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The Biggest Loser: One Physician's Perspective

Posted: 05/14/10 05:11 PM ET

I care for a patient every 15 minutes. One day last week was pretty typical: 12 of 16 patients were obese; the remaining four, overweight. One in three had diabetes, most had either hypertension or low back pain, and I referred three to psychotherapy for stress-related symptoms. Yes, I counted. Four were tearful during our encounter, but with one, they were tears of joy: Denise [not her real name] entered my exam room beaming, with eyes welled up and pride on her face. She'd lost 10 pounds in 8 weeks, moving her BMI from obese to overweight. When I asked how she did it, her reply made me laugh aloud. "I watched The Biggest Loser! I finally started doing some exercise. Well, that, and I stopped with the rice and bread."

I've watched The Biggest Loser a handful of times over the NBC show's nine seasons -- the first time, from between parted fingers, horrified. I've since softened my stance, and come to realize that the show, despite many valid criticisms, has done a lot of good.

Messaging That Hits the Mark

Healthcare professionals and policymakers have warned Americans of the perils of obesity for many years, to little effect. Perhaps our messaging hasn't penetrated: fire-and-brimstone phrases like "epidemic" and "war on obesity" serve well as headlines, but, judging by statistics, have done little to successfully effect change. People who are obese know it. They feel it in their joints, in the stab of an insulin needle, in the bitter residue on their tongues from pills swallowed, and sometimes in the stares of people on the street. People who are obese have likely tried to lose weight and failed; they know exactly how difficult the journey is. If the struggle to reduce obesity's prevalence is indeed a war, we're losing, and in part, it's because our message isn't resonating.

With seven million people tuning in to each episode, The Biggest Loser has helped thrust the medical community's warnings about obesity into a prominent position in the national consciousness. Whatever each viewer's motivation may be for watching, they wind up seeing a process of physical and mental transformation through the facing of demons, support, accountability, and plain old-fashioned sweat. To be clear, the methods used on the show won't work for everyone (frankly, Jillian scares the be-jeezus out of me and I'd rather everyone kept their shirts on, thank you very much), and any expert worth his/her salt will tell you that responsible non-surgical weight loss should be at a rate of only 1-2 pounds per week. Nonetheless, the show's message, delivered in an entertaining package, penetrates: Losing weight takes commitment and work.

We can learn something from the show and expand our strategy to put a less-grim face on a condition whose underpinnings are often profound psychological and socioeconomic challenges, and whose cure is based on lifelong discipline and commitment. In caring for obese patients one-on-one, many of my colleagues and I cling to the "small changes yield big results" approach, based on the fact that just a 7-10 percent reduction in body mass improves one's risk profile across a spectrum of disease. Beyond that, we rely on understanding what makes each person tick in order to motivate them: some call it the art of medicine, others would call it target marketing. Let's find a way to do this on a larger scale.

Money Works

The Biggest Loser has inspired thousands of informal and employer-sponsored weight-loss contests, many of which replicate the show's blueprint of verified weigh-ins, start and end dates, and large cash prizes. By accident or intent, these contests use techniques backed by respected clinical evidence. Financial incentives have been well studied in weight loss, and are proven to improve outcomes over standard interventions alone. Faced with backbreaking healthcare costs, corporations are promising cold, hard cash as part of comprehensive wellness plans aimed at motivating employees to improve their health.

Recent research on the influence of social networks on smoking and weight shows community support is an equally valuable motivational tool. The informal networks formed by teams of competitors provide influence, support, and consistent motivation -- all keys to successful behavior modification.

The perfect long-term strategy will help those who have successfully lost weight maintain a healthy BMI over a lifetime. Sadly, roughly half of Biggest Loser contestants regained significant weight over time. But, half did not. Some of the best minds in behavioral economics and healthcare are working on finding a better long-term solution. In the future, financial incentives, coupled with a healthcare system that prioritizes prevention and wellness, will be able to help. In my view, pragmatism trumps perfection: while we await the holy grail, why not offer a different chalice to those who are so thirsty?

A New Look at the Gym

It's well known that exercise is a critical component of any long-term weight-loss plan. Historically, the obese have not been a significant sector of the gym-going market: on the whole, the health-club industry has not sought their patronage, and most obese people avoid going for reasons ranging from self-consciousness to the inability to use equipment made for people of smaller size. By showing contestants that are capable and excited to push themselves physically, The Biggest Loser has helped drive demand for gym services. In response, health clubs have made changes to welcome them: obesity-focused chains like Kingley Health have machines tailored for the obese as well as nutritional and wellness coaching; and 24-hour gyms like Snap Fitness and Anytime Fitness report that a significant part of their growth is due to increased interest from obese patrons who prefer to exercise during off-peak hours.

We all have something at stake in helping all Americans achieve a healthy weight -- corporations, health care providers, government, and patients alike. The Biggest Loser isn't perfect, but it's been an undeniable success in messaging and motivation. This fact led my partners and me to create The Matchup, a national weight-loss competition on HealthyWage.com that we hope will inspire thousands of Americans to team up and participate in some healthy competition. We've partnered with thousands of health clubs across the country and two former Biggest Losers, Pete Thomas and Neil Tejwani, and will reward the three top-performing teams with $18,000. Our goal is to capture the enthusiasm for weight loss fostered by The Biggest Loser, and to change thousands of Americans' lives.