TW:  if you find the programme triggering, this post may also be triggering.

I watched Operation Transformation  (OT).  And I really didn’t want to.  But, on the balance, I think if my patients are going to be bringing it up with me in clinic (and some will, understandably) I should be prepared to for the discussion.

Ok, the breakdown. What did they get wrong? What did they get right?

What they got wrong:

1. Public weigh-ins. In 2023.  The move to add clothes is a welcome nod to human dignity,  isn’t enough to fix everything wrong with it.
   • Dr. Sumi Dunne is a good doc. I have no doubt that the leaders had blood pressure, fasting cholesterol, diabetes/blood sugar screening, grip-strengths, sit-to-stands, one-leg standing tests….  So I think that the many health measurements done that were cut in editing/production.  Why not talk about that rather than rolling it in to abstract adjusted age?  Real, tangible, measurable outcomes that make a real difference to patient health risks.  Could we not just do a health profile at the start – do the whole show – and measure them again at the last episode?   How is the starting weight more important than other metrics like blood pressure or fasting lipids or blood sugar? If it is just a number, each of the participants could have been given a different metric to work on that wasn’t weight. 
   • This show had the potential to educate about the leading cause of liver cirrhosis in Ireland: NAFLD (non alcoholic fatty liver disease).  Rather than putting leaders on scales, getting special ultrasounds of the liver (called Fibroscan) could check and measure this for patients.  Again, a tangible, measurable outcome that affects health.

2. The science behind these programmes.
   • OT is based on an older US show called Biggest Loser (yes, that title is serious weight stigma!). Studies that followed up past contestants has shown does not create lasting weight loss or improved health outcomes months or years later.
   • There was still a talk of “energy in, energy out” and talking about eating less and moving more — which is an outdated model of obesity and management of the disease of obesity.
   • Obesity is a complex, chronic, and recurring disease which has more risk factors than diet or exercise, including genetics.

3. Missed opportunities to talk about what is really wrong – and it’s not any individual.
   • The leaders are average. That should be highlighted.  60% of the Irish population is above a healthy weight or has obesity. This is not a problem with individuals.  This is another opportunity missed to talk about the bigger problems, cultural factors and public health rather than hand-picking 5 people (if I were cynical, I’d feel almost as if were done to exploit the annual January “New Year, New You” marketing trends.)
   • Let’s talk about healthcare access: 2 out of the 5 leaders had already been seen by heart specialists at one point in their journeys, yet seem to have inadequate access to allied health professional rehab programmes which include physios, exercise, psychology, and dietitians.
   • This show really highlights how healthcare in Ireland is broken: These patients now felt that they had to compete to enter a once-a-year television show to receive care rather than just be referred to a specialist team. If those patients had had the opportunity to receive the same care and NOT be exposed on national TV, would they?

Okay, in the balance of positivity, what did they get right?

1. Sophie Pratt is the CORU-registered dietitian. For one leader, she recommended making no more changes than just establishing a regular meal routine — with no other changes to what she ate. This!  So, so often it is the first thing change that I discuss with my patients. (Did you know? If patients have to make many changes for health reasons, as lifestyle medicine physicians we commonly work through adding one or two first steps before we link our patients in with the registered dietitian to avoid making too many changes all at once)  Many patients with obesity regularly skip meals and many do not eat enough!
2. The food partnerships with convenience stores. Many people with obesity live in “food deserts” which means that it is difficult to access grocery shops that carry a wide variety of affordable fresh produce or whole foods, and often are forced to shop in convenience shops that have a higher proportion of highly processed foods. What I love (and to be honest, there isn’t much about OT I love): the free meal plans with the ingredients being more accessible to a wider population AND plant-based options given. Shopping lists and plans are done for you. If you go the website, there is good education on meal planning/prep which is a key part of the work I do with patients in clinic (and it’s not as easy for some to do.)

Maybe I’m being harsh.  Maybe they will do this all differently this year and episode 2 will be better.  If they follow the science:  there is no health reason to do a public weigh-in for Week 2.  None.  A public weigh-in next week simply underlines that no matter how they dress this show up (including not-so-subtle background music “I love the shape of your body”), it is focusing on weight-loss for sake of weight loss.

Dr. Kate McCann is a SCOPE (obesity) and Lifestyle Medicine certified physician.