Losing big -- fast

ON NBC’s whip-’em-into-shape weight-loss show, “The Biggest Loser,” the contestants spill an ocean of tears. Tears of frustration and tears of joy. Lips quiver. Chests heave. Noses run as tears well up then flow down dirt-streaked cheeks. And that’s just the men.

But the physical and emotional shellacking that the morbidly obese contestants undergo while dieting and exercising their way to dazzling new figures is only part of the show’s can’t-look-away formula. The reality series offers the tantalizing suggestion that excess pounds can be dropped quickly, without surgery, and that they can be kept off. That’s right. Poof. As celebrities such as Kirstie Alley and Janet Jackson conduct well-publicized battles to slim down -- and stay slimmed down -- the notion that real, permanent success is possible for everyone has made the weekly show a certifiable franchise.

The jury is still out among weight-loss experts. Long-term success, they say, is extraordinarily difficult.

Nonetheless, the show has spawned a bestselling weight-loss book, cookbook, DVD and an online community of folks who are paying $20 a month for “The Biggest Loser” diet information and support. It has also fueled a blood lust for competitive weight loss at schools, hospitals, fitness centers and even military bases, where creative dieters are using the principles of the show, albeit without the public flogging, to form their own contests.

Although most obesity doctors recommend losing weight slowly with moderate calorie reduction and moderate exercise, the physician and wildly telegenic trainers involved with the show are going about it differently. They think that their extreme, exercise-based diet plan may prove superior to slow-but-steady garden-variety diets at keeping weight off. “Most of these people had never been told that they could go out and get aggressive with exercise,” says the show’s physician Dr. Robert Huizenga, a Beverly Hills internist and sports physician.

And aggressive they are. Four to six hours a day of cardio and resistance training. For anyone, that’s intense; for the contestants, it’s a killer.

The goal is to get them close to a normal weight in a short period of time, while preserving as much muscle as possible. Because muscle burns more calories than fat, Huizenga thinks the contestants will burn more calories at their new goal weight than they would have following a traditional diet -- and thus be better positioned to keep the weight off.

Huizenga is so convinced of his theory that he has been tracking data on the weight, fat, lean tissue and other body composition changes in each contestant, starting in the first season, in an effort to prove it.

“This is an ongoing experiment essentially, and the results will have ramifications for the obesity problem in this country,” he says.

His preliminary data are intriguing.

Halfway into the show’s third full season, first-year contestants are nearing the two-year mark. Those contestants lost an average of 25% of their body weight over 22 weeks -- a whopping percentage by any standard. At one year and 22 weeks, the contestants had retained an average weight loss of 22.6%.

Huizenga is currently crunching the group’s results for year two.

In the general population, says Dr. Holly Wyatt, medical director of the obesity clinic at the University of Colorado and researcher at the National Weight Control Registry, research suggests that of those losing 10% of their body weight -- still considered a significant amount -- only about 20% will retain the weight loss in the first year. And, she points out, the numbers just get worse after that first year.

Pointing to the intractability of the problem, even several former contestants contacted for this story, presumably on their best behavior, have reported a slight regain -- or more -- of the weight they lost.

On paper, Huizenga’s premise has merit, says James Hill, director of the Center for Human Nutrition at the University of Colorado. “It absolutely, theoretically, could give them an advantage in keeping weight off,” he says. Massive amounts of exercise should enable the contestants to retain a little more muscle than traditional diets, and it could -- with emphasis on the could -- help them keep the weight off, he says.

“We don’t have any studies in real life where that has happened,” he says, “but we don’t have any studies that have really used the intensity of the exercise that they’re using on the show.”

In the end, though, obesity experts say the biggest factor in keeping weight off may boil down to something much simpler: whether the contestants continue to exercise.

At the ranch

These are the waning days of shooting on the lavish Hummingbird Nest ranch in Simi Valley.

Built on a site once inhabited by the Chumash tribe, the 140-acre ranch retains an eerie sense of time standing still. The huge Spanish colonial main house overlooks horse pastures and corrals, pools and an immaculately groomed equestrian lawn. On a warm July morning, there’s mist hanging over nearby hills and a rainbow in the distance.

