Speak Up, or You Will Be the Biggest Loser. And That’s Not a Good Thing.

Rapid weight loss is incompatible with mental and physical health. Period.

I beg to differ with Daily Beast columnist Tricia Romano, who believes Rachel Frederickson’s extreme weight loss on the Biggest Loser is none of our business. And I disagree that her weight is just a tad lower than a healthy BMI. And Rachel’s BL trainer Bob Harper is simply wrong when he assumes that “…when contestants leave home ... they are in charge of themselves.” 

Admittedly, I’ve never watched more than a few minutes of TBL—I found it intolerable. Yet the show is unfortunately quite popular. Many of my plus size patients report being inspired, identifying with the desperate contestants, tolerant of the verbal abuse and crazy diet and activity demands. They're smitten by the fairy tale that rapid weight loss through extreme measures works. And that extreme weight loss equals extreme happiness. Let me inform you otherwise; I yearn to protect you from the damage, both visible and hidden, from this diet mentality.

But first, about Rachel—the latest victim 

My summary of The Biggest Loser.

It was a media frenzy as Biggest Loser Rachel Frederickson returned to the show, 45 lbs below her “healthy” weight of 150 pounds when departing TBL. She weighed in at 105 pounds, a 155 pound total weight loss. And the $250,000 reward money was likely the least of the motivators. If you’ve ever known anyone who’s lived with an eating disorder, you know the situation well. It may start with a seemingly reasonable weight loss goal, typically with a common diet. And then once that goal is met, their goal gets reset. “Just five more pounds”, they think. “Then I’ll be happy/ satisfied/thin enough.” Yet for some, no amount of weight is ever quite enough, and the struggle continues. It moves from perhaps a sincere interest in losing some weight—perhaps at the recommendation of their doctor, even—to something completely different. 

And while it is frequently said that eating disorders are about control, the experience of the eating disorder sufferer hardly feels like being in control. Rumination about food and weight and eating consumes thoughts, and normal life comes to a halt. Social activities are put on hold to accommodate diet rules, and isolation becomes the norm. They may be visibly underweight, or appear to be of average or even over weight. Starvation can occur at any size. Really.

As for the Daily Beast writer’s comment “at 5 foot 5 inches and 105 pounds, Frederickson’s is slightly below the recommended BMI. But she’s also small-boned and lithe”, allow me to respond. For her height, midpoint of a healthy range may be 125 pounds by the charts, but at less than 90% of that weight (under 112 pounds), most women lose their periods. As for athletes (she was apparently a world class swimmer prior to her weight gain) a higher weight range is generally expected as healthy, with increased muscle mass. 

Of course there are small boned, women who were always petite, for whom a lower weight certainly may be okay. Weight, as I mentioned, is not the best measure of health. But a significant weight drop below one’s highest weight, referred to by researchers as weight suppression, may have undesirable effects, including precipitating eating disorders. 

Rachel reports feeling fine, but the evidence tells us otherwise. Exercising 3-4 hours per day strikes me as a big red flag for preoccupation with her weight. It’s not her fault, though. The Biggest Loser promotes rapid weight loss and unrealistic goals. We know from a classic starvation study by Dr. Ancel Keys in 1944 that starvation resulting in even a 25% weight loss—much less than her almost 60% drop in body weight—impacts thoughts, moods, sexual desire, and eating behaviors. All that, in addition to the slowed heart rate (no, it is not an athlete’s low pulse), low body temperature, and abnormal menses. 

Three, maybe four exercise classes a day, is her reported activity, while consuming under 1600 calories from a 'healthy' diet. Excuse me? 'Healthy diet' is a term that simply doesn’t apply to this intake relative to activity. I don’t care how healthy the individual foods are, whether they are organic, whole grain, whatever—there’s nothing healthy here. This is a severely restrictive intake for this level of activity.

It’s none of my business, Tricia? On the contrary. I can’t simply sit and watch and not shout out how outrageous and unhealthy this is. I am not, however, faulting Rachel. The Biggest Loser took a vulnerable contestant—perhaps no different than other contestants—a woman who reports emotional overeating resulting in a 100 pound weight gain following a breakup. They turn out an excessive exerciser, who’s restricting her calories and likely quite unhealthy by many measures. 

Call it the flip side of the same coin—first likely struggling with binge eating now struggling to trust her body and her signals and eat to meet her needs. Are we to view this as success? Not in the least. Were her eating behaviors addressed? Was she given strategies for coping versus using food or food restriction or compulsive exercise? Was she guided to learn to trust her hunger and her fullness again, or simply instructed to count calories? 

A former contestant, Ms. Hibbard acknowledges the unhealthy behavior she and others practiced on the ranch, particularly preceding weigh-ins (similar to what Weight Watchers report). Contestants, she claims, “dehydrated themselves through excessive workouts in warm layers of clothing, drank only coffee because it acts as a diuretic and ate little to nothing.” She adds: “I feel I did a vulnerable disservice by not saying on television the night of my finale. ‘I’m sad, and I’m sick from being on this show’”. (http://www.nytimes.com/2014/02/09/fashion/Biggest-Loser-Rachel-Frederickson.html?_r=0)

Hibbard might have been late to speak up. But we don’t have to be silent. The impact of a show like The Biggest Loser is dangerous—to its contestants, and to its viewers. It promises health, while causing harm; and it delays and potentially complicates contestants’ preexisting eating disorders. It shames participants through their weight loss struggle, and turns viewers to criticizing the Loser, like Rachel, for whom continued weight loss may feel out of her hands. 



