What That Biggest Loser Study Can Teach Us About Obesity

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On Monday, the New York Times published an article about contestants from The Biggest Loser‘s eighth season, all of whom lost incredible amounts of weight on the show—and almost none of whom had been able to keep it all off in the years that followed. The article focused on a study done by National Institutes of Health researcher Kevin Hall, a study that suggests the contestants regained the pounds largely because drastic dieting and weight loss had caused their metabolisms to, seemingly irreversibly, slow, causing them to burn fewer calories each day.

The article took off online, inspiring 2,400 on-page comments and reaching trending status on Facebook. And while the results of the study warrant that attention, Dr. W. Scott Butsch, of Massachusetts General Hospital’s Weight Center, says the takeaway is about more than metabolism: It’s about the misconception that weight loss, and weight maintenance, is simply about lifestyle.

“There’s a lack of education around obesity. It seems easier to accept that it’s a behavioral problem,” Butsch says. “It absolutely isn’t a one-size-fits-all [condition].”

That’s easy to understand, in theory. But Butsch says there’s still an underlying bias, even in the health field, that makes it hard to separate obesity from mental images of junk food binges and sedentary lifestyles. Yes, for some people, those are the primary ingredients for obesity—but for many others, they aren’t. That stigma can damage not only obese individuals’ psyches, but the care they receive from doctors.

“[There are] overarching comments of feeling like these individuals are less self-disciplined, less compliant, more annoying,” Butsch says. “These kinds of unfortunate character assassinations lead to physicians or other healthcare providers thinking that they’re wasting their time. Overall, they probably treat them with less respect.”

That’s a phenomenon corroborated by medical research. One 2015 study found that doctors may “view obesity as an avoidable risk factor that impedes their ability to treat and prevent disease.” Other research has shown that many medical students, whether explicitly or implicitly, have an “anti-fat” bias. Still more papers have shown that obese patients are less likely to receive cancer screenings, despite being at a higher risk of developing cancer than people without weight problems.

“We have to treat individuals with obesity like any other disease: with respect, and with a general interest in helping them reduce the risks that are associated with the disease,” Butsch says. “Routine diet and exercise recommendations may not cure somebody’s obesity.”

That’s a sad truth all too familiar to the Biggest Loser contestants highlighted in the Times piece, and to many people who have tried, unsuccessfully, to achieve and sustain weight loss. But Butsch says it’s something that still needs to be emphasized to the general public, and to many medical professionals.

“We have to focus on prevention of obesity and education around obesity, both for the public and to the health professions,” he says. “When you’re educated around obesity, I think we will make better treatment choices for patients.”