The Problem with the Biggest Losers

Three years ago a group of us at work did our own version of "The Biggest Loser," the popular TV reality show that gets highly obese people to lose a lot of weight. None of us were at the level of obesity seen on TV. Some of us even had a relatively healthy habit of exercise when we started the competition. We did all need to lose weight, though.

Over the next several months we did our weigh-ins and kept doing whatever we each wanted to do to lose the weight. I cut back my sugar consumption, added a boost to my exercise, and counted calories. I was successful. I placed second in the group. I had started at 211 and, over the two months I lost around 25 pounds. I continued on my regimen. By November 2013 I was at 176 pounds.

Two things happened then.

1- I semi-retired and got out of what had been an almost daily six-year habit of exercise because I was no longer working every day.
2- I had a minor surgery that slowed me down a little.

The results:

• By March 2014 I was consistently above 185: +10 pounds in 4 months.
• I went over 190 for the first time in mid-year 2014.
• By May 2015 it was 203.
• My cholesterol and blood sugar crept back up to borderline levels by Fall 2015
• I peaked in March 2016 at 214. Back up 38 pounds. 

With all this in mind I saw the news articles last week on a study of "Biggest Loser" TV participants:

"Biggest Loser" study: Why keeping weight off is so hard

Here's a little bit as reported by CBS News:

It's well known among obesity experts that when people lose weight, their resting metabolic rate slows, meaning they burn fewer calories while at rest. Their rate is often slower than it would be compared to other people of the same size who hadn't lost a lot of weight.

"The phenomenon is called 'metabolic adaptation' or 'adaptive thermogenesis,' and it acts to counter weight loss and is thought to contribute to weight regain," wrote the authors, researchers from the National Institute of Diabetes and Digestive and Kidney Diseases, part of the National Institutes of Health (NIH), in Bethesda, Maryland.

To learn more, using blood, urine and other tests, they calculated the resting metabolic rate and body composition changes in Season 8 contestants six years after the end of the weight loss competition.

The results are both shocking and not surprising with even the small, personal anecdotal evidence in my own situation:

...only one of the 14 contestants succeeded in maintaining their slimmer weight. The rest regained a significant amount of the weight lost during the competition, and their resting metabolic rates (RMR) remained unusually low.

And obesity experts said it supports previous research and what they've seen in their patient populations -- that it's really hard for people who've been obese and then lose a lot of weight to maintain their lower weight, or to lose weight again after they've buoyed back up to a higher weight.

Yep!

I know I have faced the problem talked about above. Along with the medical findings I have seen two other factors involved:

• Judgement of others who wonder why you can't exercise will-power. This breeds our own self-esteem issues as we buy into it. We wonder why we are so weak and powerless.Then the second factor kicks in:
• Instant gratification. We want to lose the weight quickly. We can't be patient and let it be a slow, daily process. That is partly because slow daily progress only shows up in the long-term, the big picture that few of us are able to sustain.

In the end we become losers at being The Loser.

It may very well be that we have been pursuing the wrong goals or missing some important points. Back to the news articles:

Dr. William Yancy, director of the Duke Diet and Fitness Center, said "The Biggest Loser" perpetuates the idea that the recipe for weight loss is simple: diet and exercise and you can drop the weight. But he said the study helps show how much more complicated an equation it is to keep the weight off for the long term.

"There's that constant mentality that if you diet and exercise to lose weight it can be fixed. But it's a lifelong challenge and we've struggled really hard to make it be seen like diabetes, that it [obesity] needs to be treated like a chronic illness," said Yancy.

He said that he's seen people manage to keep the weight off when they've approached obesity with the attitude that it's a chronic illness.

Yes, I realize the danger in making everything into a "disease" or "illness." That can easily become a cop-out, a reason to give up and just keep on eating and gaining. It is the issue that I have faced every day for the last 27+ years with addiction and alcoholism, both personally in recovery and professionally as a counselor. It can lead to a denial of responsibility and a fatalism that can be truly fatal.

What if our ability to lose weight and keep it off IS an illness? Well, I don't know the details of how that works, per se, but I do know how it works with addiction. As a result I also know that there is a key element that we need to bear in mind.

Responsibility. I am not a victim of my disease.