Most of season three’s original 14 contestants have already left the ranch, having been jettisoned in weekly eliminations. (The identity of the remaining few is closely guarded because the final episode, revealing the $250,000 winner, won’t air until Dec. 13.)

At 8 a.m., Bob Harper, one of the show’s two trainers, bounds into the living room crackling with energy, tattooed and buff, hair pointing up at the top like he just rolled out of bed. He’s wearing an orange, tattered T-shirt and plaid Bermuda shorts and somehow carries it off.

Trainer Kim Lyons -- tanned with long, honey-colored hair -- comes in a few minutes later. They’re both brimming with good health and are tauter than a gum eraser.

It must seem a cruel trick to the contestants to have trainers who are perfect physical specimens. In fact, some previous contestants said that in their low moments, “I really wanted to punch [a former trainer] in her face.” And from one of this year’s contestants: “I wanted to push Harper off a cliff.”

The trainers take the love-hate nature of the relationship in stride. Half the battle, they say, is bolstering self-esteem.

“We tell them it’s not about looking like the girl on the magazine cover,” says Harper. “That girl doesn’t even look like that. It’s about feeling better about yourself.”

Harper and Lyons will spend the next few hours with their team, working on elliptical machines, stationary bikes and treadmills. Some might do balance exercises or targeted weight training while others go running on nearby trails.

Over the course of three months, the remaining contestants have spent seemingly endless hours in the gym, eating every three hours like clockwork. At the end of the day, they will have consumed five small meals loosely weighted as follows: 45% carbohydrates, 30% lean protein and 25% fat.

The contestants’ calorie allotment is based on a formula that includes their resting metabolism. Based on this formula, a 250-pound woman, for example, receives a minimum allotment of 1,200 to 1,550 calories a day.

At the beginning of the season, Huizenga, former team physician for the Los Angeles Raiders, performs a full work-up on each contestant that includes a treadmill stress test, blood tests and a high-tech analysis of lean tissue and body fat.

He follows up with blood and urine tests each week for the first six weeks, then every two to three weeks thereafter, looking for irregularities in sodium, potassium, muscle enzymes, uric acid and bicarbonate -- signs of gout, gallstones, dehydration or muscle deterioration.

“Many of them arrive with hypertension, sleep apnea, hyperuricemia [pre-gout], gout or gall stone disease,” Huizenga says. Some also clock in with asthma, acid reflux, pre-diabetes indicators and, in a few cases, full-blown diabetes.

Weight loss can reduce or eliminate these problems, and indeed by the end of the show, the contestants show a marked improvement in blood pressure and cholesterol as well as improvements in acid reflux disease, sleep apnea and more, according to their reports and Huizenga. After a few weeks, people who could barely ascend a flight of stairs work out full throttle at the gym.

Each of the contestants interviewed for this story said his or her weight had become life-threatening. “I knew that if I didn’t do something, I was going to die,” one said.

Forget about clean plates

During the show, the participants are constantly tutored in the basics of nutrition and portion control -- but the trainers have to start with the basics. “None of these guys know what an average portion is,” says Harper. “And I tell them forget about the clean plate club that we learned from our parents. It’s OK to throw it away.”

After three months at the ranch, the contestants are jazzed about their weight loss, but ready to go home. When asked about the possibility of regaining the weight, they all jump in, insisting that they now have the tools -- better knowledge of nutrition and exercise -- to keep the weight off.

The lessons learned have even had a trickle-down effect on the crew. A production assistant has lost 30 pounds, just keeping up with the contestants. Last year after the second season, production assistant Mike Duffy and camera assistant Nick “Tiny” Freleng picked up enough diet tips to lose 90 pounds and 160 pounds, respectively.

Some of the show’s editors are exercising at work. “I walk into the edit bay and they’re doing sit-ups,” says executive producer JD Roth.

Curiously, it’s not the speed of the contestants’ weight loss that engenders skepticism from obesity experts about the prospects of long-term maintenance.

