Apr 12 2012

How to Lose Weight – Eat Less, Exercise More

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89 Responses to “How to Lose Weight – Eat Less, Exercise More”

  1. mufion 12 Apr 2012 at 11:13 am

    While the “eat less, exercise more” message is no surprise, compare it with the message of this article – “The Dangers of Dieting a Body Adapted to Famine” by a clinical psychologist.

  2. starskepticon 12 Apr 2012 at 11:24 am

    Eating less is not necessarily the same as dieting…

  3. roadfoodon 12 Apr 2012 at 11:38 am

    A little over a year ago, my doctor finally convinced me that I needed to get serious about losing weight. I have long believed that “diets don’t work”, that what really matters is calories in vs. calories out, and that the only effective long-term strategy is to change your eating habits. So I did not go on a diet, I didn’t join a weight-loss program, I didn’t try to count my calories or points or use any portion-control strategy. What I did was to cut way down (and that’s cut down, not cut out) on my snacking and desserts, and try to make some healthier choices of my main meals. I still eat a fair amount of fast food and still indulge in the occasional decadent dessert. Oh, and I try to exercise two or three times a week. In a year, I went from 219 lbs. to 185. Since I’m not on a diet, there’s nothing for me to go off of. I made changes to my eating habits and, while a year is probably too early to really tell, it still feels like I will be able to continue like this indefinitely. Just one anecdote, but it supports what Steve is saying.

  4. Bronze Dogon 12 Apr 2012 at 11:42 am

    I’ve lost some weight by cutting calories in a place that my subconscious didn’t consider important (“It’s liquid! It goes right through me!”): I went from regular Dr. Pepper to Ten, their 10 calorie version. I lost 9 pounds in about a month. Probably helps that the diet version still fills up my stomach just as much as regular.

    Of course, xkcd came up with a visualization some people might find useful to remember.

  5. clgoodon 12 Apr 2012 at 11:44 am

    FWIW, here’s the blog entry I wrote on the subject last September:

    http://skeptoid.com/blog/2011/09/27/how-does-a-skeptic-lose-weight/

    As a further anecdote, I still use “Lose It!” to track my calorie budget, and I am still maintaining my goal weight after about a year of maintenance. And I know of one other prominent skeptic who has lost a lot of weight using the exact same method. The strength of it is that it helps you control your caloric intake, and doesn’t require eating or avoiding any specific foods.

  6. nybgruson 12 Apr 2012 at 11:56 am

    i’ll jump on the anecdote train:

    I went from 255lbs to 175lbs in 5 months. I drastically cut my dietary intake (and at that time was hardcore zero carb – more on that in a sec) and worked out 30+hours per week.

    That was almost 5 years ago. I have since come back to a comfortable 185-195lbs and tend to trade in muscle for fat depending on what is going on in my life.

    My diet is quite varied and I still indulge in just about everything I used to. I just do it a LOT less and I work out a LOT more (not my 30+ hours/week but usually – though not recently – 8-10/week).

    I thought, at the time, that the low carb thing is what did it for me. I even used biochemical justifications (aka just-so stories) to explain it. In retrospect, I’d say it was simply that the strict restrictions I put on my diet made it so I simply couldn’t eat as many calories because I had to turn down so many foods and eating opportunities.

    I think that is what makes diets temporarily succesful – people become vigilant about what they eat, turn down foods they “can’t” eat, and turn down opportunities to eat. When that becomes tiresome, they revert back to their old eating habits and right back to their old weight.

    From my experience, I can say that succesful weight loss is not just about focusing on calories in vs out. It is about realizing that the reason you are fat is because of you and who you are and how you live. It is not the cake making you fat – it is your lifetsyle. The problem is most people want to lose weight without making a permanent change in their general lifestyle. That is simply not possible. The more weight you have to lose, the more drastic the change in lifestyle will need to be.

  7. SARAon 12 Apr 2012 at 12:26 pm

    I recently posted a rebuttal to an article I read about things that help you lose weight. My point was the same as Dr. Novella’s. The level of ire I generated by suggesting that their favorite methods of weight loss all boiled down to fewer calories and exercise was phenomenal.

