Tuesday, May 29, 2012

Biggest Loser MD Deluded, Unethical or Clueless?


Take your pick, but I think he's got to be one of those three.

His name is Dr. Robert Huizenga and last week he presented a Biggest Loser themed report at the 21st Annual Scientific and Clinical Congress of the American Association of Clinical Endocrinologists in Philadelphia.

The presentation detailed what an overly excited press release called a "pioneering study" whereby Huizenga found that when looking at 35 contestants from seasons 11, 12 and 13 of The Biggest Loser, severe dietary restriction combined with insane amounts of exercise dramatically improved metabolic outcomes including diabetes and hypertension.

That's "pioneering"? Is it really news that weight loss and exercise improve diabetes and hypertension? The only outcome related to hypertension and diabetes that would have been surprising to me would have been if they didn't markedly improve.

But where I'm truly left dumbfounded is Huizenga's reported consequent belief that the Biggest Loser modality of weight management - literally a minimum of 4 hours a day of exercise coupled with a highly restricted diet - is, "a better mousetrap".

I'm not sure what world Dr. Huizenga comes from, but in the one where I live people, even if they want to, don't have four spare hours a day to exercise. You see in my world people have jobs, families and other real-life-actual-human-being things that regardless of their weight or health intentions, are going to supersede any misguided physician's recommendations that in order to be healthy they need to spend every third waking hour of their lives in a gym. I'm thinking if 4 hours a day of exercise is his "better mousetrap", he'd best be prepared not to catch any mice.

And there are more differences between our two worlds. For instance in mine virtually everyone knows how incredibly unrealistic and perhaps even unethical it would be to suggest a better mousetrap had been built if it's build was based on Biggest Loser contestant outcomes without looking at whether or not those outcomes were preserved when the show turned off its ever present cameras. Not so apparently in Huizenga's world where his conclusions are indeed based on Biggest Loser participants' outcomes recorded only at the end of their 24 week contest. An end where his subjects were all still competing for huge sums of prize money, and where they were still being followed by television cameras, millions of viewers, and the potential to turn their experiences into careers. Hardly an end that's clinically applicable to the general population.

There's one other piece that's really bothering me. Why did Huizenga's study only include 35 contestants? By my count that's only 59% of those seasons' contestants. A pretty terrible loss to follow up in a venue where as is evidenced by each season's finale, there's virtually no loss to follow up.

Huizenga's apparently applied for a grant to compare outcomes between bariatric surgery and  Biggest Loser contestants. If funded let's hope that his study design doesn't include subject cherry picking, and that his follow up period is at the very least a clinically useful few years long, though given what he's done here, I won't hold my breath hoping for an ethical and appropriate methodology.

As to Huizenga's motives - well aside from supporting his show and television career I can think of two: Cognitive dissonance and confirmation bias.  Those two?  They're like the bed bugs of science, except instead of spreading disease, they spread delusion.

Someone ought to fumigate that guy.

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29 comments:

  1. Dr. F - not to be disrespectful but most (note I said most) MDs do not have a clue how to improve metabolic health or fitness if it doesn't involve something drastic. That's why were stuck with ridiculous VLCD and diabolical diets! You're right, however, this guy needs to wake up!

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  2. Anonymous7:21 am

    Dr F, you are spot on about this "eureka" study. Sadly there will always be a long line of those who interest in being published is more important than the validity of what they publish.

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  3. Extrapolating a bit, I can see somebody using this "research to promote special "camps" for the obese. Arbeit macht frei, right?

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  4. Apparently, he missed the morning interview here in the US on one of our biggest shows of the post-Biggest-Loser WINNER that gained all his weight back and blamed it on his screwed up metabolism. Because he couldn't maintain the 4 hours a day of exercise, anything he put in his mouth made him gain weight.

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  5. Roman8:45 am

    An audience of endocrinologists, eh? There must have been some, at least, who sat there cringing and rolling their eyes to the ceiling, during that presentation!
    :D

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  6. I think Huizenga's basic message is bang on: if you want to lose the weight you need to make a major, focussed and serious commitment. A soft workout regimen of a couple half-hearted hours per week won't produce much in the way of results. I agree most people can't spare 4 hours at the gym every day but how about sending out a message that at minimum, one needs an hour per day of all-in exercise plus more on weekends and holidays? I think people are missing the point because the experts tend to soft pedal the truth (because people don't like to hear it).

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    1. Sorry, but I've been losing weight slowly but steadily since last year without exercising. Over 80 lbs so far.

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    2. Congratulations on the loss: 80+ is nothing to sneeze at, but I think doing it without exercise is a bad idea.

