Much has been going around today about the most recent "winner" on the Biggest Loser. Rachel won the contest, with an ending weight of 105 pounds--equivalent to a BMI of 18 for her height, which is underweight. There are plenty of good discussions I won't try to repeat, including this one, where the writer says that the message is "if you are fat, you should do whatever it takes to not be fat anymore".
That message is absolutely true, and permeates everything in our society. We had a lively supper discussion this evening, including my 14 year old daughter. I don't want to throw around "eating disorder", because that represents a diagnosis. But I will throw around ideas like "disordered eating", "unhealthy weight loss", and "obsessive relationships with food and or exercise".
Let's start with the science. One place obesity researchers turn to is something called the National Weight Control Registry. This is comprised of a group of people who lost at least 30 pounds and kept it off for at least one year. Now, this is certainly a bar lower than that achieved by contestants on The Biggest Loser, but plenty of the people within this registry have experienced such weight losses. Almost all of them report having eaten less and exercised more as part of their weight loss strategy. But let's take a look at what makes them the most successful. (Yes, it's a news outlet. If I link you to a journal, most of you will get stuck behind a paywall. Some trust must ensue.)
They never cheat, even on holidays and special occasions. Count calories constantly. They weigh themselves every day. Exercise every day, equivalent to nearly 30 miles a week. Eat up to 300 calories a day less than others--meaning less than other "thin" people. These are just the averages, so plenty of people are above that.
Like I said, I'm not going to toss around the idea of "eating disorders", but that seems a bit on the obsessive side to me. Maintaining a weight loss doesn't mean being active and seeking out healthy food. It means thinking about your weight ALL THE TIME. Even when you've already reached that Holy Grail of "Healthy Weight".
Is this what we want? We certainly advocate for people to lose weight. Since these strategies are some of the only ways to maintain that loss, it would seem it is what we want. However, these characteristics--obsessive restriction of food, obsessive exercise, obsession with weight--are hallmarks of eating disorders. It is, of course, much more complex, but my point is that perhaps we should consider whether the behaviors that lead to long-term weight loss "success" are potentially damaging to mental health.
What's more important is that these behaviors will often be overlooked by medical professionals, as was recently discussed with regard to adolescents. I could show up at my primary care doctor's office with a dramatic weight loss, perhaps 50 pounds, getting myself down into the overweight category. I would be congratulated on my success. Almost any obese person who did that would be. We forget to ask the question of "how did you do that?"
As for our supper discussions, we talked about how this "extreme" approach, being thin at any cost, is more than just an idea held by a few trying to succeed at the near-impossible task of maintaining weight loss. It is the only idea promoted.
My daughter has a friend who, after trying many different ways to lose weight, and still being told by her doctor that she is overweight, has now decided to limit herself to weight-loss shakes. Her doctor is probably right, based on current definitions, but I seriously doubt this was his or her intended behavioral change. Consider what this child's day is now--constantly thinking about what she eats.
As a real sign of the extreme as the new normal, my daughter's PE class is the INSANITY Workout. I'm completely serious here. Where we live, most teenagers arrive in high school with virtually no physical education under their belts, a casualty of high-stakes testing and intense focus on academic skills. If a child arrives in 9th grade with no math skills, the school holds some responsibility for that. And we divide them up by skill level, ensuring that kids have a chance to succeed at an appropriate level. Not so with PE. After years without PE or other physical training, these kids are doing INSANITY. On top of that, a kid starting with a 15-minute mile--not a crazy speed for an overweight kid who has spent the last ten years relatively inactive, doing 3 hours of homework of night--has to get that down to about 8 minutes in order to get an A. In a matter of 9 weeks.
Oh, and the kids all get weighed before and after.
The expectations simply can't be achieved in a healthy way. Don't get me wrong--I want kids to be a healthy weight. I want them to eat well and be active. But I also want them to enjoy eating well and feel the benefits of being active. An ounce of prevention is absolutely worth a pound of cure. But once they've reached the point of being overweight, we don't just give up them, do we? Do we try to teach them reasonable, healthy behaviors, at the risk of them never achieving a "desired" weight? Or do we push them to extremes to reach that weight?
Obviously, I believe in the message of health and healthy behaviors. But the environment we live in, one comprised of The Biggest Loser and INSANITY and gorgeous women like Jennifer Lawrence being Photoshopped to remove nonexistent flaws, what do you think will win out?
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