Mariew24

Quick! Obesity is killing you! You need to drop weight and get your life back. What do you do? Do you exercise four hours a day? Or do you go for weight loss surgery?


Dr. Huizenga of the Biggest Loser and colleagues asked exactly that question – and you can bet what they concluded. The first two articles in this series looked at their research. It compared Biggest Loser methods to bariatric surgery and reported findings on weight loss and other effects.
As it turns out (spoiler alert if you haven’t read the previous articles in this series!), weight loss is faster among Biggest Loser contestants, at least for the first 7 months. And then? Who knows? The gastric bypass patients in the study continued to lose weight through 12 months, while the Biggest Loser contestants…weren’t even tracked. Who knows what they weighed at 12 months and beyond?
The research raises a lot of other questions for me. Here are the ones I would like to ask Dr. Huizenga, with each question followed by an explanation of what I am curious about.
Cost is obviously an important factor for almost everyone. Can you please explain your reasoning in saying a program like the Biggest Loser is more cost-effective than weight loss surgery?
Exercise for four hours a day – cheap, right? In theory, sure. Just join a gym for $60 a month and work out as much as you want. But is it really that simple? Not really, if you’re an average human being.
Take a look at the Biggest Loser contestants’ program. They didn’t just have access to a gym. They had trainers 6 days a week, a room away from real-world worries and temptations, and all the healthy foods they could dream of, not to mention medical care as needed. Value? Well, at a value of $2,500 per week (as listed on the Biggest Loser Resort website), contestants who were on the ranch for 13 weeks received a package valued at $32,500. That doesn’t include any additional support, like contact with trainers after the show was over.
There’s no getting around the fact that weight loss surgery has a big price tag of $5,000 or $10,000 or $25,000. But that’s only if you’re paying out of pocket, and it’s still less than the first 13 weeks of a Biggest Loser style weight loss program. Get some insurance reimbursement, and you could get surgery for free or for a reduced cost. Plus, you don’t need to leave your job for a few months to live at the ranch – another cost in itself.
Why do you believe slowed metabolism is more significant in weight loss surgery patients compared to Biggest Loser contestants?
You found a slowed metabolism in Biggest Loser contestants compared to gastric bypass patients at 7 months. You attributed the slow to contestants losing weight for the show’s finale…but the weight loss surgery patients in your study were also still losing weight at that time?
One of the reasons you promote intense exercise over weight loss surgery is because patients maintain more lean muscle mass and metabolism when they work out…but this didn’t seem to be a huge benefit in your study!
Can you please provide a sample day that includes four hours of daily exercise and that individuals could follow on a long-term basis to lose weight?
Okay, Dr. Huizenga says exercise can come out of television time, but I’m having trouble thinking of a daily schedule that includes four hours of exercise and still lets someone take care of the family and work. Here’s how I see it: wake up at 4:30, work out from 5:00 to 7:00 (thus missing your kids waking up), take kids to school, go to work by 8:30, walk on your lunch hour (that’s your hour 3 of exercise), get off work at 5, pick up kids, run errands, and get home by 6, have dinner at 6:30, work out from 7 to 8 (thus missing family time), put kids to bed, go to bed at 8:30 for a solid 8 hours of sleep. Fun life! (Not!).
Maybe you can drop some of your duties for a few weeks, but for the months or years it takes to hit goal weight? That’s just not realistic. And how much exercise is necessary for maintenance? I guess the study didn’t say…because it didn’t follow the Biggest Loser contestants for more than 7 months.
People aren’t supervised on a daily basis like they are on Biggest Loser. Is it safe to exercise for 4 hours a day, especially when we’re talking about people who may not have this kind of background?
Most people don’t have access to trainers and medical support the way Biggest Loser contestants do. And, people who are 100 or 200 lb. overweight aren’t generally used to exercising for hours a day (let’s face it: except for athletes, most people aren’t). How do they know what to do? How can they prevent injuries? Are there any health risks associated with exercising to the extreme?
How do you explain these health values?
Most of the health values improved with weight loss, but some of the Biggest Loser contestants’ values got worse. Why do you think “bad” LDL cholesterol increased by about 20 percent, and total cholesterol also increased significantly?
What are the long-term results in Biggest Loser contestants?
The show has been airing since 2004, and it has just completed Season 16. You must be in touch with some of these contestants and have the ability to contact others. What are their long-term results? Have they kept the weight off?
There are plenty of studies on long-term effectiveness of weight loss surgery. Most find that bariatric surgery is generally effective for weight control and improvements in health conditions such as diabetes, arthritic pain, and sleep apnea, for example. Many studies conclude that among people who are eligible for weight loss surgery, the ones who get surgery do better than the ones who don’t.
Is it really justified to say exercise is better than weight loss surgery when there is no evidence supporting that?

