Friday, 6 May 2016

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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