Following my Sunday Herald Sun column critical of ‘The Biggest Loser’ last week , I heard from a number of women in recovery from eating disorders, who wrote about the negative impact the series had on them – including Melbourne woman Belinda Davis, 38, who was happy for me to share her story here.
It all began when I was about 10-years-old. Having footage beamed into our lounge rooms every night of starving Ethiopian children just filled me with immense guilt. I would tell my mother that I would eat less so that those kids could have my share It was probably then that I developed unusual eating habits and thoughts around food.
In my 20’s I tried every bizarre new diet on the market plus a few I made up myself. There would be periods of my life that weren’t heavily dominated by the eating disorder but it was always there, lingering, waiting. That was until I was 31 and I longed for the voice to return just that little bit stronger, just to help me shed those few kilos. The eating disorder voices (demands) are strong, powerful and destructive, especially when looking for control in one’s life.
Before I knew it, this “voice” had taken over my life. Of course, there are many reasons behind an eating disorder but those childhood feelings of guilt still remain. I was severely emaciated and weighed everything before I even thought of consuming it.
With the support of great people, including an amazing clinical psychologist and a dietician who supported me daily in the initial stages of recovery, I have been able to recover. It was a long road, my general health was poor. Eating disorders are not glamourous in the slightest. Having ECGs, Dexa scans (for bone density) and regular blood tests are not what one thinks of when dreaming of “thinness”.
Since my recovery I lost my fiancé to suicide (August 2009) which lead to nervous breakdowns that landed me in hospital. But thankfully, though I was vulnerable, anorexia didn’t rear its ugly head again this time. Fortunately, I had learned that dieting didn’t bring me happiness, contentment or a life I wanted.
The Biggest Loser
I still recall the very first season. It was 2006, during the peak of my anorexia.
I was thrilled with the motivation it gave me to exercise after the episode. Obviously, I wasn’t the only one. In the beginning, my partner and I would see a number of people heading out of their houses for a brisk evening walk or jog. I thought this was a good thing. As the show continued, I saw the obsession with calorie counting, specific diets and of course, the Sunday nail biter, “the weigh in”. I wished I could lose as much as them. I couldn’t.
As the years went by, the show got worse, more extreme. Today, I cannot watch it for I learned (the hard way) how to manage a healthy weight. And I knew the show would set me back. All I see in the commercials is contestants being belittled, put down, yelled at, being sick, crying and with forlorn expressions.
The saddest part is to think that this show is aired in a very family friendly time slot. Just trying to imagine how many families sit down to watch this program together makes me hang my head in shame. What have we become? I really do feel for all those kids out there that are subject to this propaganda. The messages they must be learning could be not only damaging but life threatening. Let’s think about it (from the mind of our inner child):
It is ok if people in authority yell at me and call me names. It does make me feel bad about myself but they are “trainers” so they must be “right”.
If I am thin I am worthy of a relationship (think back to the “Singles” series that aired last year).
People cheer and get excited when I lose weight, it must be VERY important (and being ‘big’ must be VERY bad).
I am defined by my size (which is only good if I look like someone who works out at the gym for a living).
I now associate the word “loser” with someone who is bad (fat, lazy, greedy etc).
Fat shaming, the obesity ‘epidemic’ and extreme over correction is no way to control weight.
Why, as a society, can we not appreciate good deeds, intelligence, kindness and respect? It all comes down to what we/they can sell. I can only be happy that I am now in a fairly strong recovery because programs that embrace unhealthy under- eating and obsessional behaviour only serve as a trigger.
I cannot believe that this type of show is allowed on the air. With a failing public health system, it shocks me to see that people are being pushed to follow this extremism. Show me a study that says losing more than 500g per week is healthy or a study that says morbidly obese people should be expected to work out in a gym? I was so worried that “Big Kev” was going to have a heart attack.
I now know what a healthy diet consists of, how healthy weight loss works and the importance of fitness appropriate exercise. The Biggest Loser doesn’t promote any of this.
REALITY weight-loss show The Biggest Loser claims to be all about health – leading a new “social movement” against the “obesity crisis”.
But many authorities – and those suffering from disordered eating – say it actually contributes to bad health.
Parading and humiliating obese people, dangerously rapid weight loss, severe calorie restriction, pre weigh-in dehydration and punishing exercise do not develop healthy patterns for long-term health.
Whenever the series returns, Melbourne woman Jodi, 24, (who asked her surname not be used) avoids TV.
Seeing the show, or even ads for it, can trigger harmful eating patterns.
