Contestants on NBC’s The Biggest Loser are known to push their bodies further than they ever thought possible for a chance at a new life — oh, and a $250,000 grand prize. They run, jump, and lift their way through grueling fitness challenges, overhaul their diet plans, and put it all to the test during temptation challenges. The latter gives contestants an opportunity to win rewards like money and watch videos from home if they’re willing to eat thousands of calories worth of junk food. It’s controversial to say the least — not that the show, now in its 17th season, is a stranger to criticism.

Trainer Jillian Michaels, for example, was accused of “cheating” in 2013 when she was caught giving her team caffeine supplements. Similar allegations were made recently in a New York Post article, where three former contestants said they were also given Adderall and “yellow jacket” pills containing ephedra, a supplement that is believed to aid with weight loss when combined with caffeine. These pills are especially problematic considering the Food and Drug Administration banned ephedra in 2004 after it was linked to negative side effects like irregular heartbeats and heart attacks.

Though the Los Angeles County Sheriff’s Department announced this week that it would look into those allegations, perhaps the most controversial aspect of the show is that many, if not most, of the contestants don’t maintain their drastic weight loss. A study published last month found that 14 of the 16 contestants in the show’s eighth season regained a significant amount of pounds back over six years, while a third added on all or more despite maintaining the same activity level.

Interested to see why this happens, Medical Daily spoke with licensed therapist and weight loss expert Armando Gonzalez, aka Dr. Mondo, whose eight-stage weight loss program came out of his graduate dissertation on the psychological states of former The Biggest Loser contestants. Beyond weight gain, he reveals the harmful effects of fat shaming, and the importance of learning to love yourself no matter how you look in the mirror.

What is your background, and how did you come to research weight loss psychology and The Biggest Loser?

I have a doctorate and license in marriage and family therapy, and I basically made my mission in business and life to help support people who go through drastic weight loss. That’s always been near and dear to my heart because that’s been my story, too.

I grew up as a kid that was overweight. I never got made fun of a whole lot for it, but I was always pretty much of the mindset, like a lot of us, that chubby guys, if we can make people laugh or entertain them, then usually they’ll be laughing with us and not at us. … I always knew that I was overweight, I was aware of it, and it was really something that I was self-conscious of. I struggled with self-esteem all throughout my life.

When I was 18, I lost, I think, about 50 to 60 pounds and my whole life went through this dramatic change. All of a sudden I had all this attention from the opposite sex. I started dating more. All of that gave me almost a false sense of confidence — I felt like I deserved to be confident, but eventually I gained the weight back, and I went through this rollercoaster a few more times in my early 20s, where I would get really healthy and then I’d get really unhealthy. It wasn’t until two or three times in that I realized that what I was chasing was this internal transformation.

Really what I was searching for was a new story about myself, a new sense of confidence, self-esteem, and a new way of conducting myself in relationships where I wasn’t just a people pleaser but where there was more balance.

I thought that weight loss was going to be the magic thing to cure all of that, and it wasn’t. So I went through this crisis. I got a bachelor’s degree in psychology and started studying food stuff, body image stuff. By the time I was ready to do my doctorate program, I was really just determined to understand what sort of research was out there that talked about all this. I figured there was just a pile of it. … I was pretty shocked to find that not only was there not a pile of research that talks about the common changes people go through when they lose a drastic amount of weight, but on top of that, a lot of my own experiences that I’ve had and that other people I have talked to have mentioned — the struggles, the stage of not recognizing yourself in the mirror, the stage of getting new attention and liking it on one hand but being terrified and overwhelmed by it on the other — there’s no roadmap for that because research hadn’t yet caught up to understanding that that’s even a real phenomenon. So it became my mission to say that OK, I want to do the research that’s going to really explore this stuff.

Initially I was just going to use general population folks around Sacramento to participate, but then I had this idea of, you know, why not swing for the fences and try to get some folks from NBC’s The Biggest Loser to be the ones that we studied in the research. ... I did intensive interviews with five former contestants of the show. I had conversations about all their psychological experiences: what life was like before weight loss, what it was like during it, what it was like after. From that point I spent about a year-and-a-half analyzing that data and looking at the common themes that I see everyone going through.