Thanks for posting this, Alex.
First, 26 is a pretty small sample size to draw conclusions from. I would be interested in knowing if the choice of 13 Biggest Loser contestants is truly randomized. I suspect that the quality of the evidence in this particular study would be considered low.
I'm trying to figure out how I would be able to commute and work and still be able to exercise or even watch TV 4-6 hours per day (which I don't). If I needed to do that under the supervision of a Biggest Loser trainer, I certainly would have to work to afford it.
I find it really funny that Dr. H is, in essence recommending one surgery over another in the form of an orthopedic surgery when the participant becomes injured.

Thanks for posting this, Alex.
First, 26 is a pretty small sample size to draw conclusions from. I would be interested in knowing if the choice of 13 Biggest Loser contestants is truly randomized. I suspect that the quality of the evidence in this particular study would be considered low.
I'm trying to figure out how I would be able to commute and work and still be able to exercise or even watch TV 4-6 hours per day (which I don't). If I needed to do that under the supervision of a Biggest Loser trainer, I certainly would have to work to afford it.
I find it really funny that Dr. H is, in essence recommending one surgery over another in the form of an orthopedic surgery when the participant becomes injured.

Oh and I forgot!!

Unlike Biggest Loser, once I have WLS, I CANNOT be "voted off the island".

Thanks for posting this, Alex.
First, 26 is a pretty small sample size to draw conclusions from. I would be interested in knowing if the choice of 13 Biggest Loser contestants is truly randomized. I suspect that the quality of the evidence in this particular study would be considered low.
I'm trying to figure out how I would be able to commute and work and still be able to exercise or even watch TV 4-6 hours per day (which I don't). If I needed to do that under the supervision of a Biggest Loser trainer, I certainly would have to work to afford it.
I find it really funny that Dr. H is, in essence recommending one surgery over another in the form of an orthopedic surgery when the participant becomes injured.

Thanks for posting this, Alex.
First, 26 is a pretty small sample size to draw conclusions from. I would be interested in knowing if the choice of 13 Biggest Loser contestants is truly randomized. I suspect that the quality of the evidence in this particular study would be considered low.
I'm trying to figure out how I would be able to commute and work and still be able to exercise or even watch TV 4-6 hours per day (which I don't). If I needed to do that under the supervision of a Biggest Loser trainer, I certainly would have to work to afford it.
I find it really funny that Dr. H is, in essence recommending one surgery over another in the form of an orthopedic surgery when the participant becomes injured.

Thanks for posting this, Alex.
First, 26 is a pretty small sample size to draw conclusions from. I would be interested in knowing if the choice of 13 Biggest Loser contestants is truly randomized. I suspect that the quality of the evidence in this particular study would be considered low.
I'm trying to figure out how I would be able to commute and work and still be able to exercise or even watch TV 4-6 hours per day (which I don't). If I needed to do that under the supervision of a Biggest Loser trainer, I certainly would have to work to afford it.
I find it really funny that Dr. H is, in essence recommending one surgery over another in the form of an orthopedic surgery when the participant becomes injured.

Thanks for posting this, Alex.
First, 26 is a pretty small sample size to draw conclusions from. I would be interested in knowing if the choice of 13 Biggest Loser contestants is truly randomized. I suspect that the quality of the evidence in this particular study would be considered low.
I'm trying to figure out how I would be able to commute and work and still be able to exercise or even watch TV 4-6 hours per day (which I don't). If I needed to do that under the supervision of a Biggest Loser trainer, I certainly would have to work to afford it.
I find it really funny that Dr. H is, in essence recommending one surgery over another in the form of an orthopedic surgery when the participant becomes injured.