    I’ve come to the conclusion that fad diet devotees are almost as bad as religions. Once someone is converted, they need to believe harder in order to maintain the diet.

  8. jwrayon 12 Apr 2012 at 12:37 pm

    The direct, immediate effect of exercise on calories out is negligible next to 24/7 idle calorie burning that is a function of muscle mass. If you run for an hour, you may burn 200 calories immediately. Whoop-de-doo. Different adults idly burn between like 800 and 4000 calories a day depending on the size and tone of their muscles. So whatever athletes do to increase their muscle mass is how you increase calories out. In addition to exercise, that means eating a well balanced diet with adequate protein in every meal.

    You can eat 1200 calories a day of mostly twinkies, and exercise all you want, but you’re going to lose most of your your muscle mass, lose most of your calories-out, and gain weight. Calories out does not stay constant when you mess with the calories in, so it’s not as simple as eating less and exercising more. You have to eat like an athlete forever.

  9. stands2reasonon 12 Apr 2012 at 12:49 pm

    Dr. Novella, do you really think the claim that reducing fat is good for weight loss is well-supported? There’s lots of food high in fat that’s good for you like nuts and fish. In my experience (yeah I know) fat can make you feel full a lot quicker than carbs.

  10. jt512on 12 Apr 2012 at 12:53 pm

    nybrgus wrote:

    I went from 255lbs to 175lbs in 5 months. I drastically cut my dietary intake (and at that time was hardcore zero carb—more on that in a sec) and worked out 30+hours per week.

    That’s 4 lb/wk! I would normally say that that was implausible, but with with 30 hr/wk of exercise it is plausible! How were you able to spend so much time exercising?

  11. Enzoon 12 Apr 2012 at 2:18 pm

    First…I don’t normally comment just to say this, but awesome write up! That concluding paragraph is probably the most concise, straightforward advise for weight loss I’ve ever read.

    Second @ nybrgus

    30+ hours per week of excercise?! Good for you. That’s 4+ hours per day every day for a week! @.@ That alone was probably more than enough. When I was in training for a martial arts performance I was at 3 hours per day 5 days a week and I needed 3500+ calories/day just to maintain my weight.

  12. Steven Novellaon 12 Apr 2012 at 2:29 pm

    jwray – you are correct in that muscle mass does increase calories burned. That is another benefit of exercise.

    For my summary I assumed but could have explicitly stated to have a generally well-rounded or balanced diet. There is no magical proportion of macronutrients, but there is a healthy range and living on Twinkies is way outside of that range.

    If you have a reasonable balance of protein, fat, and carbohydrates (which it is hard not to get unless you have a ridiculously narrow or unusual diet), then you will get enough protein to maintain muscle mass and you won’t lose muscle while exercising.

  13. WhatPaleBlueDoton 12 Apr 2012 at 3:11 pm

    I’m one of the magical “few” whose weight isn’t a product of lifestyle. And frankly, the moralizing is wasteful and counterproductive. We live in a system committed to reducing physical effort and commodifying access to food, exercise, and healthcare. Exercising 30 hours a week for the sake of exercise itself is quite simply pathological and would be deemed such for anyone who wasn’t fat. But creating those pathological beliefs and behaviors in fat people doesn’t make them healthy beliefs and behaviors. It means you’re making someone even more unhealthy.

    As it happens, now that my PCOS is being treated properly, I’m losing weight literally sitting on my butt and eating what I want. Instead of allowing others to create new pathology, I chose to treat the one I had. Magic.

    And, for those whose weight is a product of lifestyle, more drastic changes for fatter people isn’t healthy or helpful. Gradual changes that cause loss over time are sustainable. Becoming a religious nutrition nut isn’t good for anyone.

  14. SARAon 12 Apr 2012 at 4:02 pm

    I would also like to note – that while the actual physical side of weight loss requires only that you intake fewer calories than you burn, the reality of weight loss is inside our heads.

    I have struggled with weight loss for years. I tried just about every fad diet there was and knew more about nutrition than my doctor at one point. About 15 years ago, I got a gastric bypass. I weighed 400lbs and lost 237lbs.

    My most successful weight loss programs were a liquid fast of 800 calories a day (I lost 90 lbs before I broke it) and the gastric bypass.

