Childhood obesity & The Biggest Loser—bold step or backward thinking?

You might have heard of NBC’s The Biggest Loser?  If you haven’t, then I feel pretty confident that you’re successfully staying under the two hour (one hour if trying to get to a healthier weight) recommended maximum daily quantity of screen time!

This season’s Biggest Loser  includes 3 teenagers. NBC’s rationale is that it’s helping to “tackle the childhood obesity epidemic head-on.” The network has sought to position the inclusion of teenagers as a bold step in our national effort to address a childhood obesity epidemic of monumental proportions. Granted that the teens apparently aren’t subjected to the same extremes (such as being yelled at and pushed to the point of vomiting during exercise) as adults, but the attitudes the show promotesand the teens’ participationare very concerning.

Problem number 1: The name

The first issue is the show’s name: The Biggest Loser.  It’s doubtlessly intended as a playful pun, but it has an undeniably mean edge – one that should make any of us uncomfortable if we’re concerned about judging and stigmatizing people based on looks. The name “Biggest Loser” feels especially loaded to me, cutting uncomfortably close to both my work and my personal life. As medical director of the Texas Center for the Prevention and Treatment of Childhood Obesity, I interact daily with kids who are challenged by their weight. Patients and parents shed tears while recounting stories of guilt, stigma and bullying.  I too was a big kid and continue to have to make choices every day as I try to maintain a healthy weight, and so I can relate to these kids.

Problem number 2: The kids

As for the actual teenagers on The Biggest Loser, I worry about the stress they face nowand may face forever onwardsfrom living out their weight loss struggles on national TV.  I know firsthand that making changes as an individual is hard. But to expect these kids to also be “ambassadors for change” for their families and for the viewing audience is too much to ask.  More importantly: Research shows that people challenged by their weight are more likely to suffer from depression, anxiety, and low self-esteem, which is why many of our patients at the Texas Center for the Prevention and Treatment of Childhood Obesity receive support and treatment from our behavioral health team. I hope that the show’s teens and adults receive this too, both during the show and afterwards. Otherwise they’re at high risk for a lifetime of feelings of guilt and blame.

Problem number 3: The scope of the childhood obesity challenge

Then there’s the fact that obesity is the result of so many factors. Personal choice and new habits are an important piece of the puzzle. (If I didn’t believe that, then I wouldn’t see patients in our clinic.) But there are broader forces at play. Food subsidies have contributed to the pervasiveness of processed sugars and cheap carbohydrates – all linked to America’s increasing girth – in the convenient, inexpensive foods we all gobble so readily.

These same subsidies have exacerbated the price difference between processed foods and healthier vegetables and fruit. Meanwhile, our busy lives revolve around driving rather than walking and often leave us “too busy” for exerciseand sleep. In many urban neighborhoods, crime contributes to lack of activity, since outside play and even walking down the sidewalk (if residents are lucky enough to have one) seem too dangerous to pursue.

The show tackles none of these issues. Granted that one episode showed contestants (whom some might describe as food addicts) locked up in a room full of junk food and sweets for hours. Perhaps the scene was a metaphor for the home environment in which so many children and adults live: Processed snacks, no room to move. Maybe it influenced some TV viewers to examine (and change) their own home environments. Or maybe not.

Problem number 4: The ripple effect

Perhaps most troubling of all is the impact the show has on its audience. In one study, watching 40 minutes of The Biggest Loser caused viewers to have “significantly higher levels of dislike of overweight individuals.” Surely tackling the childhood obesity epidemic should be done from a place of empathetic concern, even love. Not active dislike.

Turning lemons into lemonade

That said, The Biggest Loser  captures a massive audience. (The premier reportedly attracted 7 million-plus viewers.)  Many, many families, children and teens are watching.

Does that include you? In a perfect world, you might turn off the tube and do something better with your time. (After all, excessive screen time is linked to unhealthy weight.) But if you aren’t willing to do that, at least engage in some active viewing. Take opportunity to open a dialogue with your family about what’s happening on screen. How do you and your kids feel about the approaches taken on the show? What are the pros and cons of each?

My own take on healthy messages that we ought to be spreading is simple, and it comes from a concrete evidence base. The families who are most successful in our programs do three things:

  1. Make small changes that stick.  They start small with the easiest changes and then build on progressive successes as they move to a healthy lifestyle.
  2. Make changes as a family. Kids will be far less successful if we expect them to become healthier on their own, and healthy changes are good for everyone, regardless of weight.
  3. Keep it positive. There are strong reasons and forces influencing our daily choices, so changing our habits can be tough. Additionally, kids and adults challenged by their weight are more likely to also be challenged by depression, anxiety, low self-esteem and using food to comfort negative emotions. So focusing on the positive, and not dwelling on slip ups or appearances, is extra important. 

Dr. Stephen Pont is the medical director at the Texas Center for the Prevention and Treatment of Childhood Obesity. If you watch The Biggest Loser and are on Twitter, check out #PedsDocsBL where American Academy of Pediatrics physicians and other doctors (including Stephen @DrStephenPont) from the US, Canada, Mexico, and as far away as New Zealand share thoughts on the show—some positive and some not so positive—every Monday night.