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  7. I'm curious about the rate of overuse injury in those who do 4 hours of exercise a day for a longer period. Such an injury can put an exercise plan on ice for a year or more... and weight regain becomes almost inevitable then.

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  8. Collette - i struggled with an injury this winter nplus the reemergence of a depression so I was doing the couple if bare minimum workouts. I still lost weight. I couldnt be as dedicated as i was before, but i had my eating infrastructure in place (planning meals etc). It was the best i could do at that time. I had a net loss of 5lbs over the winter. It's not much but it's better than nothing. I am guessing my weight will come off faster this summer with training for a triathlon.

    I had a biggest loser type weight loss while i was at university, i lost 90lbs in 9 months. I maintained it mostly until i got pregnant 4.5 years later. While losing the weight all i needed to focus on were my studies. I also was a complete slave to my eating and exercise.

    I think I have a much richer life now. I have been to Dr. F's clinic for the past 9 months and have lost "only" approaching 30lbs. I also work full-time , I am a mom who's highly involved with her daughter, i volunteer and i spend time with people who I love and care about. I also for the first time in over a decade stress about Halloween, Christmas and other events.

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    1. *i didn't stress over Halloween, Christmas and other events.

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    2. Alison: daily exercise is wonderful for depression. It doesn't have to be the gym. It could be yoga or swimming or anything that doesn't aggravate an existing injury. I stand by my assertion that daily exercise is very important. Again, it doesn't have to be a gym workout, it can be a walk or gardening or anything that gets you moving. It may not even take off pounds but the inches fall away and the body feels and looks amazing. And, yes, your life will be enriched all the more. (And I think a slow steady weight loss is ideal -- congrats on losing the 30 pounds! -- and best of luck with the triathlon!)

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  9. I love to watch Biggest Loser, I am usually inspired. However, For Dr. H to base his "study" on 35 contesteants is ludicrous. There are many auditions that are passed over for health reasons. Some over the years who have been told, "lose X number of pounds, then try again to get on the show." People with AutoImmune Disorders for instance might really struggle with 4 hours of exercise a day. Persons with celiac disease, muscle weakness, connective tissue/joint issues would probably never be considered for the show. And losing weight doesn't remove the disorder like it can for Hypertension and Type 2 Diabetes.
    When weight loss programs say "check with your Doctor before starting" the unfortunate reality is that so many General Physicians have little knowledge or committment to true health and vitality.

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  10. Anonymous10:49 am

    What about season 1 thru 10 participants. I would like the real truth as to how many have kept the weight off. That would be a intresting study.

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  11. Margaret S.11:17 am

    But @Collette, it's not true that people need a minimum of 1 hour exercise per day. Setting such a high goal sets people up for failure, or for abandoning the attempt even before they start; “I don‘t have an hour a day, so I might as well not even try to lose weight at all.” It's true that you need to make a major focused commitment to a lifestyle change, but successful weight lose can be achieved with 100% of that focus being on intake (food), not exercise.

    I'm not saying that exercise isn't good for us; of course it enhances our health status, but there is no minimum amount to reap the benefits.. Dr. Freedhoff blogged about this not so long ago.

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    1. I do not doubt that successful weight loss is possible without exercise but then the result is a skinny unhealthy person. Are we aiming to simply be thin or to be healthy? We can argue all day about what is a minimum amount of exercise but I think it is ludicrous to suggest that five minutes a day is enough. I say let's get honest with ourselves about what it really takes to get fit.

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  12. who in the Real world has 4 hours a day to work out...no one! Exercise is absolutely vitally important to health and well-being. But when it comes to weight loss, I think it's pretty clear to anyone who's struggled with it that what you eat makes the biggest impact.

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  13. I vote all three.

    Anonymous -- I also had the question about seasons 1 through 10. If the vast majority of people who lose weight regain it -- and more -- within 2 to 5 years, it seems to be cherry-picking to only look at the last 3 seasons.

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  14. Even if everyone had 4 hours a day to workout, plenty of studies have shown that even that amount of exercise is not enough to sustain massive weight loss over a period of years. That's because the real truth that no one wants to hear is not that you have to exercise intensively to lose massive amounts of weight, but that dieting causes most people to gain weight over time because of something scientists call the Famine Response.

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  15. Anonymous3:44 pm

    I like the post but I really don't like the last sentence.

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  16. Anonymous6:42 pm

    Great post! I agree with the point you made about how hard it is for people to dedicate so much time to going to the gym while they have other things in life to deal with. One thing I’ve found to be extremely helpful and useful as a supplement to my current diet/exercise plan is Fullbar (www.fullbar.com). Their gummies and bars help curve my hunger, help me with portion control and keep me from consuming more calories than I really need.

