Lessons from “The Biggest Loser” – Our Take

By. Dr. Linda Anegawa

It seems everyone is talking about the article published this week in the New York Times, about the long-term outcomes of some of the most successful dieters in “The Biggest Loser” (hereafter referred to as “TBL”) reality TV series.   This research, published in the journal Obesity, looked at long-term outcomes of some of the most successful dieters, in terms of total pounds lost.


The article claims to portray a depressing fact of these participants’ weight losses:  many of them not only regained weight 6 years later, but some regained large amounts of weight – even as much as 100 pounds.


What a buzz this has created on social media, and in our office!  Dieters are wondering (and rightly so):  (1) why diet in the first place at all, if we are destined to gain a bunch of it, or even ALL of it back?   And: (2) we know our metabolisms slow with weight loss, so to maintain the loss, will we actually have to munch only celery sticks forever, and forbid even the slightest indulgences?


I heard an NPR segment in response, where it was pointed out that regaining 100 pounds might not be a total disaster.  The physician-speaker argued that while the TBL dieters had regained, they were still mostly below their initial start weight.  And, extensive clinical research documents that small amounts of weight loss can have great health benefits.  While itʻs true that 5-10% loss of excess weight can be beneficial for sure, to me (and maybe to many of you) that feels almost like a consolation prize, after all that hard work.


Here are some of my theories about TBLʻs dieters, and what may have contributed to their current weight woes:

  1. The TBL dieters’ insulin resistance/metabolic syndrome tendencies were incompletely addressed. By having our dieters at OSR Weight follow the Ideal Protein protocol, we ensure that first, insulin hypersecretion is reversed through diet – the pancreas “rests” if you will. Then, through the gentle and very gradual re-introduction of small amounts of dietary carbohydrates, the pancreas is slowly “restarted”.  Without going through this pancreas-resting and then re-starting process, individuals with metabolic syndrome will tend to regain weight quite rapidly if carbs are re-introduced in too great amounts, or too frequently in the diet.  I’ve definitely witnessed this firsthand in the last year of prescribing the Ideal Protein protocol for patients.  What’s more is, the study’s authors even point this out themselves:  “Interestingly, insulin resistance was not significantly improved 6 years after the competition compared with baseline despite significant weight loss.”  Not a surprise.
  2. Overall very little was revealed about the TBI dieters’ intake or metabolic status. Were dieters eating adequate protein?  How many carbs did they consume, exactly?  What was fat intake – and was it healthy fat with plenty of Omega-3s?  Improper diet can dramatically impact weight regain.  Were dieters screened for other hormonal issues such as low testosterone in the men?  Hormonal imbalance can adversely affect healthy weight maintenance, sometimes dramatically.
  3. Issues of body image and adjustment to a new frame were likely incompletely addressed. During and after weight loss, both the conscious and sub-conscious mind needs to adjust to the dieter’s new size, a process which psychologists say can take at least a year.  If in a dieterʻs sub-conscious mind she still sees herself as obese, she will gravitate towards eating more food than is necessary to maintain a slimmer frame, and thus regain weight.  Strategies which can be helpful for adjustment include taking photos every 15-20 pounds throughout the transformation, professional counseling, support groups, and frequent dieter followup, especially early in the maintenance phase when dieters are most vulnerable.   It’s not clear from the study that any of this was done for the TBL dieters.
  4. The prevalence of eating disorders may have been undetected and thus incompletely addressed with TBLʻs protocols. Eating disorders such as binge eating disorder, bulimia, and night eating disorder are under-recognized and under-treated in those who are 100 or more pounds overweight.  No diet can ever possibly treat these complex disorders alone!  We often recommend that individuals with suspected eating disorders first undergo a psychological assessment prior to attempting healthy lifestyle change.  Otherwise, dieters are doomed to fail before they even start.
  5. No reference was made to any kind of weight maintenance protocol for TBL alumni to help keep them on track. Unlike Ideal Proteinʻs phase 4 which gives our dieters clear rules, behaviors, and education to stay healthy and manage occasional indulgences, Iʻm not sure that the TBL dieters had this comprehensive of a plan in place, which places them at a significant disadvantage.


No matter how we look at this study though, there’s much that we just donʻt get about fat mass disease.  Nutrient composition is important, as is dieter education and support.  But looking at both weight loss AND maintenance as an ongoing, holistic, lifelong process, with a comprehensive management system to aide the dieter – this may be the most critical.   We need to cultivate a “maintenance mindset” right from the start, as diets in themselves clearly can’t FIX any particular problem.



Link to New York Times article:



Link to the research study:


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