Episode #141: Have You Watched "The Biggest Loser Documentary?"

In this episode of Conquer Your Weight, Dr. Sarah Stombaugh shares her thoughts on The Biggest Loser Documentary. The hit TV show drew millions of viewers with its dramatic weight loss transformations, but the documentary revealed the lasting struggles many contestants faced.

Dr. Stombaugh discusses:

• What the documentary portrayed accurately about weight loss and metabolic adaptation.
  
  
• The misleading messages about willpower, dieting, and sustainability
  
  
• Why extreme approaches like those on the show can do more harm than good.
  
  
• The lessons we can all take away for long-term, healthy, and realistic weight management.
  
  

Whether you watched The Biggest Loser back in the day or you’re just curious about what the documentary uncovered, this episode will give you a physician’s perspective on what we can learn—and what we should leave behind.

Listen now to discover how to break free from unrealistic expectations and focus on compassionate, sustainable weight loss.

Ready to get started on your weight loss journey? We're enrolling patients now for in-person visits in Charlottesville, Virginia and for telemedicine throughout the states of Illinois, Tennessee, and Virginia. Visit www.sarahstombaughmd.com to learn more and get started today. 

Are you taking a GLP medication? We are thrilled to share we are offering an online course, The GLP Guide, to answer the most common questions people have while taking GLP medications.

To sign up, please visit: www.sarahstombaughmd.com/glp

Transcript

Dr. Sarah Stombaugh:

This is Dr. Sarah Stombaugh, and you are listening to the Conquer Your Weight Podcast.

Announcer:

Welcome to the Conquer Your Weight Podcast, where you will learn to understand your mind and body so you can achieve long-term weight loss. Here's your host, obesity medicine physician and life coach, Dr. Sarah Stombaugh.

Dr. Sarah Stombaugh:

Hello, everyone, and welcome to this week's episode of the Conquer Your Weight podcast. We are going to be talking about the Biggest Loser documentary, which hit Netflix last month. And I've actually had quite a few patients with whom they've brought it up to me and said, “Oh my gosh, Dr. Stombaugh, you have to listen to this or you have to watch it. Have you watched it yet? What do you think about it?” And it sparked some really interesting conversations in clinic. One thing that I will admit to you guys is that I'm not a huge TV person actually at all. And so it involved a little bit of research for me here, both in going back to catch some episodes of the show. I did catch some episodes when they aired live, but refreshing my mind on it a little bit as well as watching the documentary. So we are going to dive into that both just a little bit of a summary of what The Biggest Loser is, what it did, how it portrayed weight loss, and then I'll share some of my thoughts of what are some of the challenges and really damaging principles that came up, I think, as part of the documentary? But then also, what are some of the positive takeaways? Because this show was filmed in an era where while bariatric surgery was an option, medical weight loss was not then what it is right now. And I think there are some really powerful takeaways that we can take from the show and then that were summarized and shared also in the documentary. 

Before we dive too much into today's episode, I would love to invite you to be a patient in my practice. I am enrolling patients now for in-person visits in Charlottesville, Virginia, and for telemedicine visits for patients who live in Illinois, Tennessee, or Virginia. So if you are in any of those states and you've been looking for a healthcare provider who's able to support you in a comprehensive way, look at your whole health, take that opportunity to make a plan the aligns with your goals and your preferences, I would love to be the one to support you in that journey. My biggest goal is that patients find sustainable ways to lose weight. And we'll contrast that a little bit with what was happening on The Biggest Loser. And so I think part of the show that became so almost cringy for me was that it's very opposite from some of the things that I do in my own medical practice. And we'll talk about why we do some of the things that we do. So with that, if you're looking for a doctor, you're in those States, Illinois, Tennessee, Virginia, visit www.sarahstombaumd.com. And I would love to connect with you, learn more about you and support you as you're a doctor.