As a recovering binge and restrict eater, and accredited exercise scientist, Jodi says just hearing about TBL makes her feel “sad, pathetic, not good enough”.
“My logical self knows that I’m not overweight or obese, but my eating disorder tells me I am,” Jodi says.
“Contestants receive so much praise and recognition for their weight loss, which contributes to me linking my self-worth with my weight.
“It makes me aware that other people notice my weight and might judge me on it.
This makes it harder for Jodi to trust her treatment team, which encourages her to take small steps, eat mindfully and exercise in a healthy way.
Hearing trainers screaming at contestants that they are just weak undermines professional advice.
“I’m concerned as this is being passed onto the fitness industry, where trainers now think it’s OK to train clients at those same intensities.”
The show can also scare people off exercise. Researchers in the Faculty of Physical Education and Recreation found that watching a short video of The Biggest Loser fuelled negative attitudes toward exercise.
“People are screaming and crying and throwing up, and if you’re not a regular exerciser you might think this is what exercise is – that it’s this horrible experience where you have to push yourself to the limits, which is completely wrong,” says Tanya Berry, Canada Research Chair in Physical Activity Promotion.
Authorities say that because the only measure of success is scales, the show is purely about weight-loss not about overall health. The fact that contestants can’t even cover their bodies in a lightweight top during the weigh-in shows TBL is about sadistic voyeurism – and fuelling a $414 million weight-loss industry.
Eating disorder professionals say the show makes their work harder, as clients believe what they see on the show is realistic in daily life. Sarah McMahon, co-director of BodyMatters Australasia, says there is no evidence to support long-term sustained weight loss and behavioural change in most contestants.
“These clients are typically young and have poor media literacy and limited education about exercise and physiology,” she says.
“It makes a humiliating public spectacle of them under the guise of ‘self- improvement’. They will actively participate in their own persecution because the dream of being thin has been sold so convincingly”.
Dr Rick Kausman, Director of The Butterfly Foundation and author of best-selling If Not Dieting, Then What?’, says if you wanted to make a show that helped people be healthy, you’d do the opposite of TBL.
“Instead of shaming you would use compassion.
Research shows self-compassion helps us take care of ourselves much better than self-criticism.
Instead of a focus on weight, small meaningful changes in behaviour are much more likely to be sustained.”
“Rather than inspire people to make change, the show is more likely to make people mentally and physically unhealthy.
“Stigma around weight acts as a barrier for people seeking health care.
“Studies shown that patients are less likely to see their doctor for regular check-ups for fear of being told off about their weight.” he says.
“This is a disaster for preventative health”.
If we truly cared about helping people be healthy, we’d take this manipulative and highly emotional propaganda off-air immediately.
Yesterday dietitian Susie Burrell made the extraordinary claim that obesity is socially contagious in an opinion piece titled ‘Wanna get skinny? Might be time to ditch your fat friends’.
Burrell cited the Framingham Heart Study as evidence that people who have fat friends are more likely to become fat themselves. She called for readers to avoid fat people, lest they become infected with this modern-day social contagion.
This is so messed up I don’t even know where to begin.
The Framingham Heart Study was a decades-long analysis of heart disease that started in 1948 in a Massachusetts town.
Nearly 40 years later, ‘social contagionist’ scientists from Harvard Medical School and the University of California dredged up the old data and performed statistical analysis, concluding that obesity is socially contagious.
The same authors have made claims in the New England Journal of Medicine and various media outlets that everything from obesity to divorce to poor sleep to loneliness is also socially transmissible.
Their conclusions have since met widespread criticism.
In a paper titled ‘The Spread of Evidence-Poor Medicine via Flawed Social Network Analysis’, the mathematician Russell Lyons reported the statistical methods used by lead author Nicolas Christakis and James Fowler to be riddled with statistical errors on many levels.
Lyons’ paper has since passed peer review and was published in the journal Statistics, Politics, and Policy. A PhD candidate at the Sociomedical Sciences at Columbia University’s School of Public Health, David Merritt Jones, has been keeping a close eye on the developments as they unfold. He reports:
Two other recent papers raise serious doubts about their conclusions. And now something of a consensus is forming within the statistics and social-networking communities that Christakis and Fowler’s headline-grabbing contagion papers are fatally flawed.
Andrew Gelman, a professor of statistics at Columbia, wrote a delicately worded blog post in June noting that he’d ‘have to go with Lyons’ and say that the claims of contagious obesity, divorce and the like ‘have not been convincingly demonstrated’.