Got it. So to to have a little bit better muscle mass and achieve a little more weight loss, I just need to exercise 6 hours a day.
Excuse me while I tell my husband that being at the gym is now my full time job. I'm sure he will understand.

The main thing we are lacking here is a comparison of weight maintenance 5+ years out. That's the info that actually MATTERS. And I love how he lists the costs and risks of WLS as arguments against it and then advocates orthopedic surgery! The mortality rate for Gastric Sleeve is lower than the mortality rate for knee replacement.
Still everyone can lose weight in a million different ways, so comparing weight loss between WLS and Biggest Loser's extreme exercise plan is completely meaningless. What we really need to know is what the maintenance stats are.

On top of the 3-4 hours of time during the day, which I don't have (nor do I watch TV most days much less for that long on any day), I would potentially need:
a hard core trainer which I really can't afford a dietician to plan my meals the desire to potentially cause serious damage my knees, my back, my ankles by continuing on program if an injury occurs time off work to heal from any injuries incurred as my job is pretty demanding physically a complete lifestyle change to accommodate my new schedule to not only lose the weight but maintain it. Instead, because of weight loss surgery I have been able to:
go to the gym on my own time and take group classes visit the NUT that was included in my follow up care after surgery go easy on my body if an injury occurs take just a few days off work while I got over the initial surgery lose weight and maintain while still spending time with my family, friends, and doing the things I love to do instead of spending every free moment at the gym and most importantly, live a lifestyle that I can easily maintain for the rest of my life, into my 60s, 70s, 80s.

Love it, hate it or ignore it completely, the “Biggest Loser” on NBC is one of America’s favorite shows. Millions of viewers tune in each week to watch contestants weigh in as they shed pounds during this inspirational weight loss competition. If you are a bariatric surgery patient or candidate, however, this inspirational show can be bittersweet.


You root for each contestant because you understand their fight against obesity. But if you have been a long-time viewer, you may also cringe regularly. That’s because of the show’s history of devaluing weight loss surgery as a legitimate weight loss aid. More than once, Biggest Loser trainers and the head doctor, Dr. Robert Huizenga, have stated Biggest Loser methods is a better way to lose weight than surgery, which they imply is dangerous and an inappropriate solution in all cases.
New Study: Biggest Loser versus Bariatric Surgery
Are these obesity experts right to discourage weight loss surgery in the national spotlight? Or should they acknowledge bariatric surgery as a possibly beneficial weight loss approach? A lot of us would love to know more about the weight loss program on the Biggest Loser competition and how its results are compared to weight loss surgery.
Now, we can. Dr. Huizenga has published a study comparing Biggest Loser to weight loss surgery – in particular, gastric bypass. It answers a lot of questions…and raises a lot, too! Here are the basics of the study.
The Study Groups
The study compared 13 contestants on the Biggest Loser to 13 roux-en-Y gastric bypass patients. The weight loss surgery patients followed their surgeon’s standard program, including the weight loss surgery diet and any required post-surgery follow-up care and support.
Biggest Loser contestants were on the Biggest Loser Ranch until week 13 or until they got voted off and were at home until the finale. While on the ranch, they exercised for 90 minutes 6 days a week under supervision and were encouraged to exercise up to three additional hours each day on their own. Their diet included lean protein, fruits, and vegetables, and limited sugars, fats, and processed grains.
The Results
By seven months, or the time between the start of the Biggest Loser season and the show’s finale, Biggest Loser contestants were ahead of bariatric surgery patients. The average Biggest Loser weight loss was 108 pounds while weight loss surgery patients averaged a loss of 78 pounds. By the end of the year, weight loss surgery patients got to an average loss of 89 pounds.
In addition, Biggest Loser contestants lost less muscle and more body fat. However, they also had a lower resting metabolism – that is, they burned fewer calories per day than the weight loss surgery patients. That means they are more likely to put the weight back on.
These are the key findings.
Biggest Loser contestants lost more weight at 7 months, but the gap narrowed by 12 months.
Biggest Loser contestants lost more body fat.
Weight loss surgery patients had a higher metabolism.
Weight loss surgery patients had lower levels of leptin, a hormone related to hunger.

