‘Biggest Loser’ results: Better than weight-loss surgery?

"Biggest Loser" contestant Sandy Johnson, left, with trainer Jillian Michaels. The TV show's approach of combining moderate calorie restriction and roughly four hours of daily exercise yields bigger health gains than bariatric surgery, the program's medical director says.
(Anne Cusack / Los Angeles Times)

Contestants on the reality TV program “The Biggest Loser”not only lost weight fast, they “rapidly and substantially” lowered their blood pressure and improved their metabolic function, the physician who is the show’s medical consultant reported Friday to the American Assn. of Clinical Endocrinologists.

Dr. Robert Huizenga, the medical director of the NBC program and several other shows, including Univision’s “Dale Con Ganas,” says the combination of moderate calorie restriction and roughly four hours of daily exercise yields bigger health gains, more cheaply and with fewer complications, than bariatric surgery.

The formula for weight loss a la “Biggest Loser”: a daily regimen of one hour of intense resistance exercise, one hour of intense aerobic exercise and two hours of moderate aerobic activity, and calorie intake that ranges from 1,600 to 2,000 calories for men and 1,000 to 1,400 for women. The show’s approach to weight loss has been highly controversial, with many dietitian and physicians denouncing “Biggest Loser” for promoting rapid and unsustainable weight loss and unrealistic expectations for physical activity.


In an interview after his presentation Friday, Huizenga defended the show’s approach, saying that although slow weight loss can be effective, it rarely resolves patients’ obesity-related health problems entirely before patients abandon it and weight regain ensues. He added that slow weight loss routinely results in muscle loss, leaving patients with a higher proportion of fat-to-lean muscle tissue: “Loser” participants, by contrast, changed their body composition in the opposite direction, ending with a higher ratio of lean muscle and bone to fat than they had had at the outset. Participants’ average percentage of body fat decreased from a starting level of 48.9% to 30.4% at week 24.

Huizenga said that such changes had “never been documented before in the history of severe weight loss.” He said he had applied to the National Institutes of Health for a study grant that would allow him to compare the health benefits of a “Biggest Loser”-type regimen with those of bariatric surgery.

At a minimum, said Huizenga, the health benefits seen in the “Loser” participants demonstrate that current definitions of intensive medical intervention for weight loss fall far short of what will be needed to restore the severely obese to health.

“What doctors call ‘aggressive medical therapy’ is laughable,” said Huizenga, an assistant clinical professor at UCLA’s Geffen School of Medicine.

In a study of 35 of the show’s contestants from Seasons 11, 12 and 13, Huizenga said he had documented “absolutely unprecedented” drops in measures of metabolic dysfunction within five weeks of patients starting a grueling regimen of exercise and caloric restriction. Significant improvements in subjects’ fasting glucose levels, insulin levels and adiponectin levels were evident at the end of their first week in the rigorous program, and persisted throughout an assessment period of 10 months.

Participants’ average starting body mass index was 40, the cutoff for “severe obesity,” and half arrived on the set of the show with Type 2 diabetes or pre-diabetes. Thirty of the 35 participants were hypertensive and took medication to control their high blood pressure. Among participants who came in with an apparent clean bill of health, Huizenga said finer measures of metabolic function showed clear signs of trouble.


By Week 5 of their participation in the program, “all diagnostic criteria for pre-diabetes, diabetes and hypertension were absent in each participant,” he said.

In an interview, Huizenga said the “Biggest Loser” approach, which shocks a patient’s body to build muscle and bone while losing fat, may be intensive and costly. But he asserted it would probably be cheaper to treat obesity with such an intensive, short-term program than to treat a bariatric patient at a cost of $30,000 per surgery and the additional expense of treating complications.

“If someone like me could get half the amount that a bariatric surgeon gets to treat a single patient, you could see some amazing things,” Huizenga said.