Where the new #BiggestLoser missed the mark.

Picture of Dr. Jen Kerns

Dr. Jen Kerns

The premiere of The Biggest Loser on January 28 felt all too familiar, and if it was any indication of the season to come, I have serious doubts that this new version is actually the kindler/gentler bastion of holistic health promised by the network and the show’s host. There were claims in advance that this season will be more about getting healthy than losing weight, yet the show’s formula is the same: hold a massive cash prize ($100,000) over the contestants’ heads to motivate them to produce the greatest weight loss in a fixed amount of time. That is one big carrot, and whether or not they encourage sleep or talk about their feelings, people will do what they have to do to win such a big prize.

Beyond that elephant in the room, the season premiere had its obvious missteps (nicely pointed out by my friend @NicoleisNik Nicole Michalek), such as continuing to require body-conscious people to expose their half-naked bodies in front of the world during weigh-ins, and forcing contestants to exercise to the point of vomiting. (This might make for good TV, but only serves to reinforce their negative feelings about exercise through conditioning. After all, anyone whose parents caught them smoking as kids and were forced to chain smoke cigarettes until they puked, or who threw up violently after too many tequila shots, knows the power of vomiting on one’s desire to repeat the same behavior that caused the vomiting.) There were a few more subtle statements that I took issue with, as well. Here are my top three:

  1. When @MyTrainerBob Bob Harper said, “literally, you are what you eat when it comes to your cholesterol issues,” that was wrong. There is a wide variety in individual response to a low fat vs. high fat diet (with many people, my husband @KevinBMarvel included, actually improvingtheir cholesterol and lipid profiles on a very high fat low carb diet), and the consumption of dietary cholesterol does not necessarily equal increased blood cholesterol levels. That said, other people do improve their lipid profiles on a low fat diet — it’s complicated and nuanced. So my best advice is to check your own detailed lipid profiles before and after adopting any lifestyle intervention to see how it affects your unique genetics and physiology.
  1. When 47 year old contestant @coachjim2020 “Coach” Jim DiBattista was told by Bob that he has type 2 diabetes, he had an emotional outpouring of shame and regret: “People have diabetes — like real, type 1 diabetes — like, they don’t have a choice. They’re genetically built that way. I did this to myself. I ate myself into a sickness.” My heart broke for him and for all of the viewers watching this show who have type 2 diabetes and are wrongly blaming themselves. Type 2 diabetes has a strong genetic component, and although it is absolutely a weight-related condition in that your risk of developing the disease rises as your weight rises (and weight loss can cure it in many), there are also countless people of normal weight who suffer with the disease. In fact, astudy

that was just published last month examined almost 5 million Americans and found that there was a high rate of diabetes in normal weight people. It varied greatly based on race/ethnicity, with normal-weight whites having the lowest prevalence (5%) and normal-weight Hawaiians and Pacific Islanders having the highest prevalence (a whopping 18%). A diagnosis of type 2 diabetes is not your “fault,” just as obesity is not your fault: our brains evolved to predispose us to overeat highly rewarding (calorie dense foods), some people are more genetically predisposed than others, and our environment in this modern era (with abundant processed foods engineered to get us to overeat them and technology making physical movement almost obsolete) is worsening that predisposition. That said, once someone realizes that their quality life and their health could be impacted for the better by doing the long hard work of making informed choices and changing their lifestyle to lose weight and eat fewer processed carbohydrates, they can often melt way the type 2 diabetes in addition to the body fat.

  1. Trainer @ericafitlove Erica Lugo wasn’t exactly accurate when she claimed that high intensity interval training (#HIIT) is the best for weight loss: “when you spike your heart rate up and then back down it kinda tricks your body ‘cause it never gets used to the same tempo so it’s awesome for losing weight and burning fat.” Ok, again, this is complicated, and I am by no means saying that HIIT isn’t good for weight loss. But it’s not “tricking” your body, and it’s not necessarily better than traditional moderate intensity continuous exercise. First, note that energy consumed (diet) has a much greater impact on weight loss than does energy expended (exercise) in study after study, at least in the real world where the amount of exercise we’re talking about is realistic for most working adults (when contestants on the Biggest Loser or professional athletes work out for 5 hours a day, that’s an entirely different story). Evenour own research found that the amount of weight loss during the Biggest Loser competition was significantly correlated with calories eaten and not with calories burned (whereas 6 years later the exercise became more related to successful maintenance of weight loss). Indeed, one of my most successful weight loss patients today is a veteran who is disabled enough that he rides everywhere in a scooter, but has lost almost 100 pounds by changing his diet. So please, those of you out there who can’t be as active as the professional athletes also known as Biggest Loser contestants, don’t think that you can’t change your life! That said, regular exercise can help marginally boost weight loss beyond what you’d achieve with diet alone, and there have been many scientific studies of different types of exercise and their effect on weight loss. Deciding which exercise method is best depends on how you compare them. A large meta-analysis comparing moderate-intensity continuous training compared with high-intensity interval training found that the two types of exercise produce no difference in body fat percentage reduction (though HIIT in the specific form of intermittent sprints may produce greater absolute fat mass reduction – meaning more pounds of fat lost — than moderate continuous exercise). Another study found that overweight and obese adults had similar rates of adherence to and enjoyment of HIIT vs. moderate-intensity continuous training, but did not lose weight with either intervention over the 8 weeks of the study (more evidence that diet is more impactful than exercise for weight loss!). Interestingly, the HIIT group had greater drops in LDL cholesterol and (as expected) greater increases in VO2 max, a measure of peak aerobic exercise capacity, but conversely, had increases is blood inflammatory markers (interleukin-6 and C-reactive protein). Moderate intensity continuous exercise actually improved inflammatory markers in participants. Another study found that belly fat reductions in young obese women were comparable between moderate continuous exercise and HIIT when work-equivalent training sessions were conducted. How to interepret this? If you spend 30 minutes doing a HIIT workout one day and 30 minutes walking quickly the next day, you’ll burn more calories and lose more weight with the HIIT workout — but that’s intuitive, because your work is greater. If you compare a work-equivalent (calorie-burning equivalent) HIIT workout of 15 minutes to say 30 minutes of fast walking, you’ll burn the same calories and lose the same amount of fat. So HIIT allows you to be more efficient if you’re pressed for time and trying to condense your calorie burning into a shorter session, but not necessarily better if you’ve got time to do a proper moderate-intensity workout. There are other benefits to HIIT workouts and I am a fan of them, but technically they may not be better than moderate continuous exercise specifically for burning fat when you compare equivalent work loads. A great overview of other studies and how HIIT isn’t necessarily the magic bullet that Erica Lugo claimed was written here last year.

Despite my reservations, I’ll be watching the show again next week, and will try to come back here to discuss other topics and/or clarify issues as I see them arise. I’m disappointed that the premiere of the show had many of the problems that plagued the original series, but hopeful that the 12 brave folks who signed up to lose weight on TV for our viewing pleasure are living their best lives right now and happy that they participated in the show. I know that being on the show changed my own life in ways I couldn’t have predicted, and I wouldn’t change a thing about my own involvement. Cheers to my BL brethren!




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