Don’t accept the promise of rapid weight loss, or believe that extremes of eating or exercising will work. Because they never do.

When fat things happen to good people. On being thin, fat, and your false assumptions.

"Such crazy thoughts in that Aussie article!"

Do you think that if only you do the right thing—eat a healthy diet, exercise, get enough sleep—then you will achieve your dreamed of weight, live free of disease and live happily ever after? This, dear readers, is a fairy tale. 

If you believe that eating nutrient packed, low calorie foods is solely responsible for whether or not you get cancer, or arthritis or MS, think again. And don’t be fooled by the preaching of Dr. Fuhrman in his book, Eat for Health, that health equals nutrition divided by calories, period. Health is not such a simple equation. And no, eating whole grain, veggie packed meals won’t protect you from an eating disorder either. 

If you think that eating 'right' ensures thinness, as was recently emphatically suggested in a popular newspaper article in Australia, it is yet another fantasy.

And if you torture your overweight self with the belief that you must lose weight--at all costs, and that your inability to reach target goals based on BMI charts is your personal failure, you’re wrong again.

“What is she thinking?” you’re thinking? Let’s start from the top. 

Eating healthy equals health

Yes, diet can impact many, many health measures. And I certainly encourage a balanced, varied diet filled with a complement of vitamins, minerals, antioxidants, and an appropriate level of fiber, to name a few. Yes, there are correlations in populations that have higher intakes of alcohol and saturated fat, for instance, with increased rates of cancer and high cholesterol, respectively. And a nutrient-rich diet chock full of antioxidants and lycopenes, like those found in tomato-based products, may help stave off such conditions as Alzheimer’s, cancer, and other diseases. But eating a proscribed diet will not guarantee your health. Nor will it ensure happiness, which is not to say I don’t encourage making healthy choices—I surely do. But do not, for a moment, think that if you are fortunate enough to stay healthy (or unfortunate enough to become ill) that it is solely by your hand. Credit your parents for their genes, to start.

Fallacies about thin

And do you know what? Eating well does not ensure thinness either. I see my share of patients who choose the most wholesome foods, but eat in excess—even those nutrient rich, heart healthy foods, like avocado and almonds, lean protein and kale. By excess I mean frequently eating without regard for hunger, and eating past a point of comfortable fullness. And eating well—high quality, nutrient-rich foods—even eaten mindfully and intuitively—may not keep you slim. Yup, it’s a sad truth that many of you don’t want to hear. And in fact, the very act of pushing your body to be a weight it is not meant to be, may put you in worse shape—both physically and psychologically. Just wait until you hear about these studies!

Stay tuned. That’s my next post, based on fascinating research presented at the Renfrew Conference I attended last weekend.

And those who are thin do not necessarily eat well and are often hardly fit by any standard. Do be careful about equating weight with health because they do not always pair up as you’d expect. Individuals may be thin because they are genetically predisposed to be, or they may be thin because, in contrast to what journalist and dietitian Susie Burrell believes—that they “know what to do to control their weight”—they may fall quite short in controlling it appropriately. They may be no better than someone who binge eats for emotional reasons at knowing “how to cope when things are tough”. Don’t be fooled into assuming that thinness is simply a lifestyle choice, a moral higher ground.

And I’d caution her, and you, not to overgeneralize about thin people’s skill at “assuming responsibility for self”. Just spend a few hours in my office; even those without eating disorders may allow anxiety or depression to stand in their way of eating enough. How responsible for self is the person who denies herself nourishment when low energy or headachy—hunger gone too far—or pushes herself to exercise even when she reports constant fatigue, or pain? 

Eat when they are hungry, stop when they are full? Some thin people may. But overgeneralizing about a segment of the population isn’t too intelligent. 

No, I didn't leave the rest over, for the record.

Thin people may self-regulate just fine. Or they may deny their hunger and fluid load or rely on high volume low calorie foods. They may eat nourishing foods, or a diet of junk—just not excessive in calories. Or they may compulsively exercise, hardly resulting in mental health, potentially leading to loss in muscle mass, heart problems and a range of symptoms if accompanied by undernourishment. Really, the only thing you can generalize about thin people is… that they are THIN. You can’t assume they are healthy, or happy, or good at self-care or self-regulation.

And of course the reverse is also true. The only thing you can tell by looking at a fat person is….? Yup. It’s that they are fat. You cannot predict their lipid levels or their blood pressure. You can’t tell whether they’ve never exercised or they exercise too much. And you can’t determine the quality of their diet.

My own parents are perfect examples of this, as I’ve written about previously. 

The mere suggestion that health is 100% in our hands I take offense to, as would the rest of the population which struggles with MS, and cancer, and ALS, and type 1 diabetes and arthritis and, and and… And I can say the same thing about a target weight or size. I hate to break it to you, but even if you do all the ‘right things’, you may not achieve your desirable, fantasized-about weight. And you know what? It’s not your fault.

Stay tuned for part two, (which I hope to get out within the week), which will address obesity, weight loss, and the risks and benefits of change.

Did this post push your buttons? Did it challenge your thinking? Did it offer some relief? Do let me know what you’re thinking! 

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