 So let's go ahead and dive into this episode, talking about The Biggest Loser, both the show, the documentary, and I'll share some of my reflections on it. So if you have not watched The Biggest Loser, I'm guessing that that most of you have in that it was so ubiquitous. Even as someone who does not watch a huge amount of TV, it's almost impossible not to have seen at least a handful of episodes because everybody was talking about it. It really was making waves. So it started in 2004 and ran until 2016. So it had 17 seasons during that time. And they were looking at contestants and supporting them in achieving weight loss goals with the goals of the person who had the highest total percentage of body weight loss would win the biggest loser competition and would get a monetary prize. And this was set up as a 30-week challenge. The numbers started smaller. I don't remember the exact numbers starting out, but it was a dozen or a growing, they had more and more people requesting to be on the show. They thought of ways that they could bring on more and more participants. And so they did see that the number of participants, they had that climb pretty significantly up to, I think, 50 at the highest, but don't quote me on any of these numbers. That is not the point of this episode. So I didn't, you know, do not fact check those, but started smaller. The popularity of the show grew, people desired to be on the show and the number of contestants on the show also grew over time.

And it was set up as these 30-week challenges. And week by week, what we were seeing as the audience was a recap of the week culminating in what was a weekly weigh-in. And participants would get on the scale. They would see how many pounds of weight loss they had had. And then they were calculating based on their own percentage body weight. I remember initially watching a show and looking at someone who lived in, you know, maybe a 250-pound body versus a 400-pound body and thinking, how can we compare the weight loss that these two people are having? So they did look at percentage body weight. So even though when they stepped in the scale, they would show pounds lost, the biggest loser was calculated based on their percentage compared to their starting body weight. So everybody was weighed initially, and it would go through and show us training sessions and how people were training. And this often looked like people training men. So people were often spending many hours very intentionally working with their trainers in a gym, as well as other exercise around the property where this took place. People were being given nutrition advice also by their trainers. So the trainers were directing them in these two different ways.

There were also challenges that would come up, temptations that would come up. So there'd be different things, for example, where they'd say, okay, you know, here's a room of all the different high-calorie, high-density foods that you can imagine. The person who eats the most calories gets to call their loved one, for example. And so these different challenges and then temptations came up. And some of the prizes were things like calling loved ones, things like winning an exercise bike, an unknown surprise, more time with our personal trainer, maybe an advantage at the upcoming weigh-in, like additional weight that would be lost, for example, or immunity against being voted off of the show. And these different challenges and temptations varied a little bit week to week. I think a lot of that was for, you know, for the show effect of getting us as an audience engaged and interested and pulling up that competition part that really drove. And then they would have their weigh-ins at the end of every week. And starting out, people participated in teams. And so there'd be three people grouped into a team together. They'd all be wearing their yellow team, red team, whatever. They'd be wearing their clothes associated with that color. And then everybody would be weighed. The person who, or the team rather, that had collectively amongst the three of them lost the lowest amount of weight. would be able to vote off one of the members of their team. 

And then as the team sizes decreased and they actually got rid of the teams and then individuals competed against one another. And so let's talk about the show. What were the good things? What were the bad things? What are some of the key takeaways? So thinking about some of the key takeaways, we're looking at what was a really dramatic weight loss. And so there were patients for whom they lost huge percentages of their body weight. And as I'm saying it, I don't have exact numbers here, but patients who lost over a hundred pounds plus during this 30-week period of time. And so they portrayed this journey for people that was involving, and this is how they, you know, this is the tools that they used was very severe caloric restriction alongside very intense exercise regimens. And we'll go into why there may be challenges with that. But we do know this is where calories in versus calories out principle that the thermodynamics of calories in versus calories out are true. The frustrating thing is that when we use calories in versus calories out to explain weight loss, to think about weight loss as a long-term thing, it is so much more complicated compared to you know, compared to this, just calories in calories out, there's a lot of other factors in the equation. And so there's factors looking at, you know, what is our underlying insulin resistance is someone, what is their propensity to be able to lose weight? You know, have they had weight loss and regain cycles in the past, or is this new for them to be losing weight? All of these things play a role. 

