Weight loss makes for compelling reality television. Perhaps this has much to do with our fascination with fat bodies, but I imagine it helps that it can be easily packaged into neat three-act dramas. Anyone with too much time on their hands will no doubt recognise this format, which has evolved little since its emergence in the mid-90s.
Act 1 – The Set Up: A group of fat sinners are presented to us, so we can sneer and point at their terrible life choices. Tablecloths are pulled back to reveal their daily diet, with slender experts on hand to point out how calorie-filled and disgusting these choices are. (Gillian McKeith pioneered this move, which is particularly effective if it can be accompanied by a close-up of some shameful tears.)
Act 2 – The Journey: The sinners are set on a path of redemption by thin, attractive guides. There is upset, pain, self-discovery and hunger. Pies, for so long the mortal enemy, are vanquished, as our fat protagonists increasingly grow in strength. As their bodies shrink, brave heroes emerge from underneath.
Act 3 – Victory: The weigh in. After a time determined by production schedules, fat sinners are rewarded with the nirvana of significant weight loss. The more pounds are shed, the louder the cheers. Before and after pictures are compared, usually with makeovers, spray tans and high heels to maximise impact. Our guides compliment the redeemed sinners on how they look, something that would have been impossible just a few weeks before. They are allowed some of the trappings of thin privilege – nice clothes, make-up, new haircuts. A better, thinner life is finally possible.
This has become a mainstay of reality television, from the hugely popular The Biggest Loser to You Are What You Eat and the truly awful Benefits: Too Fat to Work, which had the added appeal of the fat protagonists being cast as lazy scroungers. All these programmes are exploitative trash, and although they do have a certain car-crash appeal, I generally try to avoid them.
So, when I sat down to watch The Big Crash Diet Experiment, a BBC One show detailing the effects of very low-calorie diets on obese patients, I was surprised to see the same tired old tropes rehashed, but this time with a veneer of scientific respectability.
The programme followed four obese people as they embarked on an extremely restrictive diet, which replaced all food with specially designed shakes and soups over a four-month period. Currently, there is a lot of academic interest in this type of crash diet – similar protocols formed the basis of a recent and well-publicised study on diabetes, DiRECT trial. This saw 149 Type 2 diabetic patients placed on to very low-calorie, meal-replacement diets, and nearly half saw their diabetes go into remission.
The programme asked the question if such a diet could work “in real life” presumably under the misapprehension that “real life” involves being followed around by a television crew, while having your health and lifestyle forensically examined by doctors and academics.
But, perhaps more troubling, the makers seemed hell-bent on pushing the clinical advantages of the diet, neglecting to mention that there are still many questions to be answered. There is currently no data beyond a 12-month period and little information about what unintended consequences there might be. It is well known that restrictive dieting can cause an unhealthy preoccupation with food, affect mental health and increase the risk of developing eating disorders. There is also evidence to suggest that any weight lost might be regained in the longer term. These issues certainly need addressing, with more research sorely needed.
Framing weight loss as the only solution is highly likely to stigmatise those who cannot achieve it
But the use of miracle shakes and soups was presented as a public-interest story, and it was strongly suggested that they should be made more widely available on the NHS, and perhaps even tried by home dieters. However, such dramatic calorie-cutting is a serious medical intervention and although anyone could theoretically do it unsupervised, that does not mean that they should.
Each person’s path to obesity is unique, complex and driven by a number of factors. For many, this sort of restrictive diet might be little more than a band aid placed over a deeper infection. In this programme, there was evidence of disordered eating, troubled relationships with food and signs that the extreme calorie restriction was taking a psychological toll.
And, although several of the participants showed improvements in important markers of health, particularly visceral fat loss around the liver and abdominal area, there are other strategies, particularly exercise, that can achieve similar benefits. Framing weight loss as the only solution is highly likely to stigmatise those who cannot achieve it, and exclude them from other equally effective lifestyle interventions.
Too little is known about the long term effects of very low calorie diets, particularly regarding the best methods for reintroducing food once they have ended. Until this work is complete, it is not the place of any broadcaster to present it as a solution for obesity, or as a cost-saving initiative for the NHS. Next week, ITV will be broadcasting a show with a simlar premise, predictably ramping up the tabloid factor by putting celebrities through very low-calorie diets. It remains to be seen if they will take a more responsible line.
When it comes to losing weight, it is not surprising that people lose large amounts when they dramatically restrict calories. And, although it is cheering that this temporary change can improve some markers of health, it is not the whole story. The real challenge is being able to do this in a safe, humane and sustainable way. Sometimes, in focusing too much on the body, we are in danger of neglecting the health of the mind.
Angry Chef would like to thank Katie Heath PhD for her help in researching this piece