There has been a significant increase in messaging around COVID-19 prevention and weight loss, which is something I find to be quite a problematic area. One notorious UK-based doctor has announced that he is writing a book about ‘boosting your metabolism’ against coronavirus, and dozens of magazines and newspapers have been publishing COVID-19 diet plans. However, there is a TV show, recently aired on Channel 4, which takes the biscuit.
The show is called “lose a stone in 21 days” and follows 5 participants while they take on a crazy 800kcal/day diet for 21 days. The show is presented by a health journalist, who liberally uses the title of doctor, having completed a medical degree in psychiatry before turning his hand to journalism. It is important to know that while psychiatrists are doctors and can legally use the title, the journalist in question has never practiced medicine, nor is he currently registered with the medical council in the UK. This is important to note because he does take measurements and samples from participants on the show. At no point is a registered dietitian or registered nutritionist featured.
Before delving into some of the problems relating specifically to the TV show, I wanted to touch on some of the points that are worth considering in the COVID-19 & weight discussion:
Weight is not an accurate indicator of health. When assessing COVID-19 & weight, it is important to remember that there is research telling us that fat bodies tend to receive worse healthcare- less time with doctors, doctors think of them as lazy and lacking willpower, less likely to be referred for further testing or treatment. This means that more fat people becoming seriously ill, or dying, from COVID, is not necessarily about the fat. Because of the above it could be related to poorly managed underlying conditions, delay in seeking advice or healthcare because of problems in the past or fat folks actually being treated unequally to other folks for COVID-19.
We must also acknowledge that the impact of weight stigma does not just affect how fat bodies are treated, but the impact it directly has on fat folks. We know that those who experience stigma have worse health outcomes. This can also be seen in the disproportionate death rate from COVID-19 among Black and Asian communities.
Losing weight does not protect you from COVID, nor can it boost your immunity. If anything, following a calorie-restricted diet could put you at a greater risk from COVID, because your body will be lacking the energy it needs to effectively run the immune system and recover from illness.
Lastly, let’s mention the one that is important for us all to remember; 2020 has been tough on us all. Many of us have experienced loss of loved ones, severe illness, job losses and furloughs, children at home all the time, lack of social connection, business closures, cancellation of big trips and big days. Our lives have been completely pulled apart in the last 6 months. Thinking about all that, how important do you think weight should be on anyone’s priority list? I truly think that people who are able to focus solely on weight gain/loss at this time lead very privileged lives. People are trying to hang on through a pandemic, so what is they gained weight? People have lost everything, so what if health is not the top of their agenda right now? You do not have to explain why or how you gained weight during lockdown. You don’t have to make attempts to lose that weight, now or ever. You don’t have to have “health” at the front of your mind every time you make a decision.
On to the show…
There were a few red flag points raised in the show and a few myths I want to highlight.
Let’s start with red flags:
“Reverse the effects of lockdown by shedding excess weight”- weight gain is not the worst outcome from lockdown. If folks had some extra biscuits and glasses of wine to cope, or put on some weight, that is so far from the worst “effects of lockdown”. What about mental health? What about the actually reality of the effects lockdown had on people, families and communities? It is clear that the person/people who participated in/conceived the idea for the show live impossibly privileged lives to be able to put all the shit lockdown caused to one side and focus only on WEIGHT.
Participants describe very negative relationships with food, body and weight. The show is exacerbating, rather than helping to solve, these issues. This is ultimately worse for long-term health. They also describe feeling unwell, tired, dizzy and obsessed with food, all signs of severe restriction and starvation.
One participant said “this is the first time I’ve been on a diet about health” and the host said “this is not about crash dieting”. This is a classic diet culture move, to say that your diet is a “lifestyle change” or call it “wellness”, when, of course, it is a diet! The name of the show is “lose a stone in 21 days”, which exactly describes a diet.
The show is strongly anti-carbohydrates. The participants are put on a very low-carb diet and there is a lot of discussion around why carbs (more specifically sugar) are so terrible and addictive. E.G. participants are told they “must not slip back into eating those sugary foods” and biscuits are talked about as if they are class A drugs “to get the same hit you need to eat more and more of it” (which, FYI, is not the case, because we aren’t all gorging all day on the biscuits and chocolate that are very widely available in our modern world).