What we ultimately ended up seeing in The Biggest Loser was metabolic adaptation. And we did talk about this in a previous podcast episode. So we won't go into too much depth here, but metabolic adaptation is the effect by which after you have had a very significant weight loss, your basal metabolic rate decreases compared to what you would expect for your body size. So if you imagine someone living in a 200-pound body versus someone living in a 300-pound body, if both of those people were, you know, otherwise, let's say physiologically the same, had the same body fat to muscle mass percentage, ate the same foods throughout the day or ate the same types of foods throughout the day, moved their body similarly throughout the day. And we looked at what is the basal metabolic rate of these two individuals, the 200-pound individual, the 300-pound individual, and compared them proportionally, they would be the same. The 300-pound individual would have a higher basal metabolic rate. The 200-pound individual would have a slightly lower basal metabolic rate, but they would be proportional to what we'd expect for their body size. Now, what's interesting is that if that 300-pound individual has a significant weight loss, what we see is that the basal metabolic rate will decrease disproportionately compared to what we'd expect. 

So let's say that 300-pound individual loses 100 pounds and now weighs 200 pounds. And we have the person who started at 200 pounds, still weighs 200 pounds compared to the person who had a 100-pound weight loss journey to get to 200 pounds. What we will see is that that person who had a weight loss journey now has a lower basal metabolic rate compared to that person who had not had a significant weight loss. And this came out in a study that was released in 2016, where they looked at the season eight participants of The Biggest Loser. So that was participants who had been in the show in 2009. They looked at 16 of the participants and including factors from the beginning of the show where they had looked at the different health metrics and weight and body composition and basal metabolic rate and compared it to what happened then years down the road, what they found was that even years later, participants who had had this really extreme weight loss maintained a lower basal metabolic rate compared to individuals who had not had that experience of significant weight loss. So this metabolic adaptation can make it really difficult to sustain weight loss. So this is why we see the body is sort of fighting back in a way that we have this really significant weight loss. And then over time, things like our hunger signals are being ramped up, our satiety, so feeling fullness is being ramped down. So we feel hungry more often. When we do eat, we eat larger quantities. And overall, we have to eat fewer calories in order to maintain. And so it can be really challenging for people to, especially when we're talking about diet and exercise alone, a lot of times that would mean sort of continuously ramping up the amount of exercise that we're doing while also decreasing the amount of calories that we're eating. And for some people, especially on the show where they're already having these huge significant caloric deficits, seeing that it means eating just less and less in a way that is completely unsustainable. sustainable. And so this metabolic adaptation, of course, they didn't talk about it at all in The Biggest Loser show, but that was the big nidus for the show actually getting canceled.

So if you remember, I said the show ran from 2004 to 2016. And in 2016 was when the study was released. And the participants, the prior participants of The Biggest Loser, who had both experiences, the fact in their own bodies and in their own lives, then seeing it published. Of course, this study got a lot of press when it came out. There was a really big uproar and they demanded that the show be canceled. And ultimately, it was. It started to bring up some questions in the public eye, as well as other things that had gone. But that metabolic adaptation piece was one of the really big factors in getting the show canceled. And in the documentary, that was one of the things that they shared and I think was portrayed very accurately. I think another thing that as we think about how the show was portrayed, the emotional and psychological impact of public weight loss, this is one of the things that as an outside viewer and especially watching back now as someone who has the lens that I do, someone who as an obesity medicine physician work every single day with patients who are on their weight loss journey, and we often talk about the impact of losing weight just in general and what that does in terms of inviting comments from other people. 

It is every single day that I have a conversation with at least one, if not many of my patients about how to handle the comments that they're getting about their body as they're in their weight loss journey. And a lot of times those comments are well-meaning, they're positive, but they also can be really prying. People can ask really intimate or personal questions. People can be really judgmental. People can make accusations. Oh my gosh, you're not checking that Ozempic drug, are you? People in, you know, somehow like people in our society feel like it's appropriate to comment on other people's bodies in a way that every single day I'm having this conversation with my patients. We're practicing what are the type of responses that you can have talking about, you know, why you might respond differently to your sister versus your next-door neighbor versus your colleague at work and all of that. And when we lose weight individually, setting aside the biggest loser, there's a part of it that unfortunately becomes a public journey because we wear our weight on the outside of our body. But then we think about something like the biggest loser and we're taking that and we're really zooming into what does the day-to-day look like. We're seeing these extreme measures that people are taking in order to lose weight. The stress that they're under, how hard they're working, how badly their bodies are aching and hurting them at different times. There were some people who got severely sick on the show, people who participated in challenges that were beyond their physical capacity, and people who had heart concerns, people who had rhabdomyolysis, where their muscle breakdown impacts their kidney function. And these are severe health outcomes that that happened on the show and doing this in a very public way. You know, you've got millions upon millions of Americans viewing the show week after week. And then these were real people who we’re seeing their struggles. You know, they're videotaping every aspect of this when they're breaking down, when they're in the hospital or getting in the ambulance. And then these people have to go back into their real lives and not only face the comments about their body looking different, but also having turned a lens on what is a really, really intimate part of one's life. 