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  17. Anonymous7:44 pm

    I'm training for the half Ironman. In my training I have never set aside 4 hours for exercise. Its ridiculous to think that the average person can exercise for that long on a daily basis without causing major damage to their bodies, especially obese people who likely already have muscle/joint issues. And yes, I went from obese couch potato to athlete but not by way of Biggest Loser style changes. I had gastric bypass & it saved my life.

    I watch TBL but I've always despised Dr. H because what he promotes is unhealthy and I really feel he lies to contestants and the viewers. He also has a very skewed view of weight loss surgery.

    But..he's paid by the show. He has to tow the company line as unethical as it may be. I honestly think he should lose his license

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  18. I have never watched TBL, I think the show is unethical and unrealistic. One can only hope they gave him a speakers spot as a bit of a joke. I participate in a diet and exercise forum and the things that some people come back from a trip to the doctors with, in respect of diet show how ignorant many doctors are, in fact bordering on irresponsible.

    Four hours exercise a day is not sustainable in the real world and is setting people up for injury.

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  19. The unfortunate bit about all of this is that it represents an extreme. People are given the message to either work out 4 hours, or not at all.

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  20. Denise9:10 pm

    I think you sell this guy short. He is highly respected in the fields both of endocrinology and weight management and I doubt anyone was rolling his or her eyes. He is not a deluded baffoon. Dr. Huizanga graduated from Harvard Medical School and was team physician for the Raiders, and also served as president of the NFL Physicians Society. His entire medical career has been spent observing and treating over-sized individuals, and he played a significant role in the crackdown on abuse of anabolic steroids in sports. His study was not based on "cherry-picked" contestants from The Biggest Loser. Huizanga conducted a study of over 300 TBL contestants and selected those exhibiting a particular metabolic profile among those who were initially assigned to class III morbid or super obesity, excluding those with syndromic obesity. These are the same folks who would have a high risk of complication and death from bariatric surgery. Huizanga stresses many aspects of treatment to effectuate a healthier metabolic profile...including proper sleep and social support networks. Many class III obese persons suffer from severe sleep apnea and social isolation. They do not lead the "normal" lives you discuss as incapable of accomodating 4 hours of daily exercise. The "breakthrough" is that nearly normal metabolic profiles were achieved...this is not the case with bariatric surgery, and this was achieved without the risk of complication and death associated with bariatric surgery. Be fair.

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  21. Anonymous11:40 am

    Perhaps we should take an approach similar to Lindy Climson's in fall prevention (bmj 2012) to encouraging exercise in the obese.
    Lora Giangregorio

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  22. I did a review of his book "Where Did All the Fat Go" on my blog. I consider his approach impractical and yes, I think deluded is a good word. He's "discovered" that hours of daily exercise and about 1200 calories will result in weight loss. REALLY? And he presents this amazing breakthrough thinking to the medical community?

    His book of a few years ago pitches two hours of daily exercise. He bangs away at convincing the reader that no one should have an excuse not to get up at 5:30am and go run for an hour, then to stop your life sometime before dinner and do another hour of exercise. But wait! Dozens of Biggest Loser "at home contestants" did it so you've got no excuse! Pretty much the whole book is just whining at the reader to figure out what's good for them.

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    1. Anonymous9:24 am

      But somehow the average American stops their life long enough to watch TV more than 5 hours per day.
      That's his main point stop watching the boob tube for at least a couple of hours per day and burn calories.

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    2. Anonymous12:36 am

      I never watched this show, I am not an American.
      But any kind of humiliation and threats regime to achieve anything is worthless. You cant intimidate/shame people to lose weight on the long run.
      Ive lost 60 pounds in about a year simply by first eating 2300 calories a day. Nothing more. No exercise.
      My BMI has been around 27 for the last 3 years and I am satisfied.

      EXERCISE IS NOT IMPORTANT to lose weight. No one fat wants to do it, it demoralizes. Also extremely low caloric diets dont work.
      Do what I did, set a very high mark for eating, mine was 2300 calories, and stick with it, nothing more. Its realistic and you lose weight in the long run. Yes you will probably only lose 50 pounds a year this way, nothing spectacular, but it will stay off since the body is not on a famine mode. Worked for me.
      Dont go on those crazy 1000 calories a day diets, dont do any exercise except walk a little every now and then, and you will lose weight because you will not be fricking your body out with extreme lifestyles you will not be able to maintain afterwards.
      2300 calories a day. Worked like a charm for me. try it, if you plan well you can get somewhat full on 2300 calories, and its better then starving yourself for a few weeks and then compensating and over compensating.

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