Let's talk numbers and how skewed our idea of "maintaining" is. Since everyone else does, we're use The Biggest Loser as an example of how undefined "maintenance" really is
In a previous column I explored definitions of weight maintenance used in the scientific literature.
Let’s use a familiar example to illustrate some of these definitions.
The TV show The Biggest Loser features obese people losing weight through diet and exercise. There is a prize for those who lose the greatest percentage of their starting body weight.
Several former contestants have translated their experience into careers in fitness training or as spokespeople. Given their status and visibility these people presumably have incentive to keep the weight off. NBC aired a special Thanksgiving episode in 2009 interviewing previous participants, showing how their lives have changed. Many ruefully said they’d regained since their finale.
I was curious, just how much? And over what time period?
As it turns out, some of this information is available. Of the last seven seasons of the show, 39 former contestants shared their weight in a 2009 MSNBC feature about their lives. Two contestants from the first season supplied their weight, but their height is unavailable, so we will use data from the 37 for whom we know both height and weight (seasons 2 – 7).
I plugged the numbers into a spreadsheet.
According to the current National Weight Control Registry (NWCR) definition of successful maintenance, all 37 contestants in our sample have kept off at least 10% of their starting weight, even Erik Chopin, who gained back 175 lbs after winning in Season 3. In fact all former contestants who had a finale over a year ago would qualify to join the NWCR by having kept off at least 30 lbs. Again, even Erik Chopin would be eligible, as he has kept off 39 lbs from his maximum 407 lbs.
In the “where are they now” episode, NBC didn’t appear to consider Erik a “successful maintainer.” In fact, he was offered a challenge to get fit again in time to weigh himself for the upcoming Season 9 finale.
According to a 1999 criterion for successful management by the NWCR, only six contestants have stayed within 5 pounds of goal weight. One has kept within five pounds for two years, three for one year, and two for less than a year.
| Maintenance category |
| Within 5 lbs of goal |
| Most BMI improvement |
| Under “obese” for <1 years |
| Under “obese” for 1-2 years
|
If even Eric Chopin is a “successful maintainer” by current NWCR standards, clearly this definition is at odds with what NBC (and I) consider “successful.” Can we do better? Personally I would expect “successful weight loss maintenance” to mean “keeping my body size in a healthy range.” But how would one determine that?
Let’s use a measure that accommodates differences in height. We can conveniently use Body Mass Index (BMI) which is calculated in kilograms of weight divided by the square of height in meters. This will allow us to roughly compare the results among the various contestants.
BMI does not take into account body composition. A person can have a large proportion of muscle and be placed in the “overweight” category with a BMI between 25 and 30. Because of this, let’s accept that any Body Mass Index (BMI) under 30 (i.e. below the “obese” category) can be considered generally healthy. Except for heavily muscled athletes such as bodybuilders, most people with a BMI over 30 likely carry excess body fat.
I have color-coded the BMI for each contestant at their starting weight, at their finale weight, and at the weight reported in the MSNBC article. The spreadsheet is sorted in order of greatest to least BMI improvement between the starting weight and the weight as of autumn 2009.
| BMI | Classification |
| < 18.5 | underweight |
| 18.5–24.9 | normal weight |
| 25.0–29.9 | overweight |
| 30.0-34.9 | obese |
| 35.0 – 39.9 | severe obese |
| 40.0 – 44.9 | morbid obese |
| 44.9 < | super obese
|
All but seven contestants were at a BMI under 30 at their season finale (five were obese and two were severely obese).
Of these 30 former contestants ten are now “obese” and one is now “super obese.” Twenty are still at a BMI under 30 that we will for our purposes consider ‘healthy.” This means given the known data 37% of former contestants who were not obese at their finale are now at an unhealthy weight again.
Longest maintenance of a BMI under 30:
- Nicole Machalik and Hollie Self have both stayed under a BMI of 30 since December 2007.
Overall BMI improvement as an index of health:
- Jim Germanakos dropped his BMI from 57 to the current 31 (up from 27 in December 2007), an overall improvement of -26, and has kept it off for two years. His twin, Bill Germanakos, has managed to keep an overall improvement of -19 for two years.
- Jeff Levine has sustained an overall improvement of -17 for four years.
- Nicole Machalik managed an overall improvement of -16, and has kept it off for two years.
- Hollie Self has an overall improvement of -16, and has kept it off for two years.
- Matt Hoover has an overall improvement of -17, and has kept it off for four years.
These are just the contestants whom MSNBC chose to tell us about and who shared their current weight (one is pregnant and another cited philosophical reasons). Based on the data we have for the for seasons two through seven, 68 contestants finished with a BMI under 30.
If the only contestants who stayed below “obese” were listed in the MSNBC feature, then that would mean more than 70% of contestants who once had a BMI under 30 are now obese again, within four years.
Despite media attention and presumed incentive to keep the weight off. Which means that just like the rest of us these folks have problems with weight regain.
The story clearly doesn’t end at the finale, any more than it does when we reach our goal weight. Which is why we need all the help we can get, including scientific research on how to stay at goal weight, not just keep 10% off.
Very interesting information, anja. Thanks for sharing. I particularly like how you pointed out that while Eric Chopin was within the so-called "limits" of 10% of his original weight, given his original weight was in the 400s, it clearly is not always a practical limit if the original weight was severely obese. It also seems likely that the media such as MSNBC would be wary to show those who have failed to keep the weight off, thereby slighting the true facts.
