CW: Did you hear any real world messages from the Biggest Loser science?

There are a few things that endurance sports enthusiasts understand well: the importance of hard work, dedication and the need to push through discomfort.

In fact, I would submit that these requirements act not as deterrents but as draws. Take triathlon as a case and point: if it was easy and safe, and perhaps less ‘Iron,’ who would want to do it? We endurance folks advocate for suffering.

So with this as a backdrop, what should a bike-racing heart doctor from one of America’s unhealthiest states think about the most recent bru-ha-ha about scientific findings from the Biggest Loser?

In case you haven’t heard, the medical director of the Biggest Loser, Dr. Robert Huizenga, presented an abstract at the 2012 meeting of the American Association of Clinical Endocrinologists in which he chronicled the miraculous resolution of poor health measures in selected contestants on the Biggest Loser. (Ed. Note: Endocrinologists are hormone and diabetes specialists)

The Presentation:

Dr. Huizenga presented health records on 35 (59%) contestants from the Biggest Loser (May 2011-March 2012). Normally, I tell you about the intro and methods before the results.

In this case I will start with the remarkable results:

He found that contestants enjoyed breath-taking improvements in common measures of health. The Biggest Loser regimen “virtually reversed” diagnostic criteria for pre-diabetes, diabetes and hypertension. This occurred quickly (5 weeks) and despite stopping medicines.

These findings led to far-reaching conclusions: (I’ll quote from the press release.)

• Dr. Huizenga believes that the study indicates that this type of program should be the first choice for anyone who is morbidly obese (Body Mass Index over 40) and who wants to lose weight and restore their health and well-being.
• “We backed into a better mousetrap. It’s very gratifying to see this weight loss formula of intensive exercise actually also lead to a reversal of disease conditions,” Dr. Huizenga concludes. “It’s not easy, but it also isn’t invasive surgery with all of its inherent potential risks.”

Like many pseudo-science studies, the problems come in the Methods section. For starters, Biggest Loser contestants are incented by money and potential fame. This makes them an unrealistic sample of normal obese patients. Secondly, contestants follow a very atypical and not easily repeated exercise program, including four hours of exercise per day. You’ve seen the show—said exercise often involves a great deal of intensity.

Of course, no normal person can or should exercise that much. Nor is it useful to hold up selected financially motivated contestants as normal obese patients. And most glaring is the lack of long-term follow-up. These short-term gains may be just that: short-term.

My take:

That said, I’m far less inflamed than the very well spoken physician blogger, Yoni Freedhoff, author of Weighty Matters. Dr. Freedhoff says Dr. Huizenga’s motives bring to mind two of science’s bed bugs—cognitive dissonance and conformation bias. He calls for the abstract presenter to undergo fumigation. Gosh, that kind of inflammation makes me worry that Dr. Freedhoff is at risk for AF.

Let’s put a slightly less inflamed spin on the ridiculous study. I see it as a proof of concept. I realize there are plenty of studies showing exercise helps diabetes and high blood pressure, but this one really says it. Though I do not condone the means, it is striking what can be done when the body and mind decide to do it. In just a few weeks, without medicines, these patients were able to eliminate two disastrous diseases. Leave aside the motivation and lack of long-term follow-up, Dr. Huizenga showed the most hopeless of obesity patients reversed their illness. They did it. Let me repeat: THEY did it themselves!

This leads me to another Mandrola-ism. I believe good health can start with a sprint. People, me included, frequently fly off the handle when they start exercising or dieting. Some are even silly enough to try an Ironman. I did a half-marathon with basketball sneakers and one-week of prep. In many cases, some of these health sprinters start feeling the side effects of their goal-chasing. They feel less winded, their clothes become baggy and people start to say nice things like, “you look younger.” Then they flip. In an optimist’s world, they find balance and start on a road to a healthy life. Some of the infected then became vectors of good health. They spread the word and before you know it, your hood feels like Boulder Colorado. (Okay, that’s a stretch.)

My good friend and dean of the Academy of Masters of the Obvious, Bob Bobrow, once wrote me a treatise on what’s wrong with the Biggest Loser approach to life, happiness and health. He captures the essence of the problem:

We don’t believe that you can just exercise, just play, and be healthy and happy and wise. We don’t believe that you can do what comes naturally, go with the flow, enjoy the ride and be successful. You have to push it, bear down, bust a gut.

And there has to be an end game. A goal. A finish line. We don’t exercise to exercise. We exercise to lose weight, look sexy. We exercise for rock-hard abs and buns.

His recommendations are clear:

Sustained weight loss and good health and even a happy life don’t come from gutting it out. A healthy weight and a healthy you are side effects of a healthy, sub-threshold lifestyle. They aren‘t the end result of short bouts of sprinting followed by long periods of doing nothing. There’s no stopping in life, except for death. If there’s competitive analogy, good health is an ultra-marathon, not a sprint. So be the tortoise not the hare. Plug along at your pace. Find your limits and operate within them. Push them, but occasionally, but not as a rule. Enjoy your exercise. Don’t gut it out. Work within your limits, under your threshold, whatever they may be.

Forget about goals, pounds lost, laps run, weight lifted. To steal back a pilfered phrase, “Just do it.” You will enjoy yourself, and the results you want will just happen.

Mr. Bobrow’s recommendations are often recanted when asking healthy ninety-year-olds how they have lived so well and so long.

Hmm?

JMM

P.S. Let’s do a few words on the over-achieving Dr. Huizenga. (Disclosures are always important.) A son of a nuclear physicist and Harvard and Michigan graduate, Dr. H is an associate professor of clinical medicine at UCLA. His experience as the LA Raiders team doctor inspired him to write his first book, You’re OK, It’s Just a Bruise—A Doctor’s Sideline Secrets about Pro-Football’s Most Outrageous Team. This book was notable because it was at least partly adapted to the movie Any Given Sunday. As an athlete himself, Dr. Huizenga’s interests have been in the effects of extreme exercise on obesity.

Addendum: My friend Chris Kaiser from MedpageToday has this detailed report on the abstract.