‘The Biggest Loser’ Could Be TV’s Most Important Show Ever

Sixteen seasons in, The Biggest Loser continues to be a ratings winner. But its coaches and producers are losing an opportunity to really educate the public about the science of weight gain and loss.

09.26.14 9:50 AM ET

The Biggest Loser is back for its 16th season, with its “Comeback Canyon” edition featuring former athletes. The program, which debuted a decade ago, is famous for humiliating its contestants, televising their emotional breakdowns, and putting them through training sessions intense enough to cause them to vomit. Even after all these years, the program continues to have high ratings. The franchise it spawned—cookbooks, workout videos, clothing—is worth a fortune; and Biggest Loser vacation camps are an actual thing.

Yet many critics think the show does more harm than good. Indeed, at least one study showed that people who watch the program develop more bias against the obese. Dr. Arya Sharma, professor of medicine and chair in obesity research and management at the University of Alberta, believes that anti-obesity bias negatively impacts everything “from public health messaging to funding for research or treatments.”

If it’s true that our cultural biases about obesity will determine research dollars and eventual therapies, I can’t help but wonder if shows like The Biggest Loser could do a better job educating the public about the biology of obesity. After all, here we are, in the middle of a global obesity crisis; and there they are running a metabolic lab on television. The show could highlight the real challenges of fighting obesity: We are not battling gluttony and sloth—as the show might have you believe—but physiology.

Many researchers now understand that obesity is complex. The simplistic prescription to “eat less and move more” has proven to be a dismal failure whether recommended to individuals or entire populations. If there were a pill with such poor efficacy, it might be considered malpractice to prescribe it. The Biggest Loser could acknowledge this by dropping the pretense that “starvation-and-boot camp” is some kind of cutting-edge obesity treatment. In fact, studies have shown that contestants’ metabolic rates are drastically impaired after weeks on the program. This may account for why many contestants have long-term weight regain—and it’s the long term that really matters.

“The chance of being cured of obesity is zero,” Dr. Sharma told The Daily Beast. “You have a better chance of being cured of cancer. People who keep weight off stay on life longtreatment. They might not think they are on lifelong treatment—but they are.” Dr. Sharma is referring to the fact that many people have effectively kept off weight by adopting a low-carb or low-fat eating strategy and may combine that with exercise. But, it’s clear that this is a treatment that requires a good deal of vigilance and discipline. What also should be pointed out is that these are distinctly different behaviors from those of the naturally thin, who tend to think very little about portion size and do not require several hours a day of exercise to maintain a normal weight.

To address the difficulties of staying slim after losing weight, past Biggest Loser contestants might be invited on to discuss the strategies—the treatments—they used to keep weight off. The show could feature various obesity researchers who might highlight the latest thinking in long-term weight management. Given the magnitude of the obesity epidemic, if The Biggest Loser addressed long-term weight control, it could evolve from being a gimmick to being perhaps the greatest show on earth.

But this still doesn’t address why people gain weight in the first place, which is a separate question from how people lose weight. Many people believe that the brain regulates weight—that the brain has a “set point” much like a thermostat regulates the house temperature within a narrow range. A “set point” would determine weight by regulating metabolic activity, hunger and even the desire to do exercise. “How does the body reset the “set point”? And can you reset the “set point” again?” Dr. Sharma asked. “These are active areas of research.”

Exactly why the set point gets reset at an obese weight remains a matter of great debate amongst obesity experts—and theories range from the amount of carbs or calories in the diet to environmental estrogens and antidepressants in the water supply. Regardless of the cause or causes, once you look closely, blaming obesity on gluttony is not nearly as intellectually satisfying as asking why people are so hungry in the first place.

Regardless of the reason, once the set point has been altered, the body tends to “defend” against gain or loss at a higher-than-desired weight. Most people don’t realize that when a person is overweight, his weight does not continually spiral up because everything around him is so delicious and he can’t stop himself—he’s actually in balance at a new higher weight. What I mean to say is that the calories he is consuming match the calories expended—at 200 pounds, or 300 pounds, or 400 pounds. The obese are different from naturally thin people because they can no longer effortlessly remain in a healthy energy balance at pounds.

“Pay a naturally skinny guy a million dollars to gain 300 pounds and he can’t do it,” Dr. Sharma said. This is something that The Biggest Loser would do well to underscore: It’s easy for the naturally thin to be thin. Nevertheless, the naturally thin are all-too-often contemptuous of the obese—as if they too would be 400 pounds if they didn’t have such laudable self-control.

People tend to condemn the obese because they believe that “fatness” is evidence of laziness and lack of discipline. If The Biggest Loser could correct this misconception, it would do a lot to reduce anti-obesity prejudice. But the show would also have to abandon the idea that people are obese solely because they are emotionally broken and became fat because they are salving their wounds with food. Although food addictions and highly “rewarding foods” probably play a part in the obesity epidemic, that’s clearly not the full picture.

Imagine if we were a country that prized obesity. Picture the tearful confessions we could force out of thin people who would go to “fattening camps”—imagine the obesity coaches browbeating skinny young men into admitting they hate themselves so much that they’ve been secretly sabotaging their weight gain efforts.

By focusing on the emotional drivers of obesity, The Biggest Lower has ignored some of the more interesting aspects of the biology lab they are running. At the weekly weigh-ins, it’s not uncommon for contestants to have lost no weight at all. But if “calories-in-calories-out” is a meaningful weight-loss paradigm as the show insists, then plateaus simply are not possible. Weight loss would be constant and predictable.

Since the contestants are monitored, the coaches can’t contend the plateaus are from “cheating”—so the audience deserves an explanation. The way the show has dealt with this is to imply that the contestant simply doesn’t want to lose weight badly enough, as if a bad attitude could somehow suspend the laws of physics.

In real life, diet plateaus are frustrating and cause people to give up their weight-loss efforts. The Biggest Loser would do well to examine the phenomenon, because expert opinions vary as to what causes it or even if it exists at all. What if they were to measure body composition or hormone levels or metabolic rate? All of these may factor into the inability to move the needle on the scale. How helpful would it be to find out—as many diet doctors suggest—that a contestant’s stress hormone levels are sky high and that the contestant might benefit from eating more, sleeping more and exercising less?

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To be sure, the problem with these suggestions is that it would eliminate the competitive nature of the program and the ratings might plummet. As it is now, The Biggest Loser is highly entertaining, and I confess I’ve caught myself rooting for the hardworking participants. But it’s possible the producers are underestimating the hunger for fresh perspectives on obesity. By now, more than two-thirds of Americans are overweight or obese, and the vast majority will have little success with intense exercise and dieting alone—or at least intense dieting as it’s currently perceived. “Given enough time, without long-term treatment people who once had obesity always put the weight back on,” Dr. Sharma said, “Always.”

The Biggest Loser could elucidate just what kind of a commitment it takes to be successful in the long-term.  The show has a huge audience and it seems to me the coaches really believe in their approach, based on their stupefying success in the short term. But by broadening their perspectives, the show might help us erase the commonly held belief that obesity is simply a manifestation of personal vices and replace it with an understanding of why people really get fat. Then perhaps we can start to look for cures that address the underlying causes of obesity correctly—which probably will not include starvation and humiliation.

We might learn enough that we start treating the obese with the compassion they deserve—which may just be the medicine we need.