The biggest loser winner Ryan Benson, When more than 40 former contestants from “The Biggest Loser” gather Wednesday for a reunion television special, the winner of the program’s first season, Ryan C. Benson, who lost 122 of his 330-pound starting weight, will be absent. Mr. Benson is now back above 300 pounds but he thinks he has been shunned by the show because he publicly admitted that he dropped some of the weight by fasting and dehydrating himself to the point that he was urinating blood.
Now in its eighth season, “The Biggest Loser” is one of NBC’s most-watched prime-time programs besides football, drawing an estimated 10 million viewers each week, according to Nielsen. It has clearly tapped into the American obsession with losing weight, as more than 200,000 people a year submit audition videotapes or attend open casting calls for the program.
It also has spawned a licensed merchandise business that will generate an estimated $100 million this year.
The series also highlights the difference between the pursuit of engaging television and the sometimes frenzied efforts of contestants to win, perhaps at the risk of their own health. Doctors, nutritionists and physiologists not affiliated with “The Biggest Loser” express doubt about the program’s regimen of severe caloric restriction and up to six hours a day of strenuous exercise, which cause contestants to sometimes lose more than 15 pounds a week.
At least one other contestant has confessed to using dangerous weight-loss techniques, including self-induced dehydration. On the first episode of the current season, two contestants were sent to the hospital, one by airlift after collapsing from heat stroke during a one-mile race.
New contestants are entering the show more out of shape. Each of the last two seasons has broken the record for the heaviest contestant ever, at 454 and 476 pounds.
Medical professionals generally advise against losing more than about two pounds a week. Rapid weight loss can cause many medical problems, including a weakening of the heart muscle, irregular heartbeat and dangerous reductions in potassium and electrolytes.
“I’m waiting for the first person to have a heart attack,” said Dr. Charles Burant, a professor of internal medicine at the University of Michigan Health System director of the Michigan Metabolomics and Obesity Center.
“I have had some patients who want to do the same thing, and I counsel them against it,” Dr. Burant said. “I think the show is so exploitative. They are taking poor people who have severe weight problems whose real focus is trying to win the quarter-million dollars.”
Dr. Rob Huizenga, the medical consultant to “The Biggest Loser” and an associate clinical professor of medicine at U.C.L.A., said that the program was safe. “This is not only a major amount of weight loss, it is a totally different kind of weight loss compared with surgery or starvation diets,” he said.
In interviews, the show’s trainers and producers acknowledge that unsafe practices can occur.
“If we had it to do over, we wouldn’t do it,” Dr. Huizenga said of the recent one-mile race that resulted in hospitalizations. “It was an unexpected complication and we’re going to do better,” he said, adding that “that challenge has changed a lot of the way we do things,” including more closely monitoring contestants’ body temperatures during exercise.
JD Roth, an executive producer of the series who created its current format, said that while the show was extreme, “it needs to be extreme in my opinion.”
“For some of these people this is their last chance,” he said. “And in a country right now that is wrestling with health care issues and the billions of dollars that are spent on obesity issues per year, in a way what a public service to have a show that inspires people to be healthier.”
Some contestants have claimed that dangerous weight loss techniques were common among contestants. Kai Hibbard, who lost 118 pounds and finished as the runner-up in Season 3, has written on her MySpace blog and elsewhere that she and other contestants would drink as little water as possible in the 24 hours before a weigh-in. When the cameras were off, she said, contestants would work out in as much clothing as possible.
Ms. Hibbard, who weighed 144 pounds at the show’s finale, wrote that she added 31 pounds in two weeks, most of it simply by drinking water. That experience is not isolated. Including Mr. Benson, the winners of the first four seasons of the show each have added at least 20 percent to their weight at the end of the show.
Jillian Michaels, one of the two trainers who supervise contestants’ workouts on the series, said the experience of Ms. Hibbard and Mr. Benson was evidence of “the dark side of the show.”
“Contestants can get a little too crazy and they can get too thin,” she said. She said contestants are medically checked and disqualified if they are dehydrated or are found to be taking drugs or diuretics. “That is the worst part of the show,” she said. “ It’s just part of the nature of reality TV.”
Contestants are required to sign releases that stand out even in the waiver-intensive world of reality television.
One such release, which was provided to The New York Times by a former contestant who did so on the condition of anonymity, says that “no warranty, representation or guarantee has been made as to the qualifications or credentials of the medical professionals who examine me or perform any procedures on me in connection with my participation in the series, or their ability to diagnose medical conditions that may affect my fitness to participate in the series.”
The current season started with five contestants of more than 400 pounds. Yet contestants have been required to sign a document certifying that they believe themselves to be “in excellent physical, emotional, psychological and mental health.”
Mr. Roth said that those “standard release forms” are similar to those used “on any reality show.” He added that the show’s medical professionals had “appropriate qualifications and credentials.”
Getting contestants to talk openly about the environment of the program is difficult. Shortly after a reporter started contacting former contestants to interview them about their experiences, a talent producer on the series sent an e-mail message to many former contestants reminding them that “serious consequences” could ensue if they ever talked to a reporter without the show’s permission.
To do so could subject them to a fine of $100,000 or $1 million, depending on the timing of the interview, according to the e-mail message, which was obtained by The New York Times. The show’s producers did provide an opportunity to interview several former contestants, but the interviews were conducted with an NBC publicist listening in.
Ali Vincent, a fifth-season contestant who became the first female winner of “The Biggest Loser,” said she believed that her involvement in the show was “definitely worth it.”
“I went from a life of nothing to being active every day, six days a week,” said Ms. Vincent, who started the program weighing 234 pounds and finished at 122. She now weighs about 125 pounds, she said, and is a spokeswoman for products and ventures related to “The Biggest Loser.”
Ms. Michaels and Bob Harper, the other trainer, as well as Mr. Roth all say that at least half of the contestants stay close to the weight levels they achieve on the show for several years.
Mr. Roth said he happily accepted a 50 percent success rate — noting that only a handful of former contestants regained all or most of the weight they carried before joining the show. “Getting 100 percent to keep the weight off has never been the goal,” he said. “The goal is can we inspire people in America to make a change in their life. In that, we’re batting 1,000.”
