The Biggest Loser--Couples: Pride Goes Before the Fall

And evidently, before the tattoo! Last night we watched four grown men go from macho-frat-boys in Vegas, to sniveling-melodramatic-wrecks in just two hours. What does any of this have to do with serious exercise and weight loss? Absolutely nothing. Which is the biggest problem with The Biggest Loser.

Last week the younger of the brother duo on Bob's blue team, Jay, was the biggest loser of the week. He took the customary walk up the mountain to find the three envelopes awaiting his choice, and he chose envelope three, which held a card that read "Vegas, Baby, Vegas". He quickly learned that he had won an overnight to Vegas for his entire team. The news was a welcome and surprising gift, until Bob rained on their parade, wishing he could stop them. He was afraid, of course, of all-you-can-eat buffets, being away from the gym and losing focus. The whole show has lost focus, so they might as well be in Vegas!

Anyway, in their usual style, the blue team talked, determined to stay on course and to win the weigh-in again, regardless of the temptations in Vegas; after all, they had kicked some serious butt last week, and that was after spending an entire week at home. They were not worried, simply looking forward to a boy's overnight. Unfortunately, we had to go along for the ride.

Side note: Why did we have to listen to Dan playing the guitar and singing? We get that he is the young, long-haired, Dan-cam-toting dude. But spare us the musical interludes, please? We have enough to endure.

Dressed like the gentlemen of Ocean's Eleven (courtesy of the suits provided by Bob), the four members of the blue team strode handily from gym, to casino, to healthy meals to the tattoo parlor. Tattoo parlor? Each of the team members got a tattoo featuring the word, "Pride", which is what they all shout after placing their hands together, one atop the other, in their unified pre-and-post challenge rallying cry. Full of bravado and male bonding, we watched as the four team members permanently etched their skin. Bob, you no doubt have noticed, is covered in tattoos. We're guessing this is the point at which Jackie is actually pleased she got eliminated from the team.

Long story short. They had a blast in Vegas, and came back to the ranch and won the challenge, which was all about brute strength, which to us is enormously unfair at this point. The black team is made up of three women and Bernie, who is a small (by these standards) man. The blue team is four big guys. Last night's challenge was a snap for the blue team and each team member won a trip for two to Puerto Rico. First Vegas, now Puerto Rico. This team was pumped. Dan described them as "unstoppable." Until the weigh-in, that is.

Jillian's black team had worked very hard all week in hopes of increasing their numbers at the weigh-in. They did not want to have anyone eliminated, because they already feel fairly disadvantaged by the difference in the physicality of the teams. Women have a much harder time losing weight, and their numbers demonstrate that week after week. But Jillian pushed them very, very hard and it paid off. The black team won, and Mark, the central figure of the blue team, the older brother and devious game-player, lost only one pound. Oops. Maybe not so unstoppable after all.

Roger reminded Mark that he had promised to leave voluntarily if he hit a wall with his weight loss. Mark fought back, trying to wiggle out of that commitment, but in the end, he had a crisis of conscience and told everyone, including his brother, to vote him off. To say that the last twenty minutes of the show was unbearable is an understatement. Crying, hugging, vowing eternal brotherhood, more crying, long and dramatic speeches. And then it was over. And Mark was gone. Leaving Brittany and Bernie of the black team, the only intact team from the beginning. And they are the two that were strangers when it all began.

• How will Jay do without his overbearing older brother?
• Will the blue team regret those tattoos?
• Will Mark come back the winner of the voted-off biggest loser competition?
• Will Dan actually learn to play guitar?
• Will we care about any of this?!

We still cheer for the contestants and their accomplishments. And while Mark has never been our favorite, he has demonstrated the greatest change physically and his determination will no doubt carry him further on his weight loss path. We wish them all luck.

But we long for a simpler time. When the show was an hour. When the focus was weight loss and how best to achieve it. When the contestants cheered for each other rather than conspired to "play the game" only to win the money and the weekly prizes. When Bob and Jillian were trainers, exempt from the melodrama.

Sigh. What's been lost from this show is more than weight; it's lost its soul.

(c) Photos courtesy NBC Universal.

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Technorati Tags: weight loss, Biggest Loser, reality show, fitness, diet

The Biggest Loser-Couples: Better to Have Loved and Lost?

