Thursday, September 22, 2011

A Losing Proposition (The Biggest Loser) by Jerry Brainum

The twelfth season of the television reality series, The Biggest Loser (TBL) just commenced on September 20. For those not familar with this program, the show features groups of obese people who compete with each other to see who loses the most weight. There is no apparent concern for the specific type of weight lost, just how much weight is lost. Initial baseline weights are taken of the contestants, then they are weighed weekly. Those that don't meet a certain criteria are voted off the show. The contestants receive lectures about exercise and diet, but the pressure is still on to lose the most weight. They are told to follow a diet that contains a protein/carbohydrate/fat ratio of 30:45:25, and are also told to never go below 70% of their resting daily energy expenditure. In actuality, judging by the degree of weight-loss shown by past contestants, this advice is rarely, if ever, followed.
      Consider some of the records set by TBL contestants.Michael Vontrolla lost 264 pounds during the three month season run of TBL. He started out weighing 526 pounds, what doctors call "morbidly obese." Another contestant, Moses Kinkiini, holds the record for the most weight lost in a week: 41 pounds. He also lost 100 pounds in 6 weeks, also a record. In contrast, most scientists who study obesity say that you should never attempt to lose more than 2 pounds a week. The human body is capable of burning about 3 pounds of fat a week, and any more than this would consist not only of fat, but also water and muscle. Losing 41 pounds in a week would guarantee a major loss of lean mass, including muscle, which is very unhealthy.
       To lose the weight, the contestants exercise daily for up to 6 hours, averaging 3 1/2 hours daily. For someone who is out of shape, this amount of exercise constitutes gross overtraining, and could cause rapid health deterioration.The contestants are all required to sign wavers indicating that they are in good health and are physically prepared to compete in the TBL. Yet, on a spinoff show called The Biggest Loser: Second Chances, the intial show featured a one mile all-out run that led to hospitalization of two of the contestants.The show has been criticized for its espousal of super rapid weight loss. For one, the faster weight is lost, the greater the chance that it will come back and then some. Oprah Winfrey experienced this years ago, when she dropped 57 pounds on a low calorie diet that involved ingesting only a drink. She gained all the lost weight back, and got even heavier.
      The same fate has befallen many of the TBL contestants.Losing fat too rapidly doesn't allow the brain to adjust appetite.As a consequence, it takes a superhuman level of effort to keep the weight off. Exercising strenuously when you aren't prepared for it can cause heart damage, heart rhythm disturbances, and a dangerous pattern of electrolyte imbalance that can add to the heart problems, and possibly even cause sudden death. Many of the TBL contestants admitted to not eating any food at all, and also not drinking any fluids in order to lose weight. The winner of the first season TBL later said that he urinated blood because of his sparse eating and drinking habits. He later regained all the weight back that he had lost, except for 10 pounds. A female contestant regained 31 pounds 2 weeks after the show ended.
     Despite these rather poor statistics, the official physician on the show, Rob Huizenga, who was also once the team doctor for the Los Angeles Rams football team, recently published a study in which he tried to make a case that  procedures used on TBL can actually improve certain indices of health. It's true that when you lose substantial amounts of fat, overall body inflammation drops, as does insulin levels, blood glucose, and several cardiac risk factors. The risk for diabetes also declines with weight loss. In the study, measures of the thickness and elasticity of the carotid artery in the neck were taken of several TBL contestants before and and the end of the 3-month season of the show. The results show beneficial changes in the carotid artery, suggesting an improvement in cardiovascular disease risk. Resting insulin levels dropped to less than half of baseline measurement.Total cholesterol declined by an average of 15%,Blood triglycerides dropped by 52%. But other measurements weren't so favorable. Levels of lipoprotein(a) , a risk factor for CVD, rose by 73%. Levels of sex-hormone binding globulin (SHBG) increased a whopping 94%. SHBG ties up sex hormones, including testosterone, in the blood, making it less available to cells. The study offers no explantation for these adverse measures, but suggests that the benefical effects induced by TBL regime would offset these measures, which they would not.
      Perhaps the most dangerous aspect of TBL is that fat people who watch the show will get the idea that,"If they can do it, so can I." They will then embark on extreme exercise and diet measures that in the long run will not only prove futile, but may even prove deadly.
Ahmadi, N et al. Effects of intense exercise and moderate caloric restriction on cardiovascular risk factors and inflammation.Am J Med 2011: in press.

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