Lessons to remember with Rachel Frederickson

By BodyMatters therapist Sarah McMahon

Today social media is buzzing about the extreme weight loss of Rachel Frederickson on America’s The Biggest Loser (TBL). And why wouldn’t it- losing 60% body weight in 4 months is extreme! Some have defended Rachel and the TBL, claiming it to have been done “safely”, “under medical guidance” and “with hard work”. Most pieces that I have seen have expressed criticism and concern- about her well being, as well as the impact of her weight loss on viewers. As a specialist who treats people suffering from eating disorders, I feel compelled to comment and share three observations pertaining to Rachel’s weight loss.

1. We cannot assume someone has an eating disorder simply from how they look.

According to the DSM V, the diagnostic criterion for Anorexia Nervosa is now as follows:

A: Restriction of energy intake relative to requirements, leading to a significantly low body weight [ie weight that is less than minimally normal] in the context of age, sex, developmental trajectory and physical health;

B: Intense fear of gaining weight or of becoming fat, or persistent behaviour that interferes with weight gain, even though at a significantly low weight;

C: Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self evaluation, or persistent lack of body weight or shape on self evaluation, or persistent lack of recognition of the seriousness of the current low body weight;

Restricting type: The weight loss is accomplished primarily through dieting, fasting and/or excessive exercise.

From what has been reported in the media, Rachel could meet Criterion A in that her BMI is 17.5 according to media reports. This is classed as underweight according to BMI charts. However unless we know Rachel intimately we cannot know whether she experiences intense fear of weight gain, nor can we have any insight into her current evaluation of herself. So Criterion B & C is unclear. This highlights the fact that we cannot diagnose a person with a problem simply by eyeballing them. Especially if we are not health experts. Eating disorders are a psychological problem- not a physical one.

Ultimately whether Rachel has an eating disorder- or any other health issue for that matter- it is a private issue between herself & her GP. If she does have an eating disorder, she deserves privacy and space to adjust to this diagnosis. If she doesn’t, isn’t it unfair for this to be publically speculated? Imagine for a second that a rumour started that she had lost so much weight because she had contracted AIDS. This simply wouldn’t happen. Let’s deal with the possibility of Rachel having an eating disorder in a similarly sensitive way.

2. We must ensure responsible journalism with regard to the reporting of eating disorders.

There are many medical conditions that result in weight loss. These include: cancer; diabetes; hyperthyroidism; mal-absorption; depression; stress; anxiety; and substance abuse. If Rachel has dramatically dropped weight because of a health issue, it could just as easily be one of these. And so in the same way that it would be irresponsible to frivolously propose she has developed one of the aforementioned conditions, we really need to be careful with how an accusation that someone has an eating disorder is thrown around. Falsely accusing someone of being “so anorexic” diminishes mental health literacy as it simultaneously trivialises and glamorises this diagnosis.

This is particularly concerning when we consider the seriousness of eating disorders. Anorexia Nervosa has the highest mortality of any mental illness. Eating disorders have tragically high rates of suicide. We are not talking about a stubbed toe here: eating disorders need to start to be taken seriously.

FED UP NSW Health has some excellent guidelines pertaining to the reporting of eating disorders in the media.

3. Weight loss may have taken place “under the guidance of TBL medical team”- but that does not mean it was healthy.

Losing 60% body weight in 4 months IS taking it too far. It is an extreme amount of weight loss over a short period of time that equates to approximately 4.5kg weight loss per week. The only medical professionals who would claim this to be safe are those who are paid by the weight loss industry to do so- such as consultants to TBL.

It doesn’t take a health expert to notice that TBL employs extreme methods of weight loss. It also doesn’t take a health expert to realise that the very weight loss behaviours they encourage in TBL are those same we are diagnosing in eating disorders.

As a case in point, firstly consider if the Rachel were to engage in the following behaviours* at her “before” weight:

• Dehydrating prior to weigh ins
• Losing up to 17kg in one week
• Running 10km in summer heat
• Exercising despite an injury
• Exercise despite vomiting
• Restricting to 1000 calories per day- less if possible

Unfortunately I doubt an audience who is familiar with TBL would flinch at this.

Now read the list again, considering her engaging in these behaviours at her current “after” weight:

• Dehydrating prior to weigh ins
• Losing up to 17kg in one week
• Running 10km in summer heat
• Exercising despite an injury
• Exercise despite vomiting
• Restricting to 1000 calories per day- less if possible

Enough to make you shudder? It sounds like a list of “eating disorder rules” to me.

The Ultimate Conclusion.

So in conclusion, do I think shows like TBL are dangerous? Absolutely! I do not know anyone who works in “health” who thinks this show provides any benefit to either the individuals on the show or to “public health” in general (which the current Australian TBL series is now claiming to do). Messages around food and weight are already so confused in our culture. There are many merchants and industries that profiteer from body anxiety and fat hatred. For many people, eating is a moral experience laden with layers of emotion. The fact that weight loss has been made into a game show that is watched by millions, all around the world, is an extremely sad reflection of our times. Let’s somehow harness the alarm of Rachels shocking weight loss to remind ourselves that TBL is more than a game show- the contestants are real and vulnerable people- and the viewers are too.

*Whilst I have not watched the American series that Rachel participated in, my colleague Lydia Jade Turner has commented on some of the “weight loss techniques” that were utilised in an Australian series in the following blog: https://bodymatters.com.au/the-biggest-bully-tv-show-a-loser-for-weight-loss-2