The show creates massive food fear and shame around eating, with most of the participants describing being afraid of having one chip, piece of popcorn or bite of cake, as they “don’t want to ruin it”. One mouthful of food should not induce that amount of fear. One mouthful or meal does not create or destroy health. This is important in the context of normal life- are people expected to never share a piece of birthday cake with family/friends? Should they never get ice-cream on their holidays? Food is an important part of our cultural and social life, but having food fear and following restrictive diets make enjoying food with other people almost impossible.
The show encourages avoidance techniques, including hiding certain foods, eating them on a red plate only, having a smell of fruit in the house and getting yourself out of the house to avoid “temptation”. This is not normal behaviour around food. If you are thinking about a food so much that you have to hide it or leave the house, your level of restriction is too much!
The presenter repeatedly refers to the “research”, but overall the show fails to acknowledge vast amount of the evidence on weight, diets and weight stigma. It seems the focus of the show is really only on 1 scientific study (and follow ups to it), which happens to be one that the presenters wife worked on.
There were some statistics mentioned: 2 in 5 women quit a diet after 2 weeks and only 1 in 5 last a month. The presenter argued that this is because people don’t have enough support or lack will power, but surely this is a reflection of how shit diets are. These participants followed the diet for only 3 weeks and look how much they struggled. We see the same in research trials, including the one this show is based on; people sign up to the trial and are assigned a diet, they have regular contact with professionals, are sometimes supplied with food/supplements needed for free, as participants were for this show, and often have other motivators, such as money, or on the show not wanting to fail on TV! If folks with all the support in the world struggle and report that there isn’t enough support, shouldn’t we just accept that maybe the diets just are not compatible with human life?!
“Why are these foods and drinks so tempting when we know they are bad for us?” The presenter went into a town centre with a bag of chocolate and a bag of fruit and veg, and then proceeded to ask members of the public which they would choose. Of course almost all chose the chocs, and the presenters question was “why are these foods so tempting when we know they are bad for us?” Well, for me, there are a few points here. First things first, it is not exactly fair to compare ready to eat chocolate with a pile of unwashed/unpeeled/unchopped fruit and veg. Secondly, most people would choose the option that is convenient, particularly if they are pottering around the town centre. The choice is not because chocolate is madly addictive and they can’t resist temptation. If that were the case, they would have entered one of the many shops selling chocolate and got some already!
Lastly, the participants are described as healthier in “every way” at the end of the 21 days, however the show only assessed one element of health. Participants metabolic parameters and weight were considered, but what about mental health? How were their relationships/social health impacted by the diet? How is their emotional health following weeks of restriction? What is their body image like now and can a diet improve body image? (hint: no). Weight is not the only thing that matters!
Myths on the show: (All myths are in bold)
Food is addictive. In the first episode foods like pizza are referred to as addictive, but food is not addictive. Food is essential to life, and while our relationship with food can be very complex, it is not the same as the relationship some folks have with addictive substances.
800kcal/day is enough for an adult. The participants were allowed only 800kcal/day, based on research carried out specifically on patients who were classified as morbidly ob*se and had been diagnosed with type 2 diabetes. It is not particularly appropriate to use a diet from a clinical trial in a specific patient group for a TV show and on a group of people who do not match the patient group the diet was intended for. The diet was used only to sensationalise and create a stir, not to actually help the participants to the best of their abilities. If that had been the case, surely they would have sought to include tailored nutritional advice from and RD or RNutr/ANutr?!
How long you can stand on one leg is not a good predictor of life expectancy. This came up in the show when the participants were starting exercise and the presenter challenged them to see how long they could stand on one leg with their eyes closed. This is based on research that follows participants over many years, E.G. they were asked to stand on one leg with their eyes closed at age 50, and researchers followed up with them years later to assess who had died. It is utterly unsurprising that those who were unable to stand on one leg at age 50 were more likely to have died before those who were able to stand on one leg for 30 seconds or more. My point is that standing on one leg has nothing to do with your risk of death, but rather it is a test used to assess your physical ability, which may have some correlation with your health and therefore life expectancy. However, that does not mean that your ability to balance on one leg provides an accurate life expectancy for you.