Another highly respected social-networking expert, Tom Snijders of Oxford, called the mathematical model used by Christakis and Fowler “not coherent.” And just a few days ago, Cosma Shalizi, a statistician at Carnegie Mellon, declared, ‘I agree with pretty much everything Snijders says’.
Gelman argues that the papers might not have been accepted by top journals if these technical criticisms had been aired earlier. Indeed, Lyons posted damning quotes from two anonymous reviewers of his own work. “[Christakis and Fowler's] errors are in some places so egregious that a critique of their work cannot exist without also calling into question the rigor of review process,” one of them wrote.
Christakis and Fowler have since been invited to provide an explanation of their statistical methods in the journal Annals of Applied Statistics. However, as of July 2011, this was reportedly still being revised.
It is difficult to understand why Burrell would rehash such a highly contested study and use its dubious findings to call for the hysterical and widespread discrimination against fat people.
The title of Burrell’s piece is alarming. It assumes that being skinny is what readers of The Punch either already desire or should desire to achieve.
Burrell goes on to promote stereotypes, associating ‘overweight’ with morally deficient characteristics such as laziness, while encouraging readers to seek out “thin, fit and healthy” people and “do what they do”.
Does it really need to be spelled out that not all fat people are automatically lazy, gluttonous slobs? That being “fit and healthy” is not exclusively synonymous with being thin? That we cannot assume that just because as person is thin they are engaging in healthy behaviours, or because they are fat, they are eating cheese puffs all day?
With approximately 70 per cent of our DNA contributing to our weight, why does Burrell assume everyone should – and can be – thin?
Burrell concludes that if a fat person expresses concern about their friend’s gym habits, the friend should ‘defriend’ the fat person and tell them they are ‘disappointed’ with them.
What if the fat person’s friend engages in compulsive exercise? Or is suffering from an eating disorder and really should not be exercising four hours a day? Does it really make sense to make these broad sweeping generalisations and recommendations?
Burrell’s claim that “dieting is frowned upon by those who know they too need to lose weight, but are currently making the choice not to” is grossly misleading. It is absurd to suggest that only fat people who need to lose weight are against dieting.
Numerous studies since 1959 have shown diets for weight loss carry a failure rate of 95-98 per cent after 2-5 years.
Health writer Paula Goodyer attempted to demonstrate weight loss as sustainable in an article titled ‘The Exercise Myth’ last week in The Sydney Morning Herald by citing The National Weight Control Registry which supposedly proves people can lose weight and keep it off over the long term.
Yet this registry was discredited by dietitian Joanne Ikeda and her team of researchers as far back as 2005.*
Diets don’t work, and carry unintended consequences that put a person’s health at risk. These include food and body preoccupation, weight cycling, higher than pre-diet starting weight, eating disorders, weight stigmatisation, and binge eating.
It is unethical for a health professional to recommend the discrimination and stigmatisation of fat people. It goes against the very spirit of health to promote anything that actively harms a population of people. Research has shown that shame does not lead to health-giving behaviours.
The best thing we can do for our health is focus on health-giving behaviours, and allow our weight to fall where it will.
Already a global shift away from a weight-based approach to a health-centred paradigm is happening – with the key principles including finding pleasurable physical activity, engaging in intuitive eating, and viewing health as a multi-dimensional, ongoing process including physical, intellectual, social, emotional, spiritual, and occupational aspects.
*see Ikeda et. al. (2005). The National Weight Control Registry: A Critique. Journal of Nutrition Education and Behavior, 37(4): 203-205.
Note: In response to readers’ feedback, the source of the 70 per cent statistic can be found here. What this means is that approximately 70 per cent of the outcome in weight variability in a population can be attributed to genetic causes.
I’ve watched a couple of episodes of The Biggest Loser Families and find myself cringing at the extent of degradation and shaming. To see Sarah-Jayne begging through tears not to have to stand on the scales the first time, was harrowing. It was as though she was being led to a torture rack. To hear each contestant declare their name and weight – “Hi, I’m Meg, and I weigh *** kilos” – was like watching a forced confession. Each individual was reduced to the sum of their weight.
This description of last night’s episode, from The Australian’s TV section:
“The trainers aren’t happy with their weight gain after a week of unhealthy food, but they still get the last laugh with an early morning training session and a bio-age test for all the contestants.”
The last laugh? Revenge on the fatties? Trainers hurling abuse and insults? Being punished for a life history of poverty, poor nutrition, unemployment and lack of opportunity? Is this how we encourage public health in this country?