As a recovering person I have the responsibility (!) of daily managing my disease of addiction. I have to:

• take responsibility for the actions I take each day 
• live in a way that allows for daily management of my symptoms and
• be willing to change my lifestyle to deal with the symptoms and the consequences of my disease.

This could be a description of the disease of not being able to keep the weight off, a disease that could be called pre-obesity or food-ism. I have to give it a name that is meaningful to me and describes my situation. Borderline obesity and borderline diabetes could be my description of it in my situation. It is not a disease of will-power. It is, as indicated above in the studies of the Biggest Loser participants, a disease of metabolism. Just losing the weight doesn't change the metabolic system very quickly, if at all.

I am not sure at this point where all this takes me. I can, however, begin to apply what I know about addiction and see if it works. Things like "turning it over" and daily prayer and meditation. It could be things like awareness of triggers and urges- cravings- and the many ways I have discovered and used over 27 years to deal with chemical cravings. It may be as basic (though not simple) as "easy does it" and "one day at a time."

• For today I will practice a different lifestyle.
• For today I will be aware of the urges to eat in unhealthy ways
• For today I will ask for help and support to deal with stressors
• For today I will be grateful for the healthy opportunities ahead of me
• For today I will be good to myself, not allowing my impatience to overcome my daily movement toward health.

There are probably more that I could add. But that's a start.


Link to CBS News article referenced above.

A Starting (and Startling) Insight

Susan Sontag, Illness As Metaphor (1978), foreword, p. 3, Farrar, Straus and Giroux

Illness is the night-side of life, a more onerous citizenship. Everyone who is born holds dual citizenship, in the kingdom of the well and in the kingdom of the sick. Although we all prefer to use only the good passport, sooner or later each of us is obliged, at least for a spell, to identify ourselves as citizens of that other place.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~

A few weeks ago I found out about a good, important and long-time friend who is wrestling with "end-of-life" issues. That, of course, is a fancy way of saying he is in the advanced stages of a life-threatening, terminal illness. We've talked on the phone a few times and I have spent a great deal of time reflecting on the issues he is facing- and which we will all deal with some day. Being in the second half of my sixties it is obvious that I am closer to that than I am to birth. I have also been through many times of people dying in my life. Grandparents and parents, aunts and uncles, cousins and a nephew, best friends, a college roommate and hundreds of church members have all "passed on" during my life. In the past couple years one of my best friends learned of a genetic disease which places him at risk; another has been through some real medical difficulties emphasizing his health concerns; now the person who was there at the beginning of my adulthood, helping me discover what it means to be me.

Last week at work one of our doctors gave a talk that included the above passage from Susan Sontag. The phrases- "kingdom of the well" and "kingdom of the ill" resonated as did the thought that one day we all will exchange our "passports" from one kingdom to the other. I remembered the essay, but needed a refresher so I read the book. It is an "easy" read as Sontag gives us a history of the use of metaphor to describe first tuberculosis and then cancer. (Note: She later updated this to include AIDS.) The book was written in 1978, more than 35 years ago and may be at least partly responsible for the changes that I could sense in the specific metaphors she was dealing with.

Here, from Wikipedia is a summation:

[S]he challenged the "blame the victim" mentality behind the language society often uses to describe diseases and those who suffer from them.

Drawing out the similarities between public perspectives on cancer (the paradigmatic disease of the 20th century before the appearance of AIDS), and tuberculosis (the symbolic illness of the 19th century), Sontag shows that both diseases were associated with personal psychological traits. In particular, she says that the metaphors and terms used to describe both syndromes lead to an association between repressed passion and the physical disease itself. She notes the peculiar reversal that "With the modern diseases (once TB, now cancer), the romantic idea that the disease expresses the character is invariably extended to assert that the character causes the disease–because it has not expressed itself. Passion moves inward, striking and blighting the deepest cellular recesses."
-Link

Sontag was reacting to some of the then "alternative" therapies such as the use of psychotherapy, that ended up causing many people with illnesses to see it as their fault. When AIDS came along a few years later, this "blaming the victim" became even more prevalent. AIDS was, at times, presented as God's judgement on Gay people, for example.

I actually remember sometime during this early- to mid-1970s period reflecting back ten years on my mother's death from colon cancer. I recall wondering what she had repressed in her life that she died at age 48? What fears or anger or resentments was she holding in that ate away at her?