Obesity worst affects the heart. This one is actually quite interested, because it is widely accepted that in larger bodies, the heart must work harder to pump blood around and is therefore under greater pressure and more likely to fail. However, there is also an increasing body of evidence that indicates yo-yo dieting, or weight cycling, when weight fluctuates up and down, is associated with the worst cardiovascular outcomes and that the greater the fluctuations in weight (i.e. the greater the amount of weight lost & re-gained), the greater the risk to heart health. There is also clear evidence that those at very low weights are also at a higher risk of some cardiovascular events. So, while weight loss may have benefits for heart health, there is only a benefit if the weight lost is kept to a “healthy” amount and is kept off, if not, it may be worse for health. Keep this in mind as we move to the following point…
“It is a myth that diets don’t work”. (Funny that he used that language when I am calling his myth-busting out as a myth!) In the next sentence after that quote, the host goes on to talk about how most people regain weight by year 5 after the initial diet and only around ¼ can keep weight off long term. So, if the diet is not sustainable long-term, is that not an indication that diets do not work? Also, have a look back to the last point- weight cycling results in the worst outcomes for heart health, something he claimed to be improving via dieting!
Chronic inflammation is linked with mass food production. What an irony, when the show sent a bag of mass-produced foods from Tesco to each participant in the first episode! I’m quite sure the host misspoke and meant to say processed foods, or perhaps he does not believe there is a difference between the two. Either way, mass food production is the reason humans are alive and well today. Without mass production there simply wouldn’t be enough food for us all to eat, and if we didn’t have enough food we would die. So, in this sense it is rather irrelevant to blame food for chronic inflammation, when it is the very thing that keeps us living. NOTE: vegetables, fruits, wholegrains, meat, fish, dairy and pretty much everything we eat is mass produced. There is nothing inherently wrong or unhealthy with eating mass produced foods.
We think of a banana as super healthy, but actually it has a surprising amount of sugar in”. In the show the host and his wife test their blood glucose, then eat a banana and retest their blood glucose. Of course, their blood glucose increased after they ate the banana, but that does not mean bananas are “sugar bombs” as the low-carb brigade would have you believe. Our blood glucose increases when we eat pretty much anything- because glucose is our body’s main energy source and we eat food for energy, so it is quite important actually, that when we eat glucose circulates via the blood to our cells! Also, bananas are healthy; they are a source of fibre, vitamins and minerals. We know that increasing fruit and veg consumption is associated with health benefits (independent of weight), and that currently most people don’t eat enough fruit and veg. So the message that bananas are ‘bad’ will probably do more harm than good. Let the people eat bananas!
Snoring is caused by weight gain/ob*sity. It is true that excess weight around the neck can impact snoring, it is not the only factor in whether we snore or not. Snoring is generally cause by obstructive sleep apnea, which can be caused in itself by any of the following: Old age, brain injury (temporary or permanent), decreased muscle tone (this can be caused by drugs or alcohol, neurological problems or other disorders, increased soft tissue around the airway (possibly due to weight) or structural features that result in a narrowed airway.
Live apple cider vinegar being “incredibly good for your gut”. The evidence around ACV is still sketchy to say the least. Usually when foods are described as being good for the gut, it is because they are probiotics; however, it is important to note that ACV is not a probiotic but rather a fermented product. That means, while live ACV may contain bacteria, these do not survive digestion to have an impact on our gut. That doesn’t mean ACV is bad, but it isn’t a huge claim to health either. It is also worth noting that taking ACV alone or unmixed can cause dental erosion and acid burns to the oesophagus and vocal chords.
Honestly, there were even more problems with the show, language used and methods used, but this seems like enough for you all to get the idea that shows like this are pretty much trash.
It makes me feel sick that some folks are taking advantage of a pandemic to spread their misinformation, sell diets and supplements, and further their own agenda, while also taking advantage of normal people who have had an impossibly tough year.
Please know that:
Your weight does not measure your health.
Dieting is not a long-term health solution, and in fact can damage your long-term health.
You do not need to pursue health or weight loss to deserve respect or healthcare.