Tag Archives: exercise

Loser: Biggest Loser

I’ve avoided the show The Biggest Loser on purpose, but Dr. Doug McGruff happened upon it in the break room between patients in the emergency ward:

I have never watched this show, as I assumed it would be ridiculous. I was shocked how much I had underestimated. I could not believe the amount and types of exercise these poor people were being put through. They even showed one contestant collapsing on a treadmill and being spit off the back of the machine by the spinning tread. Then there were multiple scenes of the contestants being screamed at by that Gillian lady in the tank-top/midriff shirt (talk about narcissistic) and some sadistic guy with tattoos all over his arms. The instructors’ contempt for the obese was obvious as they spewed insults (and saliva) in the faces of the contestants. I don’t care how fat or desperate I was, if someone did this to me I would punch them in the face and storm off the set. I checked in on the show between patients. The diet and exercise shown were prescriptive for ravenous hunger and ultimate failure. As I continued to work, I kept thinking about the importance of biologic signaling, and why it does not have to be this hard.

Dr. McGruff graduated from the University of Texas Medical School at San Antonio in 1989 and studied Emergency Medicine at the University of Arkansas in Little Rock, where he served as Chief Resident. He is one of the “smart guys” I like; not a researcher in some academic office running computer queries to do some fancy meta analysis, but a practicing physician who sees real people with real problems every week.

Every person who has struggled with a “diet and exercise” program to lose weight knows the problem Dr. McGruff identifies:

Overtraining (especially in the obese) triggers cortisol and other stress hormones. A low fat, high carbohydrate diet signals insulin release. These signals defend a high level of stored fat and drive huger…a true prescription for misery and failure.

Theories abound in what passes for dietary science. The ones based on science rather than just observation appeal to me the most. Dr. McGruff explains why a short high intensity workout is better than the Biggest Loser’s cardio-based workouts:

The key to turning around these sorts of metabolic disasters is to send the correct biologic and hormonal signals. If the correct signals are given, there is a disproportionate improvement in the metabolic state and body composition. This disproportionate response is courtesy of a second messenger system. Most hormones do not act directly on their target organ or tissue.

The cell wall protects the cell; most hormones cannot pass through the cell wall easily. Instead, the hormone’s fat soluble receptors bind the hormone on the outside of the cell wall and transmit the signal to a messenger inside the cell itself. I always think of the way an amplifier can take the puny signal from an iPod, process it, and play it through big, power hungry speakers. And in this case, amplification does indeed happen. The second messenger, on the inside of the cell, amplifies the signal:

The unique thing is that the second messenger then activates a chemical cascade that multiplies the signal at the target. This way a single molecule of primary messenger can produce thousands of second messenger signals at the target.

In other words, your cellular stereo amplifier is set on “10” (or “11” if you are a This is Spinal Tap fan).

This is why a proper signal is so important…the beneficial effect is hugely magnified. A brief, but intense workout that fatigues the musculature activates growth hormone, testosterone and adrenaline which all signal to empty glycogen and fat, both short and long-term. A hunter-gatherer diet creates a low insulin signal which triggers the body to defend a lower body fat set point.

The fact is, you don’t need a skinny person who has never fought a weight battle yelling at you to lose weight or become healthier. And chances are, even after that ordeal, your weight problems will return:

On camera, Zwierstra seemed giddy and brash, interrupting host Caroline Rhea, hollering at her friends in the audience, tipsy on her 3-inch heels. Secretly, she was woozy, having dehydrated herself by avoiding liquids, baking in a sauna and fasting for days to skim off those last few pounds.

The studio audience went wild as the cameras panned in. Zwierstra stepped on the scale. Rhea hollered, “Your current weight is …”

The scale heightened the tension: Beep. Beep. Beep.

144 pounds!

She’d lost 45 percent of her body weight.

But it wasn’t enough.

In the end Erik Chopin, a New York deli owner, took home the big check, losing more than 200 pounds from a starting weight that topped 400.

In January he appeared on Oprah to describe how he’d gained half of it back.

The top two contestants of The Biggest Loser’s third season have not solved their problems. The impossible standard set by the program’s extreme exercise program won’t work for them, or for many people. At its heart, The Biggest Loser uses the “calories in / calories out” principle, comparing the human body to a gas engine rather than to a metabolic organism. It is rooted in the 19th century science that measures food content in how much heat it gives off when burned in a furnace, rather than using modern science to understand how the human body actually works.

Exercise Doesn’t Shed Pounds?

Gary Taubes, the nationally acclaimed science writer, explains why exercise and weight loss are not physiologically linked:

The one thing that might be said about exercise with certainty is that it tends to makes us hungry. Maybe not immediately, but eventually. Burn more calories and the odds are very good that we’ll consume more as well. And this simple fact alone might explain both the scientific evidence and a nation’s worth of sorely disappointing anecdotal experience.

The New York magazine article is a good read, and includes Taubes’ signature style of including historical perspective to frame the issue. And he gets to the underlying philosophy behind the “calories in / calories out” theory of weight loss: the idea that the body is a thermodynamic black box that has to respond to the balance of calories taken in and calories expended.

But we are not gasoline engines. Taubes explains that the thermodynamic black box theory (TBBT) fails to take into account the role of fat tissue in our metabolism. Studies showed fat people maintaining or gaining weight while eating less than thin counterparts. But the thin people were more active. The correlation seemed to support the TBBT theory. But studies of overweight people who increased activity substantially, including a controlled study where Finnish researchers trained overweight men and women to run a marathon, showed that they maintained their weight.

Overweight people who have tried the “diet and exercise” remedy can commiserate with their Finnish brothers and sisters.

Taubes relates that our bodies have been shown to try and maintain certain levels of blood sugar, hormones, etc. We have evolved to try and counteract the entropy of our environment and gradual breakdown of our bodies. Our survival depends on it:

The key is that among the many things regulated in this homeostatic system—along with blood pressure and blood sugar, body temperature, respiration, etc.—is the amount of fat we carry. From this biological or homeostatic perspective, lean people are not those who have the willpower to exercise more and eat less. They are people whose bodies are programmed to send the calories they consume to the muscles to be burned rather than to the fat tissue to be stored—the Lance Armstrongs of the world. The rest of us tend to go the other way, shunting off calories to fat tissue, where they accumulate to excess. This shunting of calories toward fat cells to be stored or toward the muscles to be burned is a phenomenon known as fuel partitioning.

What is the mechanism for storing calories as fat? Insulin, working in concert with an enzyme, lipoprotein lipase (LPL), determines if energy should be burned or stored as fat.

Low carb dieters know that one effect of eating a low carb diet is to even out the insulin response. Those of us with insulin resistance also know that as we even out the insulin response, our cells become less resistant to the insulin in the bloodstream, and more of the glucose in our blood is used for muscular energy rather than stored as fat.

A low carb diet is more than a weight loss diet; it is a lifestyle choice that leads to more stable weight for a lifetime. This is possible because, unlike exercise, eating lower carbohydrates in your daily diet aids in the feeling of being satisfied with the amount you have eaten. When you aren’t hungry, its easier to not reach for that snack.