If you go

WHAT: Risk Factors for Eating Disorders.

WHEN: 6-8 p.m. Feb. 25.

WHERE: Medical University of South Carolina Institute of Psychiatry auditorium, 67 President St.

COST: Free.

MORE INFO: Dr. Timothy Brewerton, medical director for The Hearth Center for Healing, will moderate a panel discussion of people in recovery, family members and clinicians as part of National Eating Disorders Awareness Week, Feb. 23-March 1.

On the web: http://thehearthheals.com

I've never been a fan of the TV show, "Biggest Loser," but the show struck a nerve with many Americans last week when Rachel Frederickson won the 15th contest and a grand prize of $250,000.

As many know by now, the 24-year-old went from 260 pounds to 105, or a reported dress size of "0/2." At 5-foot-4 or 5-foot-5 (both heights were reported), it put her body mass index at either 18 or 17.5. A BMI of 18.5 or less is considered "underweight."

The reactions from viewers, TV commenters and health professions ranged from deep praise to deep concern.

Some noted that it was simply a weight loss contest and that she probably would gain weight after the show, while others said she lost too much weight and exhibited signs of an eating disorder, such as anorexia nervosa or orthorexia. Others railed that the obesity epidemic is a more serious problem than eating disorders in the United States.

Even as the debate was on fire last Wednesday, NBC's "Today Show" interviewers avoided the issue during a two-minute interview which started with Al Roker saying, "You look amazing," and ended with Savannah Guthrie saying Frederickson looked "fabulous."

Many viewers, however, read into the shocked looks of "Biggest Loser" trainers, Bob Harper and Jillian Michaels (who did not train Frederickson), when they saw her come out onto the set.

Harper posted this comment on Facebook: "Jillian and I want to take a moment to congratulate all of the BL contestants on their hard work. We're not comfortable commenting on Rachel's journey because we weren't her trainers and weren't given an opportunity to work with her at any point. Any questions about the contestants on 'The Biggest Loser' should be directed to the show's producers."

Meanwhile, Frederickson seemingly defended her weight loss Wednesday saying, "I am extremely proud of the way I lost the weight on the show... (I worked) extremely hard and (ate) extremely healthy. I'm going to maintain being healthy."

Expert weighs in

Dr. Timothy Brewerton, a top expert on eating disorders in South Carolina, says that while he is unable to diagnose Frederickson because he is not her physician, the "available information (on her) is disconcerting and worrisome, both for Rachel's sake and for the viewers of the 'Biggest Loser.'"

Brewerton says the debate over Frederickson is "food for thought" as South Carolina held its first-ever "Eating Disorders Awareness Day" on Thursday and as the country approaches National Eating Disorders Week, Feb. 23-March 1. (See box on event).

"Both dieting behavior and binge eating are very common behaviors in our culture and time, and both can become so excessive or extreme that they become serious medical and psychiatric disorders, such as anorexia nervosa, binge eating disorder and bulimia nervosa," says Brewerton, medical director for The Hearth Center for Healing in Columbia.

"It is also important to add that compulsive exercising, which appears to be fostered in the show, can be highly problematic and is often a significant part of an eating disorder."

As for Frederickson, Brewerton says that at her current weight, it is "highly unlikely" that she would be able to sustain a normal menstrual flow and that she may have altered her brain and body chemistry, based on a large body of scientific literature about the effects of chronic starvation.

Frederickson, whose BMI was at 43.3 more than seven months ago, says she ate five small meals a day comprised of carbs, fats and protein totaling 1,600 calories.

Other red flags

Noting an article in The Los Angeles Times on Wednesday, Brewerton notes that the Times stated Frederickson was a "competitive high school swimmer who gave up a full college scholarship to follow her boyfriend to Europe."

After that didn't work out and the relationship ended, she returned to the U.S. and began eating "to tamp down her sorrows," and she gained more than 100 pounds.

Brewerton says, "From a psychiatric and eating disorder specialist's perspective, her history is noteworthy, not only because she lost too much weight at a very rapid rate, nearly five pounds per week, for the show, but also because she has a history suggestive of binge eating."

Who's a loser?

Brewerton says that eating disorders affect at least 5 percent of the population and are serious, often life-threatening conditions, "caused by a complex interplay of risk factors, some of which are genetic and some of which are environmental and cultural."

Shows like the "Biggest Loser," says Brewerton, are considered by many experts in the field to be part of the problem because they inadvertently stigmatize and shame overweight people.

The title of the show, "Biggest Loser," is a double entendre.

"On the one hand, the show highlights those obese individuals who have lost the most weight, which is rewarded with big checks, tickertape and lavish praise. On the other hand, the term 'biggest loser' portrays how society thinks and feels about fat people - that they are 'big losers,' " says Brewerton.

And all of it, he adds, is a "kind of group voyeurism and perhaps a form of contemporary mass hysteria."

"What happened this season with Rachel Frederickson was inevitable, but hopefully illustrates a lesson for all of us and especially the producers and the trainers of the 'Biggest Loser.' Simply put, one can take this orthorexic obsession too far," says Brewerton.

"There is no question that too much body fat isn't healthy, but the other side of the coin is that eating disorders are real and serious disorders that can destroy lives."

Social uprising

I floated the Frederickson controversy on my Facebook page and received an array of responses, including some from some women who have endured eating disorders themselves and a trainer who formerly worked with the "Biggest Loser" show.

Amanda Roush, a personal trainer who currently works out of ECO Fitness in Mount Pleasant, says she would be "shocked" if Frederickson maintained her new weight for more than three months.

"Sadly, the contestants aren't really taught how to maintain the weight loss long term, and after the spotlight is gone, a majority of them go back to their old habits," she says.

Local runner and technical writer Amy Scott-Lundy says Frederickson just seemed "leaned out and cut, kind of like how someone would cut right before a fitness competition, and I bet that's what she did. Yes, she is thin. I am sure that off stage, when she's not all dehydrated and cut, she looks great and normal ... Fitness competitors don't stay in that kind of stage shape year round."

Local competitive cyclist, certified coach and exercise physiologist Anne Ahern Moore says that the weight-loss strategies of the "Biggest Loser" are unrealistic and give many who want to lose weight false expectations.

"I have a client who hit the 100 pounds-lost mark last week, but it's taken a year to do! She gets frustrated when she watches these shows and they are losing 30, 40, 50 pounds in six weeks. Who knows what all is going on behind the scenes to get these people to lose so fast."

Reach David Quick at 937-5516.