That was real, progressive, alternative thinking in 1975. Does that sound crazy in 2015? Not to some people. Every now and then you may still hear someone speak of a person who has a "cancer personality." Or when some research seems to indicate that a virus may be involved in some cancers, people don't believe it. When there is a vaccine, for example, some people discourage its use since it will "encourage" bad behavior which, of course causes cancer.

In some ways, thought, what all this can be is a difficulty accepting our individual powerlessness in the face of illness and death. To be able to blame it on some flaw or fault in our personality that we could have done something about, gives us a sense of lost power, yes, it's an awareness "too late" to do anything about it; but at least we are not powerless. We caused it. It is our fault. (I'll come back to that...)

First a bit more from Wikipedia about where this all goes:

Sontag says that the clearest and most truthful way of thinking about diseases is without recourse to metaphor. The tone of her treatise was angry and combative, and she makes sweeping claims that, while perhaps true to a first approximation, may go too far (Donoghue, 1978).

She believed that wrapping disease in metaphors discouraged, silenced, and shamed patients. Other writers have disagreed with her, saying that metaphors and other symbolic language help affected people form meaning out of their experiences (Clow, 2001).
-Link

Finding meaning in dying?

The current way of expressing that can be seen in obituaries where they will say that the person "fought a courageous battle" against the disease that took their life. I have at times reflected on that passage and realize that this still fits within the metaphor image.

My mother died of cancer before this phrase was used. As a 13-year old boy I wouldn't have said that I saw courage. I saw a disease taking her. She was powerless. And that scared the crap out of me. Was there meaning in that for her? For my Dad? For me? I don't think so. The meaning of dying is simple- "I am done. Time to move on."

Finding meaning in dying? Isn't that a little late to find meaning?

Or, as I have been asking it for about 25 years now,

What is the meaning of life if it ends in death?

That is something that we should not be ignoring at any time in our lives. The clearest and most truthful way IS, as Sontag says, to leave the metaphors aside, at least as we come to grips with our own mortality. It is to recognize that we do have citizenship in what appears to be two kingdoms. It also means seeing that these two kingdoms are not as far apart as we like them to be. It may even be that they are night and day of the same reality. Not flip sides, but part of a continuum.

As I have listened to my two friends wrestling with their end-of-life awareness I have been reminded of my own mortality. I have been reminded, as a radiologist said to one of the friends,

Life is a terminal illness.

But that is insufficient as well. While it places living and dying into the same plane, it also keeps the illness metaphor. Yet let's be real- we may not be able to speak of the unknown in any way other than metaphor. We use metaphorical language all the time to speak of God, in spite of what many fundamentalist literalists like to think.

So, then, where has that led me in these weeks as I have again come face-to-face with the human experience of this life/death citizenship? First,

• The meaning of life may be found in living in spite of dying.
• The meaning of death may be found in how we lived.
• And, I believe, it is in those "meanings" that we find the courage to continue in spite of illness or impending death.

At that point, as I always have to do, I return to the Twelve Steps of AA and the recovery world. As I learned early on from a spiritual guide, it is only when we come to the acceptance of our dying- the last step of death, dying and grief- that we have reached the First Step of Alcoholics Anonymous.

I am powerless and my life is unmanageable.

Leading me to Step Two

Do I believe there is some "high power" that can move me forward in sanity in spite of that?

If so, then there is Step Three

Let that higher power be my guide and source of power.

Everything else is how we do it. Simple? Sure.  Simplistic? No, not the way I have seen it. It is a daily walk in hope and meaning. The things I learn today at 66 are far different than the things I was learning 25 years ago when I first discovered these steps.

This is NOT, I repeat NOT, giving up. Powerlessness is NOT giving in to dying!! Notice again that it is only when we accept our powerlessness that we can seek the power to move on. It is only when we recognize the reality of what we face that we can look for the answers, decisions, directions and options that may impact who we are and what we do.

Illness itself may be the wrong metaphor in the end since it has a negative connotation. Can we accept "illness" as a given, part of our humanity? Can we accept that it will happen? In doing so can we also be ready to continue to affirm and uphold life when it does?

That may be a way that allows for more honesty, hope, and support.That is where courage comes in. That is where the courageous battle against an illness is not a denial of the illness but rather a willingness to seek support, care, treatment. It is a reminder that, yes, we all will die, but until that happens, we are still in the "kingdom" of the living!