Episode 1 of The Biggest Loser Australia 2011 debuted on Sunday night. The new series, targeting four family units, pitches being overweight as a problem experienced by individuals – indeed whole families – who are lazy, greedy, and slothful: in short, morally weak. They “do it to themselves”.
Trainers were given a week to “live in the shoes” of contestants. They are presented as barely surviving the experience of being drowned in gluttony and laziness.
OMG- and you have this every day?!?!… I can’t even look!!… I don’t know how you do it, I don’t know how you can physically eat this much food!! – Tiffiny, Trainer.
All that food… I was a little frightened; taken back… how many carbs can you have on one table? – Commando, Trainer.
Contestants were shown continually eating fatty and highly-processed foods. As this atypical eating behaviour was played up for the camera, the trainers (and probably viewers) reeled in disgust. Despite the participants revealing the hardships they believed contributed to their weight gain – such as childhood poverty, bullying and compromised family backgrounds. The take-home message is that, really, they have wreaked disaster upon themselves. Read more>>
Collective Shout colleague and Managing Director of BodyMatters Australasia Lydia Turner has written an important piece for Healthy Weight Week highlighting the conflicts of interest in anti-obesity research. She urges a health-based, not weight based approach to health.
This week marks the start of ‘Healthy Weight Week,’ brought to you by the Dieticians Association of Australia (DAA).
With the DAA claiming that 61 per cent of Australian adults and 25 per cent of Australian children are either overweight or obese, many people would think this is a great initiative. So why are a growing number of health professionals opposed to this campaign?
It is not well enough known that 95 per cent of obesity research is funded by private industry including Big Pharma. Corporations not only fund research, but entire university departments, charities, and educational programs as well. Seeing corporations jumping into bed with public health initiatives should raise suspicion. It is essentially putting the wolf in charge of the sheep.
Just last year the Centre for Obesity Research and Education (CORE) – a department of Monash University – published a study that found lap-banding procedures were appropriate interventions for obese teenagers as young as 14. What they didn’t reveal, however, was that the study was funded by Allergan, Australia’s largest manufacturer of lap-banding products. In mid-2010, Allergan sought approval from the Food and Drug Administration (FDA) to market lap bands to US teens after sponsoring clinical trials, essentially opening up the global teenage market for profit. Read more>>
What to do if you think your child is ‘overweight’
Julie Parker over at Beautiful You, has some good advice for parents who may be concerned about their child’s weight. You can read it here.
I’m very pleased to have Sarah McMahon, a Sydney psychologist specialising in eating disorders, write another guest blog, this time on the way the radical treatment of gastric banding is being pitched to teens, with very little attention given to the potential risks.
Promoting gastric banding to 14-year-olds: malnutrition and maintenance on the menu
I am shocked that a research article published on Wednesday by the Journal of the American Medical Association has been picked up, mixed up and hyped up by mainstream media, suggesting that gastric banding is an appropriate solution for “obese” teenagers. The research is typical of what we are seeing coming from the obesity industry, which is looking to capitalise from the condition.
What the research really found
Given the media hype, we need to look at what the research really tells us. Two groups of teenagers were randomly assigned to either a “lifestyle” group, for exercise and a healthy diet, or a “gastric banding” group, for laparoscopic adjustable gastric banding surgery with the main aim weight loss.
The gastric banding group experienced dramatically more weight loss than the lifestyle‘ group. This is not surprising. I would expect that intrusive surgery resulting in necessary food rationing is far more motivating than the “suggestions and encouragement” regarding dietary changes prescribed to the lifestyle group.
And although the extent of compliance between the groups is not clearly reported in the journal article, it requires little imagination. The reflex of a banded stomach is to vomit if the food is not small and well chewed. Not only does this force malnutrition, there is generally limited opportunity for high calorific intake. Of course vomiting is a vastly different compliance measure than the “intermittent food diaries and food counts used to measure compliance in the “lifestyle” group.
The sample size of the study was hardly robust. Less than 50 participants completed the research trial, meaning that statistically no evaluation of single health problems could be generated. This is important when considering the value of the study’s public health significance, given that the scaremongering associated with the “obesity epidemic” has gained so much momentum by medicalising the problem.
It seems that medicalising obesity somehow justifies culturally sanctioned prejudice on the basis that any intervention is “in their own interests”. Interestingly the study determined that despite the vast difference in weight loss in the gastric banding group, both groups experienced significant improvements in general health.
