On "The Biggest Loser," contestants arrive fat and leave thin. And in between, they go through an intense fitness regimen that is, to put a good face on it, grueling.
The hours-long, athlete-level routines take place from the get-go. Some contestants have completed a quasi-mini-triathlon consisting of a 250-meter swim, a 2-mile bike ride and a climb up 42 flights of stairs. Others have pulled airplanes down a runway or climbed up and down a hill as many times as they could from sunup to sundown — not just sweating copiously but sometimes feeling dizzy, vomiting and crying.
With the show taping its seventh season and continuing to spawn an ever-larger assortment of books, videos, online clubs and forums, "The Biggest Loser" has made über-boot-camp-style training sessions seem a sure-fire ticket to weight loss for sedentary, morbidly obese people. And the success of its contestants suggests there's little risk — contrary to common advice that such programs should be undertaken only with a physician's seal of approval.
Mainstream physical health experts are appalled by such extreme workouts.
"This is another example of taking a serious health condition and almost mocking it," said Jeffrey Potteiger, kinesiology professor and director of the Center for Health Enhancement at Miami University in Ohio. "I find it deplorable."
For starters, he points out that overweight people might have undiagnosed medical conditions such as high blood pressure, heart disease and diabetes.
"If you go out and do this type of workout," Potteiger said, "you are going to dramatically increase your risk for some abnormal event and possibly exacerbate the condition. People could certainly have a heart attack, a stroke or become hypoglycemic. People need to be aware of these kinds of things."
Second, the truly obese need moderate workouts that help them build up their strength and stamina gradually, he says, not ones that send them sprinting out of the blocks, risking injury.
"This is not the way we deal with this kind of weight issue," Potteiger said. "At the end of the day, you're talking about behavior change — nutritional, psychological — and that's hard to change. If it were easy, we'd be able to change all sorts of behaviors. The question in putting on a program like this is that in having people watch, it isn't a scenario that will help people change their behavior and become healthy."
Nicki Anderson, named trainer of the year by IDEA Health & Fitness Association, criticized the show's portrayal of exercise as an almost Herculean effort.
"All the show does is reinforce to those who are overweight and inactive, 'See how hard (exercise) is?' ... For most people, exercise is going to be hard, but it doesn't have to be that hard."
Although some of her clients find the show motivating, Anderson, owner of Reality Fitness, a Naperville, Ill.-based personal training studio, thinks they're being duped.
"It looks like in six weeks they lose 130 pounds. I have to struggle against what's reality and what's perceived reality. ... Our job is to help you develop steps that will develop a normal, healthy lifestyle, and nothing they're watching is about being normal and balanced."
Even if her clients do have the drive to hit the ground running — literally — the vast majority, she said, don't have the means, the time or the resources to accomplish it safely.
Then there's the matter of muscle strain that extreme exercise produces — and that can quickly crush idealistic workout goals.
"They're going to be fatigued and sore, and they're probably not going to be doing it the next day unless they're highly motivated," Anderson says.
J.D. Roth, the program's co-creator and executive producer, says the show is simply redefining what is realistically possible.
Most people, including doctors and fitness professionals, still cling to the idea that standard recommendations of moderate exercise and moderate weight loss are right for almost everyone, including the morbidly obese, he said, and some heavy folks have convinced themselves they can't do one push-up, let alone 10.
"Bob and Jillian had so much conviction about how much more these people could do," he said of the show's trainers, Bob Harper and Jillian Michaels.
As for the contestants: "In a way, these guys are trained like special forces. They're tired, they're overworked, but they're changing their food and exercise habits."
The severe workouts and stunts people do are the "extreme" part of the show, Roth said, adding that viewers will use common sense in building their own weight-loss programs.
"People are watching the show to be inspired and not to feel hopeless anymore. Viewers are saying, 'If that guy who weighs 300 pounds can do it, so can I. I can go on that run tomorrow morning.' But they're not expecting to lose 30 pounds in a week."
Diet and exercise tips offered during commercial breaks reinforce more prudent ideas, he said.
If the show has a true believer about the power of abundant, intense exercise, it's Rob Huizenga, associate professor of clinical medicine at the University of California-Los Angeles and the show's medical consultant. He knew from working with professional football players that serious workouts lead to serious weight loss, and he thought that concept could be employed for severely overweight people.
"One of the big selling points of the show," he said, "is that people learn things no one has taught them before, like how to exercise. People have no idea what they're capable of, and they don't understand that there are different exercise programs for heart health, for weight maintenance and for weight loss."
The show has made believers out of some of the contestants who think an intense, boot-camp style of training isn't such a bad thing for extremely heavy people. Jim Germanakos was a contestant on the fourth season, and though he didn't win the ultimate prize, he was able to lose 186 pounds, going from 361 to 175 pounds. The 42-year-old police officer from Massapequa, N.Y., currently carries 215 pounds on his 5-foot-8 frame, and though he would be happy to drop 5 or 10 pounds, he's content with his weight and his healthier lifestyle — something he vows he won't ever change.