Photo: Kathleen Dooher

Reality TV’s Diet Doc

The Biggest Loser, the reality television show that pits obese people against each other in a weight-loss competition, has had its share of critics. Contestants are urged to exercise up to six hours a day and cut their caloric intake in half, potentially losing twenty pounds a week, far more than the one to two pounds experts typically recommend. It’s pure Hollywood, admits Michael Dansinger, an assistant professor at Tufts School of Medicine who has been the show’s behind-the-scenes nutrition doctor for the last five years. “The top priority of a television show is to entertain,” he says, “and two to three pounds a week weight loss does not a show make.”

But he also believes overweight Americans desperately need more of the coaching, accountability, and structure found on The Biggest Loser. He has incorporated those features into his Diabetes Reversal Program at Tufts Medical Center, where he helps some forty patients keep their blood sugar in check through the grueling process of losing weight. While he may not challenge his patients to dive off a cliff, pull a car along a racetrack, or tempt themselves with a plate of their mother’s pepper steak, he does give them what all reality TV stars crave: lots of attention.

For the first few months with a new patient, he holds weekly individual counseling sessions. “The level of accountability is so much higher one-on-one,” he says. Having someone to answer to means that patients face short-term consequences for their dieting behavior. A show like The Biggest Loser provides many such consequences: a trainer in your face who might stop yelling if you run another lap, a teammate you don’t want to disappoint, the reward of a spa weekend. They’re effective because the human brain is wired to focus on the short term. “The default condition is to eat food that is delicious and avoid excess exercise,” Dansinger says. “Prevention of chronic disease turns out to be a very poor incentive for patients.”

Dansinger’s approach is based on his research. He made headlines in 2005 when he and his colleagues at the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts released a study comparing four popular diet plans: the Atkins, Ornish, Weight Watchers, and Zone diets. The results showed people lost similar amounts of weight regardless of the regimen they followed. “The adherence level of the participant,” he says, “was ten times more potent a predictor of weight loss than the type of diet.”

So Dansinger, determined to keep people on track, took to recommending food journals, where dieters write down everything they eat every day. “I’ve found that every patient who has achieved dramatic results has kept a food record, and that when patients discontinue the food record, that is often the beginning of a major weight regain or failure to continue losing,” he notes.

He began focusing on diabetes four years ago, in part because the medications for it “do such an incomplete job at reversing the complications,” he says. “Of all the weight-related diseases, diabetes responds the most dramatically to lifestyle change.” Consider the many diabetic contestants on The Biggest Loser: all have put the disease into remission through their weight loss on the show. “Most patients with type 2 diabetes are thirty-five to forty pounds above their diabetes remission weight,” Dansinger says, “and all it takes is a twenty percent reduction in calories to get there.”

His own record with patients is encouraging. Nationwide, only about five percent of type 2 diabetes patients manage to lower their blood sugar to a normal level that can be sustained without medication. Yet Dansinger’s success rate is about thirty percent—and patients achieve those results relatively fast. “If it’s going to happen, it usually happens in three to six months,” he says.

Unfortunately, weekly visits with dietitians aren’t covered by insurance for most people who need to lose weight, and physicians are too backed up to do regular lifestyle coaching. “‘I’ll see you back in three months. ’ That’s no way to provide accountability,” Dansinger says. He adds that insurance companies should, at a minimum, waive copayments for lifestyle coaching visits.

At least visits with The Biggest Loser are free. Dansinger thinks the show gives viewers hope that they can improve their lives. “Many people actually eat better and exercise more,” he says, “because they are reminded on a weekly basis that lifestyle change is potent medicine.”

JULIE FLAHERTY is the editor of Tufts Nutrition, in which this article first appeared.