Last night was not a good night for Paul. He seems to have suffered a setback not only in his weight loss, but in his emotional loss as well. Paul, you remember, teamed up for this show with his ex-wife, Kelly. Together they have experienced quite a roller-coaster journey on The Biggest Loser, but Kelly has been a key reason that Paul has consistently "put up good numbers" as they say in "weigh-in" jargon. Kelly, along with Jillian, helped motivate Paul and reminded him why he was there and why he had to get healthy, literally to save his life.

But last night's episode was very revealing: reality TV met reality, as the contestants were sent home for a week to see how they would fare in the real world. Away from their trainers, the gym, their partners and new friends, and the kitchen that is stocked with only healthy, approved food items. The results were dramatic.

Bob's blue team, who have spent the previous two weeks facing elimination, had been humiliated and demoralized by their consistent loss (not the good kind), both in the challenges and on the scale. So they left the campus with strong determination to continue their progress at home and to come back and post significant weight loss. They did not want to go to the elimination room again. It's also worth noting that while Bob provides support and oversight, he is not as connected to his team emotionally. These four macho guys are very independent and self-motivated.

Jillian's black team, by contrast, had been eking out just enough weight loss to win the weigh-ins, but they seem especially dependent on Jillian for the push that makes the difference. Jillian, you may remember, forces her team to face their emotional dependencies on food and has created strong bonds with each of the members of her team. As a result, Jillian called each of her "people" when they were home, twice a day, to check on them and remind them of their goals and potential pitfalls. Of all the members of the black team, only Paul refused to speak with Jillian while home. This proved a tragic mistake.

The homecomings were interesting and touching and some people, like Mark, the overbearing control freak who has been at the center of much of the controversy on campus, immediately pulled donuts out of the mouths of his children and threw away everything in the house that could prove a temptation. His kids were crying, his wife was surprised, but he was determined to go back to campus a winner. Uh, a loser. This is where it gets confusing.

Mark also pushed his brother Jay, both of whom live outside of Boston, and while this sometimes annoyed Jay, he listened to his older brother. After last week's episode, where the blue team lost the weigh-in by a pound, Jay, who had the lowest weight loss felt entirely responsible. So he was also very determined to do well while home. This determination, coupled with what they learned on campus, proved a powerful combination. Jay lost the most weight of anyone and at the weigh-in, Bob's team demolished Jillian's team and for the first time in weeks, the black team headed to the elimination room.

Paul, marked for elimination for a variety of reasons, including his own defeatist attitude, was sent home. This leaves Kelly alone on what used to be the yellow team.

Paul. A big guy with a lot of emotional issues, many of which were exposed on the show. But perhaps the biggest issue was that he was still in love with Kelly, his ex-wife and partner on The Biggest Loser. So as long as Paul was with Kelly, he rose to every challenge, lost a lot of weight, and kept the promise he made to himself to get healthy and live longer than his father lived. But as soon as he went home, his unhappiness made him vulnerable to his emotions and his loss, and he ate three massive plates of buffalo wings, large glasses of soda, and mountains of cake. He also refused to answer or return Jillian's calls. And in that scene at the very end of the show, where we get to see how the eliminated player is doing, we learn that Paul came down with double pneumonia as soon as he got home and actually gained six pounds.

We don't have a lot of hope for Paul. His issues are deep and his coping mechanisms are not exactly finely honed. He has a long way to go.

So the question remains: is it really better to have loved and lost? In Paul's case, we're not so sure. But we wish him luck and hope that he makes healthier choices now that he's home.

(c) NBC Universal.

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• How to Think Like a Thin Person
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Technorati Tags: weight loss, emotional eating, love, marriage, The Biggest Loser, couples

The Biggest Loser-Couples: "Walk It Out or Talk It Out"

Well, last night "The Biggest Loser-Couples" took a very interesting turn. Jillian's team, under her strong and kind leadership, looked deep within themselves to find the root cause of their obesity. They touched on nerves long deadened by trans fats, and what they unlocked will most likely serve them well in future weeks. By contrast, Bob's team, now comprised entirely of men, many of the macho variety, decided that looking deeply into their issues wasn't for them, and quickly high-fived themselves right into the elimination room!

Here's what happened.

In past posts, we expressed concern over Jillian venturing into territory for which she had no credentials--like psychotherapy. She must have read our blog, because rather than trying to help her team deal with their issues herself, she called in an expert, her mother, an experienced therapist who cares about people's mental health like her daughter cares about their physical health. (Hmmm...maybe that new show we've been hypothesizing about will be a reality show featuring Jillian and her mom...mental health, physical health....Oprah....are you listening?)

Side note: When Jillian introduced her mom, she squealed in the voice of a four year old, "Mommy." It was too cute not to mention.

