If you wonder why I am 4 episodes into a show that’s so triggering for me (and many others), it’s really because of my patients. It comes up in clinic. It is also more common than it should be for patients to confess to me that they considered applying for #OperationTransformation (some actually applied).  My response, invariably, is “I’m glad you didn’t. You’re here now, and this will be better.” I know it’s tired trope to criticize #OperationTransformation at this point. All the arguments have been made. And we all know that no matter how #OT can try to dress itself up as a show about getting healthy.  It is not. It is a weight loss show.  If it were about health, we’d have a diverse group of “leaders” pursuing diverse, unrelated health goals such as smoking cessation, reducing alcohol consumption, doing pelvic floor physio, working through food aversion, or starting family therapy.

But what we have are increasingly painful public weigh-ins.

Let’s talk about what went wrong in OT Week 4.

• This week, we saw a leader in serious psychological distress with stress and identifying as  burnt-out – being piled on with the additional stressors of an OT plan, camera crew, and public weigh-in.
• We saw a leader struggling to exercise through injury. Why?
• We saw a leader cajoled into making food that she and her family don’t like. Why?
• We saw a leader who actually lost muscle/lean mass from the rapid weight loss approach.
• We saw another leader work so hard she was in tears at multiple points – then a demoralising public weigh-in to show that it hadn’t yielded any immediate weight loss.
• We saw leaders told that “Our Goal is to have you lose 5-10%” in 6 weeks”.  Completely disregarding the leaders as autonomous and informed adults who can make decisions for their bodies and to create their own health goals.
• We don’t have enough information here because much of this is obviously on the editing room floor, but why was the question of OSA only being raised at this point in the leader’s health journey?

So, let’s talk evidence-base – not ratings-race:

4. Psychological stress is real. Stress is a factor in maintaining a healthy weight (Dr. Sumi Dunne alluded to it last night when she mentioned the role of cortisol.) Psychological screening and support of patients with chronic health conditions needs to extend beyond advising “mindfulness”. If someone says they are burnt out – believe them.
5. If you are on a weight loss journey, 1-2 pounds a week weight loss is safe and sustainable. And you don’t need to get on the scale every week, and certainly not in public, to do that.
6. Life is not a reality TV show: If you aren’t a celebrity in a jungle, you don’t have to eat food you don’t like. You don’t have to exercise until you are injured or crying in frustration.
7. Obstructive Sleep Apnoea (OSA)  is a common complication of obesity.  It is not just about snoring, but it is a risk factor in heart disease.  Pardoxically, the disruption of sleep from OSA  can also obstruct weight loss efforts (because biology!).  This leads to problems when the first line of treatment for OSA is “lose weight.” Decision  making in treatment can be difficult, and does require expert and multi-disciplinary input.
8. Lifestyle modification for treatment of obesity (5-10% weight loss) works. I do it with my patients.  But not in 6 weeks.  No one eats food they hate.  And I don’t come around their houses to make them do exercise they don’t like or when they are injured.  Mental health is central.  Their decisions matter.  And very importantly – I rarely ask them to get on a scale.
9. You can call them “leaders” but when you are treating a chronic and complex disease using registered healthcare professionals – they have become patients. Patient-led, patient-centred care.  Shared decision-making.  These aren’t just words.  This is standard of care. I’m of the opinion that a camera crew shouldn’t change that.

Even on I’m a Celebrity, Get Me Out of Here, participants can opt out of challenges that they feel are too far out of their comfort zone.  It is the very least that could be offered to participants in OT.