Further, follow up of weight loss measures were conveniently limited to two years, despite overwhelming evidence in research that suggests significant weight regain occurs from three years post surgery.
Industry promoted research
The study was undertaken by Monash University’s Centre for Obesity Research and Education (CORE). Perhaps not surprisingly, CORE receives an unrestricted research support grant from Allergen, which happens to be Australia’s leading provider of gastric banding equipment.
The lead author and pioneer of the lap banding procedure in Australia is Professor Paul O’Brien, who has previously served on the Allergen Advisory Board. Another author of the study reported consultancy with Allergen and membership of advisory boards that include Allergen, Optifast and Bariatric Advantage – all heavy weights in the weight loss industry.
It seems as though the boundary between commercial methods of weight loss, such as weight loss pills and medical interventions, are becoming blurred. Medicalising obesity to justify surgery creates an instant industry, and there is no shortage of businesses lining up to profit from it. Allergen’s webpage proposes alternative payment options, given the surgery is not covered by Medicare. These include the early release of superannuation savings or bank loans via third party medical finance.
The other side of gastric banding
Gastric banding is framed as a quick fix solution to address obesity. But does it address the real problem? Whether it is compulsive eating, binging due to psychological issues, or poor nutritional education, reducing an individual’s stomach size does not reduce the significance of these factors.
For example, eating disorders are not contraindicated, meaning that many people undertaking gastric banding may have severe psychiatric problems that are contributing to their weight gain or pursuit of thinness. I expect that this is one reason why the weight loss from gastric banding ultimately is short term and generally not sustainable.
Further, there is no standardized screening tool for the surgery. I know of countless cases of people engaging in binge behaviour who are offered the opportunity of gastric banding, at huge cost to their health. In our culture of thinness-at-all-costs, it seems that health is a reasonable trade off for thinness. Complicating this further is the fact that the subtext of our culture is that thinness equals health.
The Australian Medical Association’s 2008 report, ‘Bariatric Surgery: A Weighty Issue’, warned against the potential and inherent risks associated with gastric banding.
The cost to health from gastric banding is huge. Studies suggest that patients require follow up procedures to correct secondary health issues such as hernias, gall stones, bleeding, blood clots, infections, gastritis, correcting loose skin etc. In every 1500 cases there is one death (which can’t be corrected).
Common post-surgery complications include:
Frequent vomiting because the stomach is unable to hold so much food or because food is unable to pass out from the stomach;
Dumping syndrome which occurs when food enters the digestive tract too quickly, leading to adrenalin that results in nausea, palpitations, sweating and diarrhoea;
Nutritional deficiency due to malabsorption. This means that people need to follow a lifetime program of consuming nutritional supplements and vitamins;
Requirement for further surgery due to slippage, repositioning, adjustments and need for replacement of the band. In the aforementioned study, over one quarter of participants required revisional procedures that consisted of removal and replacement of the band or replacement of the access port;
Permanent eating difficulties including: an inability to digest particular foods, requirement for extensive chewing, difficulty in drinking at meal time, difficulty in eating at certain times during the day, and food becoming lodged in the throat.
These associated health concerns are frightening given that gastric banding is framed as the “next step” when diet, exercise and medication have failed. Descriptions on web pages, brochures and even research reports invariably begin with scaremongering about the “obesity epidemic” followed by cartoon-style drawings of the seemingly simple procedure that will not only make the person thin, but will solve all their problems. Not surprisingly, the “success stories” on brochures and the media focus on the life that was “saved” through gastric banding.
The ability of 14-year-olds to make this decision
Given the associated complications, it is not just me who believes that it is unsafe to be proposing this intervention for teenagers. In November 2009, the Dieticians Association of Australia (DAA) released a ’Position Paper on Bariatric Surgery in Children and Young People‘ which concluded that there is insufficient evidence of the surgery as a safe and long-term solution to weight loss in teenagers. Even Allergen normally requires patients to be over the age of 18 to undertake the surgery.
This begs the question: what teenager has the capacity to make a decision so significant, given the health risks and the lifetime maintenance of such a procedure? How can a teenager adhere to the strict requirements necessary to maintain the band? What happens when they experience other significant life changes, such as pregnancy?
We are talking about prescribing this intervention to people who are in high school who are legally unable to drink alcohol or drive because their brain is insufficiently developed to manage these responsibilities.
Frequent vomiting, permanent eating difficulties and soiling pants may not be the alternative to “obesity”’ that teens really need.
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