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Is There Really a <em>Biggest Loser?</em>

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Is There Really a Biggest Loser?

Fact: There is no best diet.
Michael A.  Snyder M.D.
Michael A. Snyder M.D. More by this author
Jan 12, 2011 at 09:00 AM

A quick wake-up call to the reality behind the “reality” show The Biggest Loser merits some attention, because the only realistic element to it may be its stories of failure after the cameras stop recording.

The show, as many of you know, achieves rapid transformations worthy of prime-time television drama. Contestants often drop more than 20 pounds in a week through severe calorie restriction and extreme exercise. Add to that some crazy behind-the-scenes dehydration and you’ve got a recipe for unbelievable weight loss in a short period of time.

Ryan Benson won the first season in January 2005 and regained nearly 40 pounds within five days simply by drinking water. Two and a half years after his final weigh-in at 207 pounds, he admitted to reverting back to old habits and weighed almost 300 pounds again. Matt Hoover, the second season’s winner, put nearly 15.5 pounds back on within a day of taking home the $250,000 grand prize. Other contestants who came close to winning tell stories of the drastic measures they took to drop weight fast, such as sitting in a sauna for hours, consuming sugar-free Jell-O for days, and downing diuretic foods to spur water loss.

These weight-loss stories may be real, but they certainly are not realistic by any stretch of the imagination, if you consider the means by which they lost weight and the fact that they cannot maintain the loss. The majority of their weight loss came from extraordinary physical activity (four or more hours a day; who has time for that?) and unhealthy dehydration that’s unquestionably abnormal. It concerns me that viewers at home start to feel like the proverbial “biggest losers” because they themselves cannot get the miraculous weight-loss results that the contestants experience. Here we go again: you feel like you cannot succeed at yet another diet plan.

Harsh programs like that espoused by The Biggest Loser aside, the efficacy of more “normal” commercial weight-loss programs has rarely been evaluated in rigorous long-term trials. You’d think that creators of these programs, which do take an enormous amount of money and research to develop, would want to have this kind of information, especially if it proved that their program worked. That way, they could flaunt their “great results,” stomp on the competition, and attract more customers. Something tells me that the statistics—whatever they are for each program—are not that impressive. The success rate of voluntary weight-loss efforts among my patients is, at best, 5 percent over five years.

The largest ever controlled study of weight-loss methods was published in 2009 by the New England Journal of Medicine. When researchers pitted the most popular diets against one another, they discovered that it doesn’t matter which diet you go on so long as total calories consumed is lessened. More than 800 overweight adults in Boston and Baton Rouge were assigned to one of four diets that reduced calories through different combinations of fat, carbohydrates, and protein. Each plan cut about 750 calories from a participant’s normal diet, but no one ate fewer than 1,200 calories a day. Although the diets were not named, the eating plans mimicked those of today’s most popular do-it-yourself programs.

All of the dieters started to regain weight one year later. I should add that their weight loss during the first year wasn’t stunning. At six months, participants in each type of diet had lost an average of 13.2 pounds, and at two years had maintained about 9 pounds of weight loss and a two-inch drop in waist size. After two years, every diet group had lost and regained about the same amount of weight regardless of what diet had been assigned. While the average weight loss was modest, about 15 percent of dieters lost more than 10 percent of their weight by the end of the study. After about a year many participants returned to at least some of their usual eating habits, but they reported an equal level of satiety, hunger, and diet satisfaction.

It does not matter if you are counting carbohydrates, protein, or fat. All that matters is that you are counting something and that your total caloric intake is reduced. You probably cannot live with any of these methods long term, so you need to find a simple, livable approach.

I love this study because it finally put to rest the eternal argument between the camps of “who has the best diet.” There is no best diet. The only thing that matters is that you DO SOMETHING! The fat versus carbs versus protein craziness is just that—craziness. Sure, there are basic components of your diet to help with energy, proper functioning, and essential nutritional needs. But, aside from having some wise variety in your meals, you do not have to become married to one style of food balance. If you hate diets that emphasize proteins and fat, you are not screwed because “only [name of diet] works.”

The real take-home message in this study is that it’s necessary to reduce calories. In an insightful editorial, Vanderbilt University’s Martin Katahn, Ph.D. puts the study into perspective. He observed that the lower calorie intake was not sustained; all of the subjects lost weight initially but then began to trend back upward at two years. In addition, Dr. Katahn teased out another important fact: there were subjects within each group who did better with weight loss. He noted that these individuals attended more counseling sessions and followed the prescribed dietary changes more closely. He acknowledged that willpower is limited, but he also recognized that the only hope we have of solving the obesity epidemic will be by changing the “environment” that helps us be overweight. I couldn’t agree more.

About Author
Michael A.  Snyder M.D.
Michael Snyder, M.D., F.A.C.S., is a board-certified general surgeon and a highly respected leader and mentor in the field of bariatric surgery. He has performed more than 3,500 primary bariatric surgical procedures, including post-surgical coaching Continue reading