Wednesday, December 14, 2011

Weighing In On The Population-Based Lessons from The Biggest Loser

But for being born centuries
too early, another potential
TBL contestant!
Despite vowing to never let it happen again, the Disease Management Care Blog was ensnared, along with over 7 million viewers, into watching much of last night's NBC's The Biggest Loser finale.  While the participants' physical transformations were truly astonishing, it found the lachrymose blubbering, manufactured suspense, emotional vulnerability and emphasis on exercise over diet so awful, it couldn't look away.  The icing on this cupcake was $100K winner Jennifer's spooky mydriatic gazing "bedroom eyes." 'Nuff said about that.

The good news is that this media mugging didn't stop the DMCB from extracting three weighty insights.  To wit:

Focusing massive amounts of personalized counseling for persons who are simultaneously at high risk and exhibiting willingness to change is certainly part of the answer to managing the population-based dimensions of obesity. Alas, while that makes for good pseudodrama, the DMCB worries that the show is promoting a belief that all the obese really need is some gumption and a personal trainer.  The science says otherwise.

In thinking about the distribution of obesity among normal adults (a graph is here), The Biggest Loser is intensely case managing a small number of persons at the farthest right side of the curve.  Case management has a role, but the complete answer includes overlapping strategies that move the entire weight curve to the left with less sensational but proven evidence-based interventions. They include promotion of smart food choices, portion sizes, breastfeeding, school physical education, recreational spaces, walking as well as countering excess television viewing and the food industry's pernicious marketing.  That'll take blocking and tackling by schools, employers and local governments.

The overly perceptive DMCB also thought it detected the outlines of girdles under some of the contestants' spandex. Because human skin can stretch to accommodate increasing body volume, the loss of large amount of fat from under the skin can leave patients with an unsightly saggy exterior.  While the web is replete with unproven cures, the only viable option is plastic surgery. The DMCB couldn't find any population-based research that sheds light on how many formerly obese persons become baggy and how many go on to need surgery, but Google "obesity" + "compression garment" and the results suggest this is a growth industry.  Despite their success at slimming down, the DMCB suspects that many of These Biggest Losers may have lingering body sculpting issues to deal with.

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