But then on top of that, I wanted to know [more about] the people that were maintaining their weight a year-and-a-half, two years post-transformation — what kind of psychological factors were they implementing that were different? How were they responding to these common changes? Were they doing something different to help them be more successful long-term?

From all of that, I published my study as my dissertation. It was an eight-stage model that says these are the eight stages you go through, and each of them also lists the people who are successful at navigating these changes, what they’re doing differently.

How would you define drastic weight loss?

In our study, we defined it as someone who’s losing over 25 percent of their body weight. Traditional numbers for a lot of people would be something like losing 40 pounds or more. I use the word “drastic” a lot, and I do that because I want to be true to the research I’ve done. With the research, these weren’t people who just lost 20 to 30 lbs. These were people who lost well over 50 lbs, some lost over 100 lbs [over nine to 12 months].  

What’s happening metabolically/physically when you lose so much weight that fast?

Research has shown, from a physiological standpoint, that when you lose drastic amounts of weight in a short period of time, your body is kind of programmed to protect itself. It thinks that you’re going into starvation mode. So it attempts to cling to any amounts of fat that you have. It basically says that once you’re done with the diet, it’s going to do whatever it can to start adding some weight back.

From what I also understand, there are some hormones, I think leptin, which lets us know when we’re full. After losing all the weight, folks would eat normal amounts of food that should, based on the size they are, [make them] feel satisfied. But without leptin, they weren’t getting signals that said they had enough to eat. So it made them feel extremely hungry.

It’s a combination of these physiological factors working against people [who’ve lose weight]. On one hand you have a metabolic rate that’s lower than it should be for someone [with] their same weight, so they eat less calories to maintain weight loss. They also deal with these real strong urges, more based on hormones, that work against them to put some weight back on.

What’s the psychological process that someone might go through during drastic weight loss?

When someone loses weight, psychologically, there’s a hyper sense of fear about regaining the weight. I see so many people come into my office who look like they’re in great shape, but they have this deer in the headlights look and say, “I’m so terrified of gaining this weight back,” or “I’m so terrified of having a ‘cheat meal,’” where all of a sudden it leads to a slippery slope. A lot of that is a byproduct of the diet culture and the fat shaming that we have in our society.

Now, imagine we bring back the physiological piece. You’re having these intense cravings to eat. We’re attaching psychological meanings to these cravings. What does it mean? A lot of people will tell you it means “that something is wrong with me,” that “I want bad food” — a lot of negative shame. So if they give into those cravings, it’s not just, “I made a mistake and I ate something I shouldn’t have and I ate too much today.” A lot of times, especially with people who are prone to struggling with their relationship to food, they’re very prone to high levels of shame. Giving in to a craving because your hormones are out of whack wouldn’t just be giving in to a craving. To those folks, a lot of times what it means is, “Oh my gosh, I totally just screwed up.” Shame, fear, panic. And what I always will say to people is that shame is one of the biggest silent killers in our weight maintenance journeys, because when shame visits us in those moments, it makes us feel like we just ruined everything.

That’s often the mentality and emotional mindset that leads one “cheat meal” or “binge” into a series of a cheat week, a cheat month, and before you know it, that person is completely holed up and back into isolation.

Kai Hibbard, from season three of The Biggest Loser, called the show “a fat-shaming disaster.” How does this affect a person who’s trying to lose a lot of weight?

I think it happens on the show, and the show in a lot of ways is a good microcosm of what happens in our society in general. It’s not necessarily to vilify The Biggest Loser and the trainers on the show, to say what they are doing is wrong. It’s really just saying this is our society and this is how our society views weight. I think that the impact that has is that, you know, today, girls as young as 3 years old know what it means to be fat and they’re terrified of it. Studies show that these girls know that being fat is known as something that is awful. How does that impact our identities and the stories that we tell about ourselves?

