The decision to allow overweight or obese youngsters to participate in Season 14 of The Biggest Loser TV show in the US has sparked great controversy. On the one hand the rise in childhood and adolescent obesity is a cause of great concern; but on the other hand health professionals feel that young people should not be exposed to derision and public censure because they have gained weight.
The Biggest Loser TV Show
Most South Africans are aware of what these Biggest Loser TV shows entail. A group of severely overweight or obese participants are put through sheer hell for a number of weeks to identify the one individual who is able to lose the most weight in the given period. Winners are showered with praise and wonderful prizes.
In The Biggest Loser SA in 2008, the three finalists, managed to lose a total of 161.2 kg or about 2 large adults weighing 80kg each. Statistics such as a total weight loss of 73.3 kg by Sharon, the ultimate Biggest Loser SA in 2008, are mind-boggling and may well serve as an inspiration to other individuals who struggle to lose weight.
However, reality TV shows often walk a very thin line between actually helping people to improve their lives and exposing them to public humiliation and shame. I admit that I sometimes get a creepy feeling when I see other human beings being exposed to total ridicule because they have not managed to lose the specified amount of weight. Somehow, the circuses of Rome spring to mind. What difference is there between making some poor person stand in front of all his/her peers to be weighed like a sack of potatoes and throwing them to the lions in the Colosseum? The principle remains the same - someone is sacrificed and the crowd cheers!
So what I find so reprehensible about the decision to include teenagers in Season 14 of the Biggest Loser USA is that adolescence is the one period in a person’s life when he or she is already struggling to build up their persona (body image, psychological makeup and character). To expose individuals during this "fragile period of life" to the potential ridicule and shame that accompanies weight-loss programmes on TV, is in my opinion totally reckless and should be prohibited. Let’s face it, teenagers have enough stress to handle with academic demands, peer pressure, awakening awareness of sexuality, and parental expectations, that shaming them for not losing weight may just be the last straw.
We are all aware that the obesity epidemic sweeping through the world seems unstoppable and that the current adolescent obesity statistics for countries like the US and unfortunately also South Africa, are increasing exponentially. The old adage that "fat children/teens become fat adults" is often true. In addition, being very overweight in adolescence can lead to people developing all the diseases of lifestyle at a young age, namely:
It is, therefore, imperative that everyone who is involved with nutrition, dietetics, physical activity and psychology, should make a concerted effort to assist adolescents to lose weight.
However, helping young people to lose weight requires a structured and caring approach to prevent severe psychological damage. An example of potential psychic damage is the total inversion from obesity to anorexia or other eating disorders, that can occur if teens are exposed to unrealistic slimming programmes.
According to Mahan and her coauthors (2012), adolescents suffering from severe overweight or obesity should be carefully assessed by a dietician and if necessary a support team of experts such as a psychologist, endocrinologist and even a sociologist. The reason for this approach is that childhood and teen obesity is a multifactorial condition with many contributing causes:
physical activity level
existing dietary intake
The initial workup should ideally include a detailed medical history of the teen and his/her family to identify tendencies to develop diseases such as hyperlipidaemia, hypertension and diabetes mellitus. If the young patient’s history includes two or more of these risk factors, then blood tests after an overnight fast to check for raised blood fat levels (cholesterol, triglycerides), and glucose and insulin levels, should be carried out.
The Staged Care Treatment Process
Mahan and her coauthors (2012) outline recent guidelines for the use of a "Staged Care Treatment Process" that has been developed to treat adolescent overweight and obesity. This process consists of the following stages:
If the young patient does not have any of the above mentioned conditions and has not yet completed her adolescent growth spurt, she/he is given nutrition guidance and advice on how to increase physical activity:
Eat 5 or more servings of fruits and vegetables every day
Don’t skip breakfast, because it is the most important meal of the day
Limit how much food you eat outside the home, especially fast foods and foods bought from street vendors
Eat at least 5 meals a week with your family sitting around a table if possible
Start learning what appropriate portion sizes look like - not super-sized, but usually fist-sized or smaller; half a cup, not a litre, etc
Cut down on the intake of sweetened cold drinks, squashes and even fruit juice
Do at least 60 minutes of physical activity 7 days a week
Limit time spent in front of a screen (TV, internet, computer games and movies) to no more than 2 hours a day (Mahan et al, 2012)
This stage is similar to Stage 1, but is more structured because it monitors food and drink intake of both the adolescent(s) and their families, usually by means of food diaries or records. Screen time is reduced to 1 hour a day and meal plans are provided to further monitor food and drink intake.
Non-food rewards can be used (allowing the teen to participate in an event like a social or a dance; or giving gifts of clothes, jewellery or music) to reinforce positive behaviour and health gains such as weight loss or an increase in physical activity. Monthly follow-ups by the dietician are recommended (Mahan et al, 2012).
This stage is even more structured that Stage 2 and requires the assistance of the entire multi- disciplinary team of a physician, a psychologist or social worker, a registered dietician and an exercise therapist. Teen patients and their families should have 8-12 weeks of weekly appointments with their team of counsellors followed by monthly or bimonthly checkups. In this Stage, very structured meal plans and a physical activity schedule together with a formal behaviour modification programme, are used to assist highly obese youngsters to start losing weight (Mahan et al, 2012).
This stage can only be used for severely and morbidly obese adolescents who require hospitalisation and a full team of health professionals to implement treatments such as liquid meal replacement, modified fasts, oral medication to promote weight loss, and even bariatric surgery.
Please note that Stage 4 should only be performed in a clinic or hospital and only under the supervision of highly trained health professionals who will monitor the young patient constantly. None of the treatments mentioned under Stage 4 should under any circumstances be used on teenagers to cause forced weightloss by parents or the young patients on their own (Mahan et al, 2012).
It is evident that "throwing obese/overweight teenagers to the lions" (i.e. exposing them to global approbation on TV) is NOT the solution to adolescent weight problems. I would not be surprised if a desperate young person on one of these TV shows commits suicide one day. Such a tragedy should be avoided at all costs.
Because South African TV producers tend to follow American trends, I shudder to think that we will also be exposed to a local version of The Biggest Loser SA featuring young and vulnerable contestants. This would be shameful and I would like to now already appeal to South African TV producers not to even contemplate making money out of the shame of our children.
While the US' "Staged Care Treatment Process" to treat adolescent overweight and obesity may seem like a fairytale to most South Africans, it is still important to implement a caring and nurturing process to help your teenager lose weight and regain his or her health and confidence.
(References: Mahan LK et al, 2012. Krause’s Food and the Nutrition Care Process. 13th Edition. Elsevier; Yandoli KL (2013). David Broome, Executive Producer of ‘The Biggest Loser;’ Addresses Controversy Around Teen Contestants on Huffpost Live - Video)
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Dr Ingrid van Heerden is a registered dietician and holds a doctoral degree in Nutrition and Biochemistry. She believes that "we are what we eat" and offers free nutrition and weight loss advice via her DietDoc service on Health24.com. Read more of her articles.