And as I think about every reality television show that I have ever watched, I'm having trouble imagining any of the other ones showing at least that broadly glimpses into individuals' lives, the challenges that they had. And so we see this emotional and psychological impact of public weight loss Now, I think there's some misleading and incomplete pieces of this as well. And the things that stand out really significantly to me are A, we are talking about something that is not sustainable. Now, I think whether we're talking about a weight loss journey or we're talking about any other big project or goal in our life, I think many of us can identify the feeling of, oh man, I wish I had a week or six months or whatever it was that I could just go on my own without any distractions and really focus on this thing. And that's exactly what happened. For the individuals who participated in the show, they had 30 weeks where there were no other distractions. They didn't have work. They didn't have family. They didn't have social engagements. They just had to focus on their weight. And while that can absolutely be an amazing opportunity for someone, and certainly we saw huge transformation in people's bodies and health metrics at that time, we're looking at what is a totally unsustainable way of losing weight and keeping it off for the long term.

So when you think about your day-to-day life, I think any of us looking at The Biggest Loser and seeing, okay, these people are exercising six hours a day. These people are having a severe caloric restriction. That is not something that you bring back into your day-to-day life and you're able to keep up in a sustainable way. I think also, and this is sort of a mechanism on the of the time. But when we think about weight loss, there is this overemphasis, especially in the show, on the personal willpower versus the medical, behavioral, genetic, biologic factors that contribute to obesity. And I think this show just played into our society's obesity bias that if these people with obesity just worked harder, if they just exercised more, if they just ate healthier, if they just ate less, that they could lose weight. And then we saw that that happened. And so how do we reconcile that with our society's obesity bias? And the challenge is, I think it just fuels into it even more in that we are, you know, we're sort of validating this belief that we have. What we didn't see is the participants after the show. We didn't see how none of us, you know, nobody is exercising six hours a day, unless you are paid to do, there's nobody who exercises six hours a day. That is not sustainable. And so as a society, you've got the masses of people now saying, okay, we proved it. They just need to eat less and they just need to exercise more and look how this is happening. And unfortunately, I think it just fueled that belief system even more and more. And these individuals who participated in the show went back into their lives, were not able to keep that up. And then in addition to just the... even if metabolic adaptation did not happen, the fact that these things were unsustainable, it was really a double whammy. And a lot of contestants saw pretty significant weight regain with many individuals regaining a significant portion of the weight that they had lost. And so what is true is that that was also now almost two decades ago that the show started and things have really evolved a lot in this space. 