In my research, I talk a lot about people who’ve struggled with their weight since childhood. They have this weight-saturated identity and it’s this personal narrative that tells him/her they could be the best employee, the best husband or wife. … They could do all these things and excel, but the fact that they’re overweight makes them feel like none of those things count. And so, when someone is fat-shamed, what often happens is not only is their self-esteem and self-worth being smashed down further, but they… believe that the only way out of that is to lose weight in order to feel better about themselves.

Somehow you have to unplug from that. When you have fat shaming, it makes it so hard because it’s almost like validating that deep dark voice that we all have in our heads when shame speaks to us. And it’s being validated by someone we know and trust — a trainer or by someone who’s supposed to help us. That can be extremely dangerous because now, that voice has an echo to it.

During the show, contestants are given temptation challenges, where they can eat temptation foods for a cash reward or to view a video from home. Surely this isn’t helping their journey, right?

I think on one hand it’s encouraging more of this idea that willpower is the answer. If you’re struggling right now, then it’s because you don’t have willpower, which contributes to the narrative that fat people are just lazy. I think that’s completely shallow. Psychologically, it’s engraining you more into an all-or-nothing view of food... black-and-white thinking.

What this temptation is doing is reinforcing to you that that food is bad — resist it and you’re good. You can’t keep up that mindset long-term. You can’t be a lifelong dieter. Maybe a small fraction of people who keep the weight off long-term are lifelong dieters, but at some point you have to view food not as a binary, but as something more expansive.

If you’re doing a temptation [challenge], it’s increasing shame to say, “By the way, how much willpower must you lack, and how shameful are you really, if you can just eat that piece of cake instead of hearing a message from your son or daughter?” This is reality TV at it’s finest. We are perpetrating so many of these shallow, such outdated views of food, so we have to get past those ways.

Where is the balance between positive and negative reinforcement when it comes to achieving weight loss goals?

I recently heard a podcast with Joe Rogan talking about weight loss. He mentioned that he never really struggled with his weight too much — he’s only kind of been pudgy here and there. But, he said, “I think that some of the best motivation that I have is to cuss myself out, to be hard on myself.” I would say, if you’re someone who’s struggled with weight your entire life, that method of being hard on yourself or having someone else play that tough cop, tough love thing with you. More times than not it’s never sustainable long-term. I see more damage from it than I see positive effects. What I like to do with people when I work with them is I like to say, “Look, if you are caught feeling shamed for a behavior you’re engaged in, if you’re stuck in a pattern where your behavior is shameful, you’ll never be able to change it.

The way out is, instead of viewing your behavior through a lens of shame, view it through a lens of compassion. When you do that, what we find is there’s a reason for why you’re doing what you’re doing. That compassion allows you to see your context, and then you can make different choices.

A lot of people [experience] trauma in their relationships growing up, where food is the only reliable source of comfort. So maybe they had parents who were really hard on them, or maybe they just had parents who were always working and not around a lot — they felt unimportant or scared. Early on they learned that the way to take care of their emotions, the way to take care of themselves [is with food].

What you’re after [by losing weight] is a new way of taking care of yourself, but you have to understand what got you started in the first place. I would choose compassion over shame any day because it’s a much more effective in the long-term and much more effective at really getting to the bottom of what this whole thing with food is really about.

What are people who approach weight loss the right way doing that helps them keep it off?

Our [second stage of the program] is the biggest predictor of long term success. It occurs on day one of a person’s journey and it’s called “Your Anchor for Change;” it’s also referred to as your “why.” This stage really gets down to it and asks the question: “Why do you want to lose weight?”

People who are successful long-term answer that question so much differently than the majority of people. People who have strong anchors... [want] to look better and feel better — that’s everyone’s reason. But… a lot of times their why is based on the long term, meaning they’re in a journey mindset as opposed to a destination mindset. They’re not focused on [an idea like,] “If I get to this goal weight life’s going to change” — they just realize it won’t. Because of that, it’s more focused on overall health, not a number on a scale. They also have made their “why” bigger than just being about them. Like, in a research study, they’ve said, “I want to be around for my kids,” or “I want to be around for my wife.” “I want to rewrite history, my legacy.”