I agree with your comment "Personally I would expect “successful weight loss maintenance” to mean “keeping my body size in a healthy range.”" To me, Eric Chopin is a perfect example where that theory is false, so I agree that healthy range is better, particularly using BMI and weight range, keeping in mind height and body composition.
Great article. You're doing so great. Keep it up!
Yeah, I've thought a lot about how to measure "healthy". Basically, under a BMI of 30 I figure you should go by % body fat. And the most accurate way to do that is to have a full-body DXA scan done. (Mine cost $100) And in it I found out that although my frame is small, my bones are 25% denser than average (probably because of having carried around over 300 lbs for so long). So when my BMI was 25 (borderline overweight), my body fat was actually 19% (in the "athlete" range).
Angela, please keep sharing your thoughts about this. It is true that the focus for so many is to lose weight, without real consideration for how to maintain. Making permanent changes in how we instinctively want to behave is difficult. We are warring with ourselves. We act in certain ways that feel right but have unhealthy consequences to our bodies. We want to stop having those consequences, but feel most comfortable acting in the unhealthy ways. I hope you are successful in your quest.
Yep, making a personal transformation stick is really tough, in just about every instance, whether it's drugs, alcohol, risky behaviors, procrastination, or whatever. Our minds seem to fall so easily back into the well-worn rutted paths they're accustomed to – heck they CREATED those ruts over years of habit…
I hope I'm successful too. At least this time I haven't taken the difficulty for granted. Having been around the block once before does that to a person! LOL
Fabulous! I really enjoyed reading your thoughts on this. And I completely agree with you.
Yep, making a personal transformation stick is really tough, in just about every instance, whether it's drugs, alcohol, risky behaviors, procrastination, or whatever. Our minds seem to fall so easily back into the well-worn rutted paths they're accustomed to – heck they CREATED those ruts over years of habit…
I hope I'm successful too. At least this time I haven't taken the difficulty for granted. Having been around the block once before does that to a person! LOL
Really good commentary! Maintenance is the holy grail of this process. It's not magical! Keep up the good fight! Birdie.
As you know and have stated bmi is far too flawed to be selected as a measure.
Also remember that the finale weight for us contestants is not our 'goal' weight. It is our competition weight. Same as a wrestler, boxer etc.
Pete Thomas
Fat Free For Five Years.
Hi there Pete,
Reading between the lines a little, you're not in the data Angela collected form the MSNBC article, but nonetheless it sounds like you're tired of seeing Biggest Loser folks used as an example. If that's not true, let me know. If it is, please understand this.
The point isn't to beat up on anyone dealing with weight loss and what it means for them. With all the other challenges and concerns of actually keeping weight off there's also defending yourself against all the "you lost weight wrong/less righteously" nonsense.
So TV personality, bariatric patient, diet center, folks who went it alone — I don't care how people lost weight. It all has potential to change someone's life for the better, and help others do the same.
And in most cases, we all wind up at the same place anyway — hitting goal, people thinking you're "cured" and abandoned to figure out how to keep it off with almost no support or guidance. And then be looked at as a failure for struggling with it. Some struggle with that more than others at some point, sure. But no one gives those challenges their due while everyone talks about how keeping weight off is impossible. That's not a coincidence.
Breaking that vicious cycle is the mission of this site: "Who lost weight better" or all the fat pants "success story" hype aren't games anyone wins playing. That is not something I'll indulge on this site, and if that's misunderstood in Angela's article, I want that point made brutally clear.
For the past week, Angela and I teamed up to look at how flimsy definitions of maintenance are and the far-reaching implications of it. In that sense, TV personalities are no different than anyone in the trenches.
– Without research (scientific here, but also marketing) to provide a clear understanding, the diet industry is far less likely to give maintenance any aggressive attention. We got more on this in the next week or two, but it's a horrible cycle of diet industries not offering any genuine guidance on different elements of maintenance and not wanting to focus on maintenance because too few do it.
– From a public policy standpoint, understanding that in obesity, losing weight != keeping it off won't be clear.
– Also, we're all having to work with faulty tools. Holding everything into consideration, we decided BMI was useful to decide between obese/not obese, and then otherwise ignore it. Science has its place — especially in information-deprived areas like maintenance — but it's not the end all, be all. It's just a piece of the puzzle, along with food, the "who am I now the weight's gone" questions, fitness, and new goals.
Rather, the information folks like the NWCR is important, but we're encouraging them to also look at the bigger picture. More than anyone, they're capable of creating some basic guidelines of maintenance. Using the MSNBC article as an example was just to prove — with the information available — just how poorly scientific definitions agree with the people they're trying to address and help. That's point's easier to prove when looking at the most highly visible group of people in weight loss.
But by no means are we turning up our nose to contestants. If anything — outside considerations aside — it just proves what we're saying. There's a ton of support for losing weight, and almost none for keeping it off, and that's what Angela, Kevin, Patty and I are determined to change.
Why did the study not have Peter Thomas and Ally in it? These are two contestants I can think of off the top of my head that were glaringly missing. It would have made the number a little higher of those able to maintain… Shouldn't you have looked at them all?
I wish the msnbc article HAD included data from all of them – unfortunately there were only numbers for 37 of them, as I mentioned in paragraph 6… So I used all I had.