“Biggest Loser” Versus Bariatric Surgery: Questions

Dr. Huizenga of the Biggest Loser and colleagues asked exactly that question – and you can bet what they concluded. The first two articles in this series looked at their research. It compared Biggest Loser methods to bariatric surgery and reported findings on weight loss and other effects.

As it turns out (spoiler alert if you haven’t read the previous articles in this series!), weight loss is faster among Biggest Loser contestants, at least for the first 7 months. And then? Who knows? The gastric bypass patients in the study continued to lose weight through 12 months, while the Biggest Loser contestants…weren’t even tracked. Who knows what they weighed at 12 months and beyond?

The research raises a lot of other questions for me. Here are the ones I would like to ask Dr. Huizenga, with each question followed by an explanation of what I am curious about.

Cost is obviously an important factor for almost everyone. Can you please explain your reasoning in saying a program like the Biggest Loser is more cost-effective than weight loss surgery?

Exercise for four hours a day – cheap, right? In theory, sure. Just join a gym for $60 a month and work out as much as you want. But is it really that simple? Not really, if you’re an average human being.

Take a look at the Biggest Loser contestants’ program. They didn’t just have access to a gym. They had trainers 6 days a week, a room away from real-world worries and temptations, and all the healthy foods they could dream of, not to mention medical care as needed. Value? Well, at a value of $2,500 per week (as listed on the Biggest Loser Resort website), contestants who were on the ranch for 13 weeks received a package valued at $32,500. That doesn’t include any additional support, like contact with trainers after the show was over.

There’s no getting around the fact that weight loss surgery has a big price tag of $5,000 or $10,000 or $25,000. But that’s only if you’re paying out of pocket, and it’s still less than the first 13 weeks of a Biggest Loser style weight loss program. Get some insurance reimbursement, and you could get surgery for free or for a reduced cost. Plus, you don’t need to leave your job for a few months to live at the ranch – another cost in itself.

Why do you believe slowed metabolism is more significant in weight loss surgery patients compared to Biggest Loser contestants?

You found a slowed metabolism in Biggest Loser contestants compared to gastric bypass patients at 7 months. You attributed the slow to contestants losing weight for the show’s finale…but the weight loss surgery patients in your study were also still losing weight at that time?

One of the reasons you promote intense exercise over weight loss surgery is because patients maintain more lean muscle mass and metabolism when they work out…but this didn’t seem to be a huge benefit in your study!

Can you please provide a sample day that includes four hours of daily exercise and that individuals could follow on a long-term basis to lose weight?

Okay, Dr. Huizenga says exercise can come out of television time, but I’m having trouble thinking of a daily schedule that includes four hours of exercise and still lets someone take care of the family and work. Here’s how I see it: wake up at 4:30, work out from 5:00 to 7:00 (thus missing your kids waking up), take kids to school, go to work by 8:30, walk on your lunch hour (that’s your hour 3 of exercise), get off work at 5, pick up kids, run errands, and get home by 6, have dinner at 6:30, work out from 7 to 8 (thus missing family time), put kids to bed, go to bed at 8:30 for a solid 8 hours of sleep. Fun life! (Not!).

Maybe you can drop some of your duties for a few weeks, but for the months or years it takes to hit goal weight? That’s just not realistic. And how much exercise is necessary for maintenance? I guess the study didn’t say…because it didn’t follow the Biggest Loser contestants for more than 7 months.

People aren’t supervised on a daily basis like they are on Biggest Loser. Is it safe to exercise for 4 hours a day, especially when we’re talking about people who may not have this kind of background?

Most people don’t have access to trainers and medical support the way Biggest Loser contestants do. And, people who are 100 or 200 lb. overweight aren’t generally used to exercising for hours a day (let’s face it: except for athletes, most people aren’t). How do they know what to do? How can they prevent injuries? Are there any health risks associated with exercising to the extreme?

How do you explain these health values?

Most of the health values improved with weight loss, but some of the Biggest Loser contestants’ values got worse. Why do you think “bad” LDL cholesterol increased by about 20 percent, and total cholesterol also increased significantly?

What are the long-term results in Biggest Loser contestants?

The show has been airing since 2004, and it has just completed Season 16. You must be in touch with some of these contestants and have the ability to contact others. What are their long-term results? Have they kept the weight off?

There are plenty of studies on long-term effectiveness of weight loss surgery. Most find that bariatric surgery is generally effective for weight control and improvements in health conditions such as diabetes, arthritic pain, and sleep apnea, for example. Many studies conclude that among people who are eligible for weight loss surgery, the ones who get surgery do better than the ones who don’t.

Is it really justified to say exercise is better than weight loss surgery when there is no evidence supporting that?