Sunday, January 17, 2010

Book Review: Where Did All the Fat Go?

This is the book by the brains behind "The Biggest Loser," Dr. Huizenga. The first thing that struck me about this book is that I have seen so little fanfare and publicity for it that I probably wouldn't have noticed it if I hadn't seen it featured on "Chronicles of a Late Bloomer." This puzzles me, because what person with an interest in weight loss (which is just about everyone in this country) wouldn't want to know the nitty-gritty details of how "The Biggest Loser" gets its sensational results? Criticism of the show is easy to find, but the fact is that this reality show manages to get results on the same magnitude as bariatric surgery, without the potential risks. Sure, some of the contestants regain, but so do some surgery patients.

I wonder if the reason that this book didn't get much publicity is the same reason that no one tried anything like "The Biggest Loser" before -- thin people underestimsate the overweight. Dr. H. had noticed as a doctor for the Raiders that it was almost impossible to keep weight on the 300-pound linemen when they were doing two-a-day workouts. When the producers of "The Biggest Loser" came to him for advice on how to get very overweight people to lose weight quickly for television, he proposed the high volume workouts coupled with moderate calorie reduction, and thought that 300-pound contestants could lose as much as 60 pounds in 10 weeks. (Obviously he was too conservative in his estimate!) The other experts on staff thought he was crazy because medical journals said that 20-30 pounds was the most that people could lose in supervised fasting environments. When the program succeeded with the reality show contestants, the experts still dismissed it because the weight loss happened in a "fantasy land" with a huge cash prize as motivation. Dr. H.'s chance to prove his program worked in the real world came in Season 3, when participants from all 50 states were recruited but only 16 made it on the show. Dr. H. had the chance to teach his program to the 34 contestants who went on to compete at home, and

Not everyone would be able to jump into a program like the one Dr. H. is recommending. I would think it would be most appropriate for young, relatively healthy people with a lot of weight to lose. The calorie restriction isn't severe, and the food recommended is healthy, with an emphasis on high-volume foods like fruits, vegetables, whole grains, and lean meats. The exercise recommendations aren't quite the 6 hours a day that contestants do on the ranch, because the program was designed for people to do at home while juggling work and family. Dr. H. recommends a one-hour run-walk workout 6 mornings a week for maximum calorie burn (or an alternate but still intense cardio workout if injuries or other limitations prevent running). Three afternoons/evenings a week, he recommends a 30-minute cardio warmup followed by his Push-Pull-Twist home strength training workout, which is illustrated in the book. Three other afternoons/evenings, he recommends people participate in sports or other aerobic activities that they enjoy for up to an hour, with one day off. How did the at-home contestants find the time for 2-2.5 hours a day for working out? Dr. H. says they watched that much less TV every day, which had the added benefit of less snacking time.

That sounds like, and is, a lot. Today I actually did get almost that much exercise -- I did a 45-minute Spinning class this morning and an hour-long swim in the evening. I would find it challenging to get in that much exercise, and I consider myself relatively healthy and active.

But, dodgy body image aside, I am not 100 pounds or more overweight and trying to lose it as fast as I can for a television show. One phrase it's easy to miss in Dr. H.'s recommendation is "up to" 2-2.5 hours of exercise a day. This is a book for people who are interested in fast, dramatic results, but there are takeaways for the rest of us here too:

