Biggest loser: best for weight loss?

The Biggest Loser has been getting some flack in the media about the tactics participants use (and the humiliation they endure) in order to gain the biggest advantage when it comes to the weekly weigh in. This is no surprise – I doubt anyone is under any illusions as to the type of regime these people undertake to make those types of losses. I remember watching Downsize Me, a reality diet show where well known New Zealander’s take on the challenge to overhaul their diet and their exercise in an effort to lose weight. Notable people who exercised up to two hours a day in the weeks leading up to their final weigh in are now a much larger version of their svelte self. This should make anyone question why you would put yourself through the torment of such a deprivation diet and exercise regime only to regain the weight in a few months time. On top of that, they must have put themselves in such a vulnerable position to have it played out in the public domain to then be unable to maintain such a diet. Most people would agree that this pretty much captures the essence of the Biggest Loser.

What was perplexing, then, was the recent US News and Health report that evaluated 32 popular diets and determined the Biggest Loser diet to come out on top in the categories for ‘biggest weight loss’ and ‘best for reducing diabetes-related symptoms.’ These were ranked by nutrition experts for highest ratings in seven categories:

Short term weight loss: Likelihood of losing significant weight during the first 12 months, based on available evidence (5=extremely effective, 4=very effective, 3=moderately effective, 2=minimally effective, 1=ineffective).

Long term weight loss: Likelihood of maintaining significant weight loss for two years or more, based on available evidence (5=extremely effective, 4=very effective, 3=moderately effective, 2=minimally effective, 1=ineffective).

Diabetes: Effectiveness for preventing diabetes or as a maintenance diet for diabetics (5=extremely effective, 4=very effective, 3=moderately effective, 2=minimally effective, 1=ineffective).

Heart: Effectiveness for cardiovascular disease prevention and as risk-reducing regimen for heart patients (5=extremely effective, 4=very effective, 3=moderately effective, 2=minimally effective, 1=ineffective).

Ease of compliance: Based on initial adjustment, satiety (a feeling of fullness so that you’ll stop eating), taste appeal, special requirements (5=extremely easy, 4=very easy, 3=moderately easy, 2=somewhat difficult, 1=extremely difficult).

Nutritional completeness: Based on conformance with the federal government’s Dietary Guidelines for Americans 2010, a widely accepted nutritional benchmark (5=extremely complete, 4=very complete, 3=moderately complete, 2=somewhat complete, 1=extremely incomplete).

Health risks: Including malnourishment, specific nutrient concerns, overly rapid weight loss, contraindications for certain populations or existing conditions, etc. (5=extremely safe, 4=very safe, 3=moderately safe, 2=somewhat safe, 1=extremely unsafe).

I wondered whether the nutrition experts knew something that we didn’t. If you watch the show (I did, perhaps 10 years ago) you might have an idea of what the contestants undertake on a day-to-day basis regarding diet and exercise. But for those who don’t know, here is some information on the Biggest Loser plan that is deemed to be so successful. It comes from Cheryl Foberg, the dietitian who consults to the show, and who also runs a clinical practice counseling clients along the same Biggest Loser lines.  By all accounts, it sounds pretty intensive. Unsurprisingly the food choices were around a low carbohydrate, low fat, high protein diet plan. The clients spend around a year in her counsel, with weekly to fortnightly visits reviewing food journals and exercise plans. The amount of activity recommended is up to seven hours a week – which may not rival that of a moderately competitive long distance triathlete, but is certainly up there in terms of hours spent working out.

An actual diet plan was a little harder to come across. However Foberg kindly put together a diet plan for an magazine article that emulated a weekly food plan of a biggest loser contestant. I might be wrong, but this appears to be a watered down version of the diet plan that is used on the television show. It seems to be more in line with the traditional three meals, two snacks, dietary guidelines approach to diet that would be challenging to maintain over the long term, but certainly one could follow it in the short term to lose weight. Do note, however, the recommendation by a trainer on the US Biggest Loser show, Bob Harper, to do 60-90 minutes of exercise at least four times a week to ensure success with the plan. This news piece by an Australian journalist perhaps more accurately illustrated the diet of the participants who were involved in the show, as this was given to him by the producers:

  • Breakfast: egg white omelette with spinach
  • Snack: apple
  • Lunch: chickpea and vegetable salad
  • Snack: yoghurt and 10 almonds
  • Dinner: chicken stirfry

Noone would argue that this is quite a bit more stringent than that of the seven day diet plan touted above as the way to become the Biggest Loser. Low fat, low carbohydrate, low protein and actually just low food. Undoubtedly difficult to maintain day in, day out, particularly with the demands of an exercise regime.

Speaking of exercise, while the guidelines already mentioned are recommended for those wanting to lose weight already seem at the higher end of the time and effort range. However, there is nothing like a past contestant to spell out exactly what was expected of those on a day to day basis in the show. According to this contestant who was involved in the show for three weeks, the majority of time spent on the ranch was, in fact, exercising:

  • 5 a.m.- 8 a.m: Small breakfast. Do a five mile walk or hike.
  • Mid-morning: Small snack. Work out for five hours with trainers.
  • Late afternoon/early evening: Eat late lunch or early dinner.
  • 10:30 p.m: Lights out.

Hard core, and about five times more than that recommended in the Biggest Loser weight loss plan. Take away the support structure, the environment, the hours of exercise, and it’s difficult to see how anyone could maintain the weight they lost during their time on the show.  But it appears that it’s not impossible. While there are clearly people who struggled to maintain their incredible weight loss, those who were part of this article seemed to do really well, committing a lot of energy to continuing the diet and exercise habits created on their Biggest Loser journey. Of course this doesn’t speak to the numerous people who also lost a lot of weight but didn’t win the show – there is likely less of a commitment to their weight loss journey given that, outside of those in their community, there is no public accountability for their weight loss. It seems the most successful winners capitalised on their weight loss and turned it into a career opportunity, and as such they have a vested interest in keeping fit and lean.

The one thing I’ve failed to mention (importantly) is that the US News also rated the ‘Paleo’ diet alongside others such as the aforementioned Biggest Loser, Medifast, Slimfast and other plans people turn to when wanting to lose a couple of kilos. While these diets certainly help shed the weight, sustainable they are not. Most health professionals would never recommend people follow these diets long term. There was no need to delve into the reasons why Paleo, yet again, has been slammed; people like Robb Wolf have already critiqued this far more eloquently than I ever could. Which begs the question as to why Paleo was part of this list in the first instance, if the goal wasn’t to follow an eating style that is sustainable and achievable.

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