Q & A: Sending the Right Message

Binks: moderation proponent. Butch Usury

 

Martin Binks is director of behavioral health and the research director at the Duke Diet & Fitness Center, a multidisciplinary, residential weight-loss program. He is also an assistant professor in the division of medical psychology at Duke and co-author of The Duke Diet. This past fall, Binks wrote a series of news-paper op-eds that were highly critical of The Biggest Loser and other reality-television shows structured as team weight-loss competitions. In the shows, competitors are placed on restrictive diets and grueling exercise regimens.

What's wrong with The Biggest Loser?

One of the major issues when you're sensationalizing any issue is that you lose some valuable facts. These shows may occasionally mention healthy or moderate messages, but then they negate this with these dramatic scenes of fitness trainers screaming in the ear of participants and pushing on their back when they're trying to dopushups. They make people who are severely obese run up ten flights of stairs or to the point of collapse on a treadmill. This is not only harmful but also of little long-term benefit.

I think my problem with these programs is the message that they're giving to the masses that are watching—that it's necessary to push yourself to near-collapse when exercising, that anything short of huge weight losses signifies failure, and that it's somehow motivating and acceptable to belittle people in front of others.

What effect does that approach to weight loss have?

Our experience has shown us that the majority of people who do these overly restrictive, overly intensive approaches find it difficult to sustain the effort and ultimately aren't successful. Nobody's going to be able to keep up the level of activity that they're depicting in these shows over the long term. What we promote at the Duke Diet & Fitness Center is not a "thank-God-that's-over approach" to exercise. Rather, we encourage people to find activities they can do comfortably, possibly enjoy, and maintain for a lifetime. A great goal is to start by trying to work toward adding 10,000 steps to your day. The same moderate view is true for food, whether it's cutting back on portions, or trying to eat a few more vegetables. That's something that somebody looks at and thinks, "I can do that."

Obviously these shows are popular at least in part because of what is seen as compelling human drama. And some participants do lose a lot of weight.

My intent in writing and talking about this subject is not to diminish the success of these participants or the viewers who are inspired by watching. I'm thrilled that somebody was able to lose 200-odd pounds and that they're feeling better and happier. It is wonderful that some viewers could weed through the hype and all of the negative messages and find some reasonable lasting philosophies.

But it doesn't take a genius to know that putting a group of overweight people in a room full of food and goading them into overeating is humiliating. I do understand the need for drama. If it's so boring that nobody's going to watch it, they won't reach anybody. But they just went so far over the top. One person that responded to my op-ed said that they felt The Biggest Loser was very tastefully done and it was in no way comparable to the other reality shows. And I thought, just because they're not making people eat worms, like that other reality show, that doesn't mean that it's tasteful.

In your opinion pieces, you've talked about parallels between the messages in these television series and other commercial messages.

The public is bombarded with negative, unhealthy weight-loss messages. If you look at the budgets that are available to unhealthy weight-loss messages—either through over-the-counter weight-loss aids that have no proven efficacy or safety testing, or the fad diets that are out there—it's practically a billion-dollar industry. The advertising clout isn't there behind healthier approaches.

So how do you get out a positive weight-loss message?

I think it's up to people in the field to put the healthy information out there at every opportunity. One way we do so is in the popular media. And the popular media has answered. Many television news outlets, newspapers, and magazines regularly ask for input from various medical centers around the country on content, which is a more recent evolution. My colleagues and I also provide public educational sessions and train community-based medical providers to help make the science-based messages more accessible to the average person.

This also involves overcoming the power of those advertising dollars.

In terms of the weight-loss aids, somebody has to step up and start saying, you can't make these false claims. I know that technically there are mechanisms in place in the consumer reporting realm, but in the weight-loss arena, you regularly see pills for this and pills for that that have no medicinal value whatsoever. You don't see this with other medical conditions. Weight loss seems to be held to a different standard.

I think that speaks to the issue that it seems to be okay in our society to exploit obesity and to perpetuate negative stereotypes about obese people. There are themes in The Biggest Loser programs or some of the others that subtly, or maybe not so subtly, play into pervasive stereotypes. For example, on the program they put the contestants in front of a bunch of food to tempt them to lose control. But we know that obesity is not about gluttony. Taking in 100 calories a day more than you burn will lead to a ten-pound-a-year weight gain. That's not gluttony, that's just life. They depict the contestants as needing to be yelled at and ridiculed to do exercise under the assumption that they are just "lazy"—another common stereotype. There is an underlying subtext that perpetuates the myth that people who struggle with weight are weak-willed.

I know that people say they're getting inspired by this show, but I can't help but be skeptical, given the stereotypes that exist out there in the world in terms of discrimination against obese people in school settings, in employment settings, in public places. Subtle discrimination like chairs that don't fit, with arms that are too narrow in doctors' offices, or being denied insurance or appropriate medical care due to your weight—all of which are well-documented in the research literature. To combat that sort of pervasive acceptance of weight discrimination requires an equally pervasive positive weight acceptance message.

But to some extent, don't people have to take responsibility for their own health and for making the decision not to eat those 100 calories? How do you balance maintaining a positive message with promoting personal responsibility?

It's a delicate balance sometimes. Too often people think that they have to really be hard on themselves and not accept themselves in order to change. We try to help people to balance this, to understand that, maybe I'm not where I want to be right now, but weight's only part of who I am. Too often people judge their self-worth by the number on the scale. But you're more than the sum of your pounds. We get them to say, "I'm a good father or mother, a wonderful daughter or son, an accomplished employee. I have so many good features." You don't have to hate your body in order to improve it.

It's okay for them to say, "I'd like to be a healthier weight," and figure out the steps to getting there. We help them to celebrate the steps along the way.