Dr. Huizenga’s Conclusions…Leading to More Unanswered Questions?
Dr. Huizenga believes this study is a compelling argument against bariatric surgery. He refers to the risk of death (1 in 1,000) from bariatric surgery, as well as the high cost of surgery. He acknowledges the high injury rates of contestants but believes these can be treated with orthopedic techniques and surgery. Hopefully, you know a good orthopedic surgeon and have good medical insurance!
Do You Watch TV for Four to Six Hours a Day?
The Biggest Loser includes 90 minutes per day of exercise under the watch of Biggest Loser trainers, plus contestants are encouraged to exercise up to another three hours a day on their own. Do you have a spare four and a half hours each day?
Dr. Huizenga has a solution. He says most people spend 4 to 6 hours per day watching television. He suggests you could spend that time exercising instead. Indeed, a Nielsen survey backs him up. However, while the numbers may sound reasonable, can that be true in real life?
Do you really watch TV for that many hours each day?
When you “watch” TV, are you just watching TV (and are, therefore, available to do exercise instead), or are you already doing something else, like folding laundry or cooking dinner?
Are you willing to exercise that long each day?
Are you physically able to exercise that long each day?

To sum it up, this is an interesting study. Certainly nobody actually wants bariatric surgery – but is there an alternative? Can you follow a Biggest Loser lifestyle and get the results you want? Dr. Huizenga thinks so, but we have our doubts. Coming up, we’ll have an easy-to-read comparison of Biggest Loser and bariatric surgery. Then, we have a few final questions to raise about the study. Stay tuned!
If you’re interested in reading the original research article by Dr. Huizenga and his colleagues at the National Institutes of Health, Vanderbilt University, and Pennington Biomedical Research Center, you can go here.

ASMBS (American Society for Metabolic and Bariatric Surgery) posted a really nicely done video that I believe provides some awareness to the use of bariatric surgery. I am a Registered Nurse who, in late October had Lap RNY done.
Best thing I could have done for myself. Six weeks after my surgery, I became a Bariatric Program Coordinator to help others on their journey and to quite honestly live and work this journey myself. I've also become a health coach for the same reason.
This video is one of the better ones that I've seen. Please share it:
http://asmbs.org/video-it-starts-today-obesity-surgery-helps-people-reclaim-their-lives

ASMBS (American Society for Metabolic and Bariatric Surgery) posted a really nicely done video that I believe provides some awareness to the use of bariatric surgery. I am a Registered Nurse who, in late October had Lap RNY done.
Best thing I could have done for myself. Six weeks after my surgery, I became a Bariatric Program Coordinator to help others on their journey and to quite honestly live and work this journey myself. I've also become a health coach for the same reason.
This video is one of the better ones that I've seen. Please share it:
http://asmbs.org/video-it-starts-today-obesity-surgery-helps-people-reclaim-their-lives

ASMBS (American Society for Metabolic and Bariatric Surgery) posted a really nicely done video that I believe provides some awareness to the use of bariatric surgery. I am a Registered Nurse who, in late October had Lap RNY done.
Best thing I could have done for myself. Six weeks after my surgery, I became a Bariatric Program Coordinator to help others on their journey and to quite honestly live and work this journey myself. I've also become a health coach for the same reason.
This video is one of the better ones that I've seen. Please share it:
http://asmbs.org/video-it-starts-today-obesity-surgery-helps-people-reclaim-their-lives

ASMBS (American Society for Metabolic and Bariatric Surgery) posted a really nicely done video that I believe provides some awareness to the use of bariatric surgery. I am a Registered Nurse who, in late October had Lap RNY done.
Best thing I could have done for myself. Six weeks after my surgery, I became a Bariatric Program Coordinator to help others on their journey and to quite honestly live and work this journey myself. I've also become a health coach for the same reason.
This video is one of the better ones that I've seen. Please share it:
http://asmbs.org/video-it-starts-today-obesity-surgery-helps-people-reclaim-their-lives