Confession Is Good for the Waistline

The Biggest Loser, the reality television show that pits obese people against each other in a weight-loss competition, has had its share of critics. Contestants are urged to exercise up to six hours a day and cut their calorie intake in half, potentially losing 20 pounds in one week, far more than the 1 to 2 pounds experts typically recommend.

It’s pure Hollywood, admits Michael Dansinger, an assistant professor at Tufts School of Medicine who has been the behind-the-scenes nutrition doctor for the show the last five years. “The top priority of a television show is to entertain,” he says, “and 2 to 3 pounds a week weight loss does not a show make.”

But the show has a lesson for all of us, he says. In his experience, having someone to answer to is key to losing weight. While weekly weigh-ins before millions of viewers are not for everyone, Dansinger says overweight Americans desperately need more of the coaching, accountability and structure found on The Biggest Loser.

He has incorporated that idea into his Diabetes Reversal Program at Tufts Medical Center, where he helps some 40 patients keep their blood sugar in check through the grueling process of losing weight. The results are promising.

He may not challenge his patients to dive off a cliff, pull a car along a racetrack or tempt themselves with a plate of their mother’s pepper steak, but he does give them what all reality TV stars crave and more dieters need: lots of attention.

For the first few months with a new patient, he holds weekly, individual counseling sessions. “The level of accountability is so much higher in one-on-one,” he says.

The human brain is wired such that the desire for short-term pleasures will almost always overrule the fear of long-term consequences. “The default condition is to eat food that is delicious and avoid excess exercise,” Dansinger says. “Prevention of chronic disease turns out to be a very poor incentive for patients.”

A show like The Biggest Loser has plenty of short-term consequences: a trainer in your face who might stop yelling if you run another lap, a teammate you are fearful of disappointing, the promise of a spa weekend for winning that week’s challenge. Too often, dieting at home is a go-it-alone struggle with few short-term rewards. But there are ways to succeed.

The Perfect Diet

Dansinger is all about engagement. He made headlines in 2005 when he and his colleagues at the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts released a study comparing four of the most popular diet plans out there: the Atkins, Ornish, Weight Watchers and Zone diets. The results showed people lost similar amounts of weight regardless of the regimen they followed, and the more weight they lost, the lower their risk for heart disease. It didn’t matter which diet, as long as they stuck with it.

“The adherence level of the participant was 10 times more potent a predictor of weight loss than the type of diet,” Dansinger says. “The nutrition community from that point on really embraced the concept that there is no one best diet for everyone and that many different eating strategies can work well.”

Since then, Dansinger has become less interested in finding the perfect diet and more determined to find ways to keep people on track. He swears by food journals, where dieters write down everything they eat every day.

“For years I tried to get by without requiring food records, because almost all patients find them to be a nuisance, and for some patients it’s a deal breaker,” Dansinger says. “But I’ve found that every patient who has achieved dramatic results has kept a food record, and that when patients discontinue the food record, that is often the beginning of a major weight regain or failure to continue losing.”

Diabetes Drama

Dansinger began focusing on diabetes four years ago, in part because it is an illness that hinges on lifestyle. Unlike statins for heart disease and anti-hypertensive drugs for blood pressure, “the medications of diabetes do such an incomplete job at reversing the complications,” Dansinger says. “Of all the weight-related diseases, diabetes responds the most dramatically to lifestyle change.”

In that regard, his patients, who represent a range of ages and backgrounds, are no different from the many diabetic contestants on The Biggest Loser, all of whom put the disease into remission through their weight loss on the show. Most patients don’t realize that with weight loss they have enough pancreatic function left to achieve a normal blood sugar reading. “Most patients with Type 2 diabetes are 35 to 40 pounds above their diabetes remission weight, and all it takes is a 20 percent reduction in calories to get there,” he says.

He seems to be on to something. While only about 5 percent of Type 2 diabetes patients in the United States are able to return their blood sugar to a normal level that can be sustained without medication, Dansinger has had about a 30 percent success rate. “If it’s going to happen, it usually happens in three to six months,” he says.

For most people who need to lose weight, weekly visits with dietitians aren’t covered by insurance, and physicians are too backed up to do regular lifestyle coaching. “ ‘I’ll see you back in three months’–that’s no way to provide accountability,” Dansinger says.

Insurance companies could take a first step, he says, by excusing co-payments for lifestyle coaching visits. Cash rewards and free spa weekends for losing weight? That would be nice, he says, but for now that only exists in the magical realm of television.

The Biggest Loser may not reflect the real world, Dansinger says, but “it gives us hope that we can make our lives better. Many people actually eat better and exercise more because they are reminded on a weekly basis that lifestyle change is potent medicine.”

Julie Flaherty can be reached at julie.flaherty@tufts.edu.