the doctor about his hands being swollen every morning and got what sounds like about the same round of tests (all normal). He is quite thin. So while the lecture on losing weight was uncalled for, and I suspect there are probably other things your doctor should have thought of (like carpal tunnel, as others said), I think the tests may have been kind of a standard thing to do. It’s a shame about the deductible, though. But maybe those results will come in handy in the future if you have to argue with doctors again?

  10. and WTF do the mean by “the poison in fat”…? is fat poisonous and, if so, why isn’t eveyone fat…? sheesh, despite some of the misgiving statements, I am glad to see someone address the failings of that damn show.

    • It probably refers to certain substances getting stored in adipose (fat) tissue. All kinds of fat-soluble chemicals get sequestered in fat, some good, some bad. When weight loss occurs, these chemicals can spike up in the blood stream. So its a real thing, but the quote is still stupid.

      • I think in the context of the article they meant nothing so coherent–it seems to mean why fat is so baaaaad, that fat itself is like a poison. (Never mind the mounting evidence that diabetes causes weight gain in and of itself in many cases).

        • The last doctor I saw told me that fat is toxic. He was recommending weight-loss surgery – not the “suck all the toxic fat out of your body” liposuction surgery, though. The “amputate your stomach so that you have to starve for the rest of your life” surgery, that leaves all those fat cells in place, but, you know, they shrink.

          Logic?

    • Since all life has fat in it, then all life is poisoned. Huh? O.o

  11. One sure fact to be learned from this experiment (and others that are similar) is that if someone is very fat , they are likely to remain that way .It’s time that they accept themselves the way they are and love themselves physically and realize that they are beautiful as they are meant to be. Ditto for society.

  12. Thank you for this.

  13. I was glad to see your take on this. The original article popped up in my feed and called to mind a number of “conversations” I’ve seen firsthand or heard about secondhand in the military. Helpful advice like “just put down the fork, how hard is it?” and vitriolic hatred for “fatties” because it’s clearly, obviously a choice a lazy and immoral individual is willfully making to spit in the face of military standards.
    I exercise and watch what I eat to feel good. When I’m not carrying the extra pounds and when I make healthier food choices, I feel more energetic and lighter on my feet. But the way the military runs things, I’m more motivated by fear of failure’s consequences than by some actual healthier lifestyle. It works for many people, sure. But for some of us, it’s a constant battle that no one else takes seriously. Because obviously you can just put down the fork and that fixes everything.

    • Yeah, but don’t put down the fork enough to become anorexic. Only put down the fork until you reach the “right” size. Then, you’d better stop starving yourself!

      Seriously, fat people are regularly told to starve themselves, but a person who is thin (but has absorbed so much fat-hatred that they “diet” anyway) and starves themselves is sent to a hospital to get help.

      What would really help is to stop bullying fat people, in the first place. If society didn’t think that being fat was such a terrible thing, or that fat people deserve to be treated like dirt, there would be very few anorexic or bulimic people in the world.

  14. Thank you – good article. It might make everyone happy to know that there are some doctors who understand things differently. I recently saw a couple of good TED talks on this. One diabetes doctor said it is the carbohydrates that are causing diabetes and the recommended government sponsored diet which has lots of carbs and low fats is actually causing more problems and making people more insulin dependent. She said high protein and fat and low carbohydrates actually can reverse the diabetes. But all the mainstream doctors and the government with their screwed up food pyramid is actually causing the health problems more than anything else because they pump us full of carbs. The ‘fat poison’ myth is actually killing people. It’s scary how many good doctors actually believe all the hype they have been fed. Hopefully more of them will learn the truth. If anyone reading this does have diabetes, you may want to find a more enlightened diabetes doctor who can help you.

    • It’s also entirely possible that different people do better with different nutritional profiles and that neither “all the bread” nor “low carb/high protein-and-fat” will fit on a population-wide scale. Low carbohydrate diets make me incredibly cranky and hungry all the time, even when I’m hypothetically getting a reasonable amount of food.

      • A “balanced breakfast” leaves me with a pounding headache by midmorning. On the other hand, if I load up on protein, fat, and some carbs in the morning and leave all the veggies and fruit for later in the day, I’m fine.

        • Forgot my last sentence: I tried to make myself live on a “balanced breakfast” for years anyway, because obvs. everybody needed a “balanced breakfast” and if I couldn’t make it work I must be stupid.

  15. I am glad to see your review of this article, because I “eww’d” all the way through it when it first hit. The study’s results are certainly “important” but they’re not “new” by any stretch – they’re the results these studies always get.

    Any time the article deviated from those results into speculation, it defined “condescending compassion” for the kids at home. Its premise is still that fat is a horrible thing for a human to be and that fat people must allow thin people to restrict our autonomy “for our own good.” It just excuses that meddling with “fat people are biologically inferior” instead of the usual “fat people are morally inferior.” It’s the same bull shitting a different turd. Throw in some obvious shilling for Pfizer, bariatric surgery, and for-profit hospital “obesity prevention” programs, and the ostensibly “supportive” piece just looks like it’s playing Good Cop to TBL’s Bad Cop.


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