OK, back to the show. And to what really proved to be compelling television. Jillian's mother, through a winning combination of kindness and expertise, got the black team to talk about the pain in their lives that triggers their eating. She helped them to see the connection and she offered them support and insight, both of which were welcomed and appreciated. This should have a profound and lasting effect on the black team's success, both on the show and well after.

Meanwhile, back at the ranch, Bob's team was feeling pretty disjointed after last week's nasty deception which resulted in Jackie's elimination. Her son Dan was left to pick up the pieces, and while Bob was supportive to him personally, he did not make any effort to bring his team together to mend their feelings. (We suspect Jillian would have made them talk.) So Dan, feeling very much the outsider, called the group together and they all talked and resolved to work together and they seemed to really achieve that, thanks to Dan. And no thanks to Bob.

However, the weigh-in--that incredibly tense and defining weekly experience--proved difficult for both teams. Jillian's team went first and racked up decent totals, but two of the five people had very low weight loss. This put smug smirks on the faces of the macho-therapy-trashing-we-got-this-in-the-bag-group of men. Oops. Lost by a pound. Bummer.

Lucky for Bob's team, Trent, the incredibly sweet but impossibly homesick ex-football player (pictured here) wanted out. He has said repeatedly that he was in this only to lose weight and change his life for himself and his family. He had little interest in the money or the game-playing. He also wanted to get proper medical attention for his bad knee, which often caused him to do poorly on the challenges. So he volunteered to leave, and after many conversations and much emotion (hence, the two hour show!), the team agreed to let him leave.

The impact of this week's episode will likely be felt in weeks to come. And one therapy session, no matter how powerful, does not a life change make. However, this is reality television. And the therapy was sincere. And even if Jillian's mom opened just a little, a door that had longed been locked in each of these contestants, surely Jillian will make certain they walk over that threshold with their heads held high.

And then Bob's team might one day realize that if they don't "talk it out" the only place they may "walk it out" is in the elimination room.

(c) NBC Universal.

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HOUSE: Unexpected Droop

Ptosis is a funny word. It has Greek origins so the 'p' is silent (say TOE-SISS). Same goes for the pterygium (a noncancerous eyeball growth) and the prehistoric pterodactyl.

As an ophthalmologist, when I hear about someone with 'ptosis' I presume they are talking about 'blepharoptosis', a droopy eyelid. Episode 82 of House, "Don't Ever Change" is all about a different kind of droop.

Former rock producer Roz Viner collapses from a fall during her Jewish wedding and breaks her leg. She demonstrates multiple paradoxical states such as pain in her noninjured leg and hypothermia when occupying a heated chamber. She repeatedly crashes and requires multiple different resuscitations - all of them timed to occur immediately before the next 4:00 minute block of commercials. Oy vey!

It seemed like this House offered disproportionately more nonmedical theatrics than typical episodes. The return of former applicant (cutthroat) Amber was an unexpected twist. Maybe one of my favorite fellowship candidates, the old nonphysician Henry Dobson, will enjoy a reprise! As earlier readers have commented, "Relax, it's just a fictional story!" They're right.

Things continue to deteriorate for Roz: bloody urine, rigid abdomen, unstable vital signs. Roz and her new husband observe their first Shabbat together but it won't be their last. Without explanation House performs a simple physical exam technique to divine the diagnosis. When hand pressure applied to the flank is released Roz again heads for the floor. Eureka!

House announces that all of Roz's problems are attributable to a droopy kidney, something called nephroptosis. The kidney was injured during the hora, the elevated chair dance that was performed after the wedding ceremony. The dislodged kidney (and neighboring adrenal gland) were responsible for the entire constellation of problems. Surgery can reposition the wandering organ.

It's good to know that your organs are not firmly anchored; they all have a little 'play' in them. The kidneys can travel an inch or so when rising to a standing position. Same applies to the spleen, the heart, even your eyeballs. Some flexibility is good for everyone.

Speaking of flexibility, are we to believe dancing the hora could dislodge a woman's kidney? "Relax, it's a fictional story!"

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• Your Kidneys
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Technorati Tags: House, TV, floating kidney, Jewish wedding, hora

The Biggest Loser-Couples: Cooking Up Karma

We're happy to report that last night's episode was pretty good. At least, on a relative scale. (You know we can never resist a pun.) For once the emphasis was nutrition rather than exercise and it proved an interesting topic, offering some real entertainment value. We were as surprised as anyone!