“Studies have shown that long-term, it doesn’t matter if you lose it fast or slow,” says the University of Colorado’s Wyatt. “One or two years down the road, the people who lost weight slowly were equal,” in keeping weight off to the people who lost it fast.

In fact, sudden weight loss can even be a boon over more traditional, steady plans, but not for medical reasons, says John Jakicic, director of the Physical Activity and Weight Management Research Center at the University of Pittsburgh and author of more than 50 papers on exercise and weight loss.

“My guess is that the closer you can get the person to a healthier weight, the more you might motivate that person to keep it off because they’ve had a life-changing event,” he says.

As for the premise that if contestants retain more muscle they will burn more calories than traditional dieters after the loss is achieved, Hill, at the University of Colorado, penciled it out as follows:

Assume there are two 300-pound men, each with a body composition of 180 pounds of lean mass and 120 pounds of fat, and each loses 100 pounds total. If one loses 10% of the weight in lean mass and the other loses 20% (the norm is 20% to 30%), both will reduce the number of calories they burn at rest.

But the one who loses only 10% of lean mass (thereby retaining more of it) will burn an extra 200 to 300 calories per day.

Lean mass, which includes muscle, bones and organs, burns about 12 calories per day while at rest, says Hill, whereas fat burns about two to three calories. Over time, this differential adds up, he says.

The focus of obesity experts’ concern is whether participants will maintain an exercise program. Although the contestants won’t have to put in the bone-crunching hours that they do on the show -- regular daily exercise is a must, they say.

Researchers have established a direct link between exercise and successful weight loss maintenance. A study appearing in the August 2005 issue of the Journal of Applied Physiology found that 60 to 90 minutes of daily moderate-intensity exercise was required to maintain a significant weight loss. And a report in the October 1999 issue of the Journal of the American Medical Assn. found that subjects exercising about 4 1/2 hours per week were significantly more successful at losing weight than those exercising less than 2 1/2 hours.

All agreed that although exercise generally doesn’t burn a lot of calories, it’s the gold standard for keeping weight off. “There’s a saying that exercise may be the worst way to lose weight, but it’s the best way to keep it off,” says Dr. Joseph Risser, director of clinical research at Lindora Medical Clinics.

Dr. Caroline Apovian, director of the Center for Nutrition and Weight Management at Boston Medical Center, questions the utility of the show’s research, noting that contestants are not representative of the general obese population.

Even if the long-term results are promising, she says, participants are still in the public spotlight and thus have more incentive to keep the weight off than the rank and file. “The problem has always been keeping the weight off in the real world,” she says.

But weight-loss experts were unanimous on one thing: that for those interested in losing huge amounts of weight, slow but steady makes more sense because smaller amounts of exercise can be incorporated into a normal schedule.

Matt Hoover, season two’s “biggest loser,” who has since regained 27 pounds, endorses that tried-and-true approach. “Take your time and plan to lose the weight slowly, through proper diet and exercise,” he says.

Dr. Harvey Simon, associate professor of medicine at Harvard Medical School, worries that those attempting to replicate the “Biggest Loser” regimen may be setting themselves up for failure.

“People who set unrealistic goals often end up seeking solace in the pantry,” he wrote in an e-mail, “thus becoming the biggest losers of all.”

Although no one knows what the future will bring for the contestants, one thing is certain: After Huizenga has crunched his data and determined if the contestants actually maintained muscle and kept the weight off, obesity doctors will have a little more information to work with.

The information will be welcome. Researchers need to know more about how exercise affects the physiology of the morbidly obese, the University of Pittsburgh’s Jakicic says.

“This work probably shows that in properly screened, very obese individuals who are unfit, most can ramp up to a fairly high level of exercise without negative side effects, and this is an important message,” he adds.

How this all plays out is no small thing for the “Biggest Loser” contestants, now home, hoping for a thinner future. With luck, says Harper, what the contestants learned on the ranch will stay with them.

“I tell them, ‘We’ve done what we need to do to, but then it becomes your responsibility to take the torch,’ ” says Harper. “I hope to God in heaven, and I’m going to pray every day that you are able to do it, but know that there’s no finish line. There’s never ever a finish line.”

janet.cromley@latimes.com