How does someone strike a balance with weight loss, without going too far to the opposite side of the spectrum, and becoming obsessed with weight loss?

People who are successful long term, at some point they figure out that the journey is bigger than weight loss. They also realize that, “Yeah, I really want to lose weight to feel better and look better, but what happens if I look better?” People who are successful long-term with their health have figured out that there’s no number on the scale, there’s no pant size, there’s no certain angle they can catch themselves from in the mirror that will ever be enough to make them feel worthy.

At some point people have to realize that that internal transformation that they’re looking for has to be based on nothing related to the external transformation with their weight. They have to start a process of learning how to feel and validate themselves, and write a story that says they’re worth it regardless of the number on a scale or any other external factors. But all too often I see that people lose the weight, there’s this fork in the road moment… there’s this one group of people that get freaked out by the new transformation, they look at themselves in the mirror and they feel super overwhelmed. It’s not even necessarily a sense of “I have to do better, I don’t like this, I don’t like that.” It’s more like “Oh my God. This person terrifies me,” or “This new body gets me all this attention.” So they almost retreat back into gaining the weight back subconsciously as a way of protecting themselves, because it doesn’t feel safe to be overweight.

Then you have the other group that will lose the weight and get so addicted to the attention that their selfie count goes through the roof. We’ll see people lose weight and all of a sudden they’re posting 12 selfies a week, and they’re really kind of feeling themselves. But in putting themselves out there like they are, there’s really this hollowness to their experience where they feel like they’re still not enough, [thinking], “If I could just find a way to get this love handle off...”

In a clinical sense, it works into body dysmorphic disorder, where they begin to see themselves as being different than it actually appears. You’ve gotta know you’ve arrived because if you don’t you’re going to burn out and go back to the same old behaviors.

What does “arriving” mean in this sense, maintaining a routine?

I think arriving can’t be based on the number on a scale because we’ll just move it, right? It can’t be based on shirt size, because we’ll just go down a size, or pant size. We have to measure success in ways separate from a scale. Get your blood work done — has it improved? I just recently got mine done and I noticed there were huge shifts even from where I was at a year ago, because I used to do more of the yo-yoing. For me, that’s more validation of knowing I’ve arrived.

The scale says I haven’t arrived, but the blood work says I have; and if I could just maintain this healthy lifestyle then that means I have something to celebrate. That’s one way. But it’s also… becoming a more confident version of yourself. Some of that has to do with the fact that you lost weight, but at this point, why not make this deal with yourself where you say regardless of what happens next on the scale, I’m going to keep this momentum going? That’s really why we want to lose weight. So you’ve arrived in that sense too, because weight loss has invited that more confident version of you out and into the public.

This sounds like more of a long-term program compared to what happens on The Biggest Loser. Why is that better?

I can tell you firsthand, and people will tell you this all day long if they’ve been overweight, there’s a certain point that we reach when we become smaller. Where all of a sudden we become visible again… to the opposite sex, in meetings. All of a sudden, the ideas we throw around in a business setting or with friends have even more clout to them, and it’s because we look different.

So you have so many changes happening — in your relationships, your body, your identity. Your world changes so quickly that my big theory when I hear a lot of the weight regain statistics has always been because it’s the only way for them to pull the emergency brake in their life and say, “Holy crap, this is a lot of change. Too much, too fast. I need to pull the brake and slow this down.” I don’t think it’s a conscious decision people make.

So does that mean that we throw drastic weight loss out? I could tell you, psychologically, there’s so much benefit to slowing the journey down because your mind has time to adjust to all these changes. If you lost 100 pounds in two years, that would be a much easier adjustment period versus losing that in six to nine months. And physiologically, the research shows that the slower you lose weight, the more likely you are to maintain it as well. To me, a big take home from both the psychological and physiological fields is slower is better, without a doubt.