  1. Fat loss is more important than weight loss. Dr. H. didn't want contestants to lose muscle, bone, or water tissue. He wanted them to lose fat and increase or at least maintain lean body mass. One contestant was discouraged with his modest weight loss, but an iDEXA scan indicated that his 42-pound loss was actually a loss of almost 75 pounds of fat because he had gained an amazing amount of muscle. Most women on the show just maintain their lean body mass, but that still means that the weight they lose looks like a lot more. I'm thinking of buying a body-fat-analyzing scale because I'd like to see how my body composition is changing as I work on losing weight.
  2. It's best to eat real, healthy food when you are losing. I started to wonder if the great health results from the calorie restriction experiment I read about yesterday came at least partly from the switch to high-volume, nutrient-dense foods. I saw some people in my Weight Watchers meetings who got to goal on 100-calorie packs and Skinny Cows and they didn't always look healthy (or young) even though they had restricted their calories. There are some recipes for "anabolic shakes" in this book that use ricotta cheese and lactose-free milk instead of protein powder and other supplements. Dr. H. even has recommendations on how to choose fruit so that it stays fresh all week.
  3. Exercise twice a day. If you can't -- or don't want to -- do as much as this book recommends, it still seems worth trying split workouts. Half an hour twice a day might be better than an hour once a day, because getting the body up and moving twice a day might be better for the metabolism. It's probably also easier to maintain a higher intensity for two short workouts than for one long one.
  4. Incorporate strength training. See #1 above, but also, strength training keeps bones and joints healthy. I know that I have seen that in my own life. It also makes me feel powerful. Dr. H. even has a list of equipment for home workouts for under $250 -- even less if you can find some of it used.
  5. Warm up properly before a run. There is a great sequence of warmup exercises that I had never seen before. I really think that if I used them in the future, I might prevent a lot of the running injuries I have been dealing with over the years. I showed them to my husband, who coaches cross-country runners, and he said that he does many of them with his athletes. I asked why he had never shown them to me! It was worth my purchase of the book for this sequence alone.
Dr. H. provides stats for the at-home contestants so that readers can follow along with their more realistic weight-loss numbers. Some of his at-home players, doing half as much exercise as their counterparts on the ranch, still experienced the same kinds of results, but "weeks" on the ranch were sometimes 10 days, and Dr. H. says that some players, "despite advice," dehydrated themselves before weigh-ins, which is detrimental to long-term weight loss but could help provide an advantage if the player was worried about being eliminated.

I'd be curious to hear from anyone who has tried this program. I'm going to see if I can use my 5 takeaways to enhance my own Medium-Sized Loser losses.


  1. I wouldn't follow any kind of program that the Biggest Loser uses. First of all, they all have unrealistic goals. come on exercising for 7-8 hours a day? Hello we all overweight people do live in the real world and when we see them losing that huge amount of weight we tend to think a pound or two a week isn't much. When in reality we are doing good. It's all for the tv show. And when Dr H. mocked weight loss surgery I could have reached through the tv set and said shut the heck up. I had the surgery, I am no longer obese, nor did I die from the operation... which he said a lot of people do. Good grief. It's all for the ratings and since each season the people are bigger and bigger you will see a lot of things that they will do unbelievable.

    1. Anonymous11:25 PM

      Geez Lady, did you not read the article out of your irrational hatred for a show you don't understand.

      Up to 2.5 hrs a day MAX... That's all.

  2. Looks interesting, I know I have heard mini workouts through the day can be effective in not only weight lose but with our metabolism. In all he has a good plan and sounds effective. But we are all individuals and should tailor everything to our own body. I think fitting in exercise in everyday is the way to go and being mindful of calories in and calories out too. Ofcoarse not all calories are create equal since we are limiting them for weightloss its more important they come from healthy foods that fill our daily requirements and not 100 cal packs! Give the book a try what could it hurt and let me know the results sounds intersting!

  3. Excellent review of the book, thanks! Clearly, Dr. H gets amazing results. I like the idea of breaking up exercise into twice a day installments. I am going to think about how I could do this without it totally messing with my schedule. I have been looking for a reason to add some kettlebells back into my day...and maybe a 20 minute eve kettlebell stint would make sense. There are a few exercises that are very good for cardio along with the strength. Hm. Thanks again....I think I will put that book on my wishlist along with "good calories bad calories" which also looks quite good.


"Count your calories, work out when you can, and try to be good to yourself. All the rest is bulls**t." -- Jillian Michaels at BlogHer '07