Keeping weight-loss expectations realistic can prevent health problems

In her first exercise challenge on the weight-loss reality TV show The Biggest Loser Asia, Ms Marilyn Tay’s heart rate shot up to 235 beats per minute.

She did not know it then, but she was in danger of a total collapse. “I didn’t know what was going on. I felt that my heart was beating in my throat,” says the 31-year-old sales consultant, who signed up for the show to shed the kilos that doctors say had made her unable to conceive a baby.

Standing at 1.83m tall, she tipped the scales at 158kg at the start of the competition when she and her fellow contestants were tasked to go for a road run. After 30 minutes, she felt so ill that she sought help from the medical team. The doctors said her dangerously rapid heart beat was caused by the “sudden exercise that shocked the body”.

“In reality, people trying to lose weight would start with a brisk walk. But in the competition, we couldn’t do that. We needed to lose as many kilos as we could to contribute to the team,” she says, recalling the three-month-long competition.

On the show, the Asian franchise of the American programme The Biggest Loser, two teams compete in weekly challenges to collectively lose more weight than the other. The losing team has to vote a member off the show. The last person left in the contest wins US$100,000 (S$140,400) and a Renault car.
 
The first season of the show ended recently, with Indonesian David Gurnani losing 83kg from an original 157kg to win the contest. His before-and-after photographs looked so dramatically different, many people could not believe at first glance that they were of the same person. The 1.82m 25-year-old was not available for interview.

Ms Tay, one of four Singaporeans who took part in the contest, came in fifth. She was booted out in the 12th week for failing to lose enough weight. Upon exiting the show, she had lost a total of 42kg.

Doctors warn overweight people not to aim for such rapid or drastic weight loss.

Dr Stanley Liew, Raffles Hospital’s endocrinology specialist, explains that massive weight loss in a short time is usually achieved through severe food restriction similar to that of starvation.

On the TV show, contestants reduce their daily food intake to 1,600 calories for men and 1,200 calories for women, which is more than 30 per cent under the recommended calorie intake for a normal person.

Ms Tay could barely adapt to the strict dietary regimen, since she was used to indulging in comfort food such as wonton mee, potato chips and chocolates as and when she liked. She says a contestant, Mr
Kevin Yue, once fainted during the night and had to be hospitalised as he had skipped meals in the hope of losing more weight.

Dr Liew says that in such situations of extreme reduction of food intake, severe dehydration poses a real danger as it can lead to low blood pressure, dizziness and collapse. A healthy and recommended weight-loss rate, he adds, is about 0.5kg to 1kg a week.

Dr Tham Kwang Wei, Singapore General Hospital’s director of Obesity and Metabolic Unit, Life Centre, says although the heart function improves because it is relieved from the pressure created by the excess kilos, losing weight too drastically could lead to a deficiency in potassium and magnesium that might result in an irregular heartbeat,
a condition known as heart arrhythmia.

Like Dr Liew, she, too, does not recommend following the extreme exercise regiment of The Biggest Loser Asia. She explains that its obese contestants were supervised very closely.

On the show, which aired on Hallmark Channel (StarHub Channel 17), the contestants were looked after by a team that included a physician, a nutritionist as well as two trainers, who designed workout sessions for contestants to lose as much weight as possible.

Aside from health problems, Dr Liew says that for the overweight, “back and joint injuries due to the strain from weight bearing” could also develop from strenuous exercise, which indeed was one of the problems that plagued Ms Tay during the competition.

There were times she felt so stiff after a night’s sleep that she had to sit and rest for a while before she could stand up.

To alleviate the problem, her trainer Dave Nuku had to incorporate more cross-training exercises such as boxing to work around her weak knees. He also advises those bent on losing weight to keep their
expectations realistic and to “start small”.

“Focus on the first kilo and gain momentum from there. The sheer magnitude of losing all that weight is intimidating.”

Another problem with losing so much weight so quickly is the excess skin that now hangs loosely from the underside of Ms Tay’s upper arms. She says she does not dare wear sleeveless tops for fear of exposing the “extra pockets” under her arms.

Dr Wong Soon Tee, Raffles Hospital’s dermatology specialist, says: “The saggy and loose skin occurs because the skin is not able to match the speed of the weight loss.”

Aside from waiting for the skin to tighten naturally, which would take a long time, he said people with the problem could resort to firming treatments. Surgical excision is recommended as a last resort.

Saggy skin is a small price Ms Tay is willing to pay for a lighter and healthier body. She is now trying to build up muscle through weight-resistance training at the gym to tighten her skin.

She says: “It will be smaller and less visible in one to two years’ time.”