But before we go on, we have to say "We told you so". We have believed, and repeatedly stated, that the contestants' emotional well-being had a direct correlation to their success on the scales. We know this is not a new idea, but it's easy to lose sight of the emotional aspect of this kind of life change when we're presented with a contrived set of circumstances in which to view it. We have been concerned about how these people were doing emotionally, and have expressed upset when the producers were playing around with people's emotions in an effort to boost the drama quotient. This episode proved our theory. Jillian's black team had been fairly demoralized and made to feel quite inferior to Bob's blue team. But after inspiring them, consoling them and motivating them to get back in the game, Jillian was able to turn her team around. And the results were impressive. Here's a two minute video synopsis, courtesy of NBC.



So this show was about the tides turning and the black team regaining their sense of self and their sense of self worth. You know there was no way Jillian would let her team feel like losers (the other kind) for too long. So black triumphed.

And while black was kicking butt, the blue team was having a crisis of their own. Mark, the aggressive controversial figure on the blue team discovered he had a stress fracture in his leg. This limited his options in the gym but he nonetheless managed to lose the most weight and secure immunity. But when the blue team lost the challenge and had to select someone to leave, Jackie organized the group and, with Trent on board, decided to send Trent home - he has been famously homesick and he was OK with leaving, telling everyone he'd continue the work at home and come back a winner. Jackie, suspecting Mark and Jay (the brothers) were not always men of their word, extracted from them a vow to vote for Trent - they both swore on their children's lives. Never a good idea under any circumstances; especially not a good idea on a reality show!

The votes were cast and Jackie was eliminated. She didn't leave quietly; and she reminded Mark and Jay that they had sworn on the lives of their children. They are surely cursed now and it will be interesting to see if they get "theirs".

So, moral of the story: don't mess with reality show Karma.

It never works out well. If you play politics too long on Survivor, you get kicked off the island. If you "U-Turn" someone on The Amazing Race, you end up going home. You mess with your teammates on The Biggest Loser...we'll see. But Mark may very well get a little taste of what he's been dishing out.

(c) Video courtesy of NBC Universal.

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Technorati Tags: Biggest Loser, reality TV, weight loss, nutrition, exercise

HOUSE: Remote Possibilities

A female psychiatrist stationed at the South Pole develops severe flank pain but lacks the vital medical resources to establish the diagnosis and initiate effective treatment.

The story line in Episode 81 of House, 'Frozen,' reminds us of the peril involved when working in remote locales.

Did you know that in the real world personnel assigned to polar duty for the winter must have their appendix removed beforehand to prevent a similar crisis?

Cuddy assigns the emergency case to House and much of the drama occurs in the Princeton-Hillsboro teleconference suite. House quickly develops an emotional attachment to Dr. Cate Milton, a sharp-tongued, witty and highly intelligent patient who condemns House's shotgun style of medicine: speculate, test/treat, manage complications, regroup without apology. As a viewer, the confrontation between patient and doctor was far more instructive and compelling than all the other hoopla: urine tasting, self-performed thoracentesis, self-performed needle biopsy, Black & Decker craniotomy...ugghh!

Every time House wanted to begin empiric treatment for another unproven suspect diagnosis Dr. Milton challenged him. She refused to waste the outpost's limited medical supplies without valid justification. This woman was tough - we should be as tough with our own doctors! Granted, we essentially have unlimited access to diagnostic tests and medications, but that should not encourage lazy thinking or waste. Excessive procedures and prescriptions carry risks of severe complications. Doctors are expected to narrow the possibilities to clarify the real diagnosis.

An equally valuable lesson was saved for the final scene: You tend to find what you're searching for in the last place you look. Had House performed the complete 'video physical' as promised early in the episode he would've discovered the bruised, broken great toe on Dr. Milton's foot. Fat emboli from a the marrow of a non-healing bone fracture ended up being the true source of this patient's problems.

How can you apply these lessons in your own health care universe?

1. Never hesitate to talk back:
   

• Please explain to me what you are saying.
• What other options are available?
• What kinds of problems will happen if I choose not to receive treatment?

2. Never hesitate to ask direct questions:

• What did my MRI scan show?
• Did you receive my biopsy results yet?
• Is it time to get a second opinion?

Busy doctors can easily overlook previous orders and diagnostic studies. These oversights can lead to an unnecessary delay in getting you the help you need. On more than one occasion a gentle reminder from a cooperative patient saved the day for both of us.

You don't need to travel to the ends of the earth to benefit from these valuable lessons.

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• Ace Your Doctor's Exam
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Technorati Tags: House, TV, medical tests