As I mentioned, bariatric surgery was an option then, but Bariatric surgery has also evolved a lot in the last two decades in terms of effectiveness, in terms of safety, and certainly the evolution of anti-obesity medications or obesity management medications, especially the GLP medications like Ozempic, Wegovy, Zepbound, Mounjaro, and certainly other ones coming down the pike. It's funny, as I say that, you know, we know that there are other medications coming down the pike over the next year. And so whenever I I record an episode, I'm always even thinking about the people who are listening in 2026 or 2027 and like, oh, why didn't she mention this other medication? And that's how rapidly this field is evolving. And we're understanding obesity more and more. We're coming up with therapies that are not designed to be used alone. These therapies are designed to be used in combination with nutritional changes, with movement changes, with behavioral changes, with sleep changes, with the whole picture together. to be able to support someone in a comprehensive way. And so in some ways, watching the show, I think highlights the significance of this problem, how challenging it is for people to be able to lose weight in a significant way, how it doesn't highlight in the show, but did highlight in the documentary what it means for long-term in terms of metabolic adaptation. There are, of course, dangers in extreme caloric restriction and overexercising. They highlighted a couple of people who had been injured or gotten ill when they were on the show. And I think that's an important thing to point out. Even one of the shows where they were like, quote unquote, just running a mile, for someone who has not been able to walk many hundreds of yards, the idea of running a mile, it's really insulting. And it's really cringy to watch people feel physically paining themselves and they're psychologically, they're in it and they're trying so hard and physically their bodies are not at a stage where they can do that. And so that it's painful. It was painful to watch. I went back and watched the original episode of that. It's painful to watch that back. And that is something in an individualized weight loss journey, we start where you are. And that may mean walking, getting on a exercise bike for five minutes per day, that may mean no exercise. I commonly work with patients for whom they are dealing with really severe pain, particularly really severe pain of lower body arthritis, like their knees or their hips, and it limits their exercise really significantly. And while we know that will be part of their weight loss journey eventually, it may be something that we're layering on after six months or 12 months or two years, depending where they're at in their journey, if they need to have of orthopedic surgery during that journey as well. And so pushing someone too far beyond their capability is both psychologically damaging and it is physically damaging. 

And so that was one of the things that was really challenging that they portrayed, I think, really well in the documentary, but a really significant challenge that came up. And one of the things I don't think that was portrayed really well at all was obesity as a chronic disease state. And as we learn more and more about the body, about why obesity occurs. We know that obesity is not a disease of willpower. Obesity is a chronic metabolic change in our body. Having fat mass on our body and excess fat mass in our body creates some of the cravings for things like sugar, for things like flour. And it can be this really challenging cycle that willpower alone with lifestyle changes, with even some caloric restriction and extreme exercise, those are very unlikely to be enough for people to keep their weight off long-term. And that's where when we've seen medications come about, they've been really effective. One of the things that really broke my heart in the show was that they had just a little bit, or in the documentary, rather, they had just a little bit of a nod to some of the newer medications. But interestingly, they didn't actually go into the some of the medications from one to two decades ago, you know, looking at Phentermine, or they talked about Belviq, which is lorcaserin or lorcaserin, which got pulled off of the market due to safety concerns. And there was very little conversation about the GLP medications. And so what we do know is that our understanding of obesity as a disease has evolved rapidly, even since the ending of the years is when we've seen the more popular GLP medications, particularly the once weekly GLP medications. Ozempic came out right around that time, followed by Wegovy, followed by Mounjaro, followed by Zepbound. And these medications are really starting to shift things for people. There are also tools like bariatric surgery that still may be the right fit for an individual who meets those criteria. And a lot of times it's not an either or conversation. We may be thinking about what do we need both of these tools? Would we consider bariatric surgery and a GLP medication in order to support someone's health and weight goals? And or as we look into the future, other medications that may be available as well. 

And so if you've taken the chance to watch The Biggest Loser documentary, it's a pretty easy watch. I finished it in one evening while my husband was working night float. I had put the kids to bed and like, okay, I'm washing the dishes and I guess I did it in cooking dinner But, you know, cooking the dinner and then after dinner, washing the dishes, had put the kids to bed and kind of cleaning up for the evening. Although I don't necessarily recommend watching it in one setting. I did, whether that's good or bad to admit. But it's powerful to see, especially if you were someone who watched The Biggest Loser, seeing the reflections on it. If you're in your own weight loss journey, comparing and contrasting what that looked like to what you're doing in your life. I think it can bring up some really interesting questions as it happens. in my one-on-one visits with patients about what their journeys are, fears that have come up for them about this. And so it's a pretty powerful watch. And so I do recommend watching it, but also not using it for medical advice, because I think whether we're talking about medical advice or just weight loss advice, I do not think it is the most sustainable way for patients to lose weight. And so with that, we'll go ahead and wrap up today's episode. Thank you all so much for joining me. I'll see you all next time. Bye bye.