    Both of them extreme because I don’t seem to be able to manage what I know is the rational way to lose weight. Having little or no choice seems to be easier (well, with the gastric bypass – its not easy – its painful, but that’s another story)

    In my opinion, that is where problem with the severe obesity comes from, the mental processes that are somehow defective. I find it interestingly similar (and possibly related) to depression. Knowing what will help and doing what will help are somehow disconnected. The irrationality of it makes a person feel quite insane.

  15. jt512on 12 Apr 2012 at 6:18 pm

    jwray: A light 1-hr jog burns about 600 kcal, not 200. The rest of your numbers are equally invalid, as is your entire argument.

    Jay

  16. rezistnzisfutlon 12 Apr 2012 at 8:53 pm

    Mostly, I agree with this assessment. However, I’d like to qualify it a little with opinion here based on my experience and education as a PCT as well as competitive bodybuilder.

    Most competitive bodybuilders must have a firm grasp of training and nutrition and how it applies to them individually in order to be successful, primarily the goal being to maximize their lean tissue and minimize bodyfat. Though most people aren’t looking to reach the extremes of competitive bodybuilding, many of the same concepts apply for the more general population, which is to reduce bodyfat levels while maintaining healthy lean bodymass.

    First of all, most people have a vague idea of what weight loss is, which to them is simply a number on a scale. When looked at in a little more detail, then it’s broken down into categories of loss from lean tissue, lipids (bodyfat), skeletal mass, and hydration. Simply weighing oneself on a scale day to day isn’t going to tell people much. Weighing has its place over the long-term, especially those reaching for extremes like coming down from and obese state or trying to gain muscle for competition. How clothes fit and how one appears in a mirror are very telling. Methods such as DEXA, hydrolysis, and even hand calipers when properly done, can be accurate in showing body composition. This is why indicators like BMI aren’t very explanatory to the individual (keeping in mind that BMI was originally created in measuring central obesity in populations and was never intended for individual use, but has unfortunately been adopted anyway by general physicians as the primary means, likely because it’s easy and quick).

    One reason why many people fall for fad diets is because, at first, it works. It can be dramatic seeing the pounds drop off so quickly. Unfortunately, they aren’t being told that most of that initial weight loss is just water weight, and the continued use of the diet more often than not results in the loss of precious lean tissue as much as bodyfat, and worse, a reduction in the metabolic rate which then results in regaining all that weight back and then some when they go off diet.

    Most people make diet and weight loss more complicated than it is, and it doesn’t help that we’re bombarded in the media by the myriad exercise and diet programs out there (most of the junk). As a general rule, I’ve found that those with a price tag associated with it should typically be approached with skepticism and be critically evaluated. Most of the time, people can reach the same goals more easily and less expensively with a little education.

    I will have to (again) dissent here from Dr. Novella in that I believe the notion of cals in v. cals out is overly simplistic. I’ll qualify that by saying that calories do play a big role, certainly, and excess calories from any source will typically increase fat stores, while the opposite is true when daily calories are decreased over time. While within the larger population, the specific distribution of macronutrients in a diet doesn’t have as much effect as the overall calories in weight loss/gain, when considering the individual, it can make a bigger difference. Furthermore, the kinds of foods chosen within the specific macronutrients makes a difference metabolically (ie, broccoli v. twinkies within carbohydrates), especially at the individual level. Some people are naturally more insulin sensitive than others and can handle a higher amount and wider variety of carbs when trying to lose bodyfat. Some people respond better to fewer carbs, or more specifically, low GI, high fiber carbs. While it’s true we need a balance in macronutrients for health reasons, a focus purely on the calories usually leads to mediocre results at best.

    Macronutrient timing can have an effect as well. Having a big meal full of high GI carbs just before bed more most is a bad idea, since for most cells are highly insulin resistent at that time; taking in the high carbs for breakfast or post-exercise is going to be more readily assimilated by the body since the body is more insulin sensitive at those times. The endocrine system governs the body, and most bodybuilding competitors have learned basic concepts of how to control hormones to most successfully acheive their goals. The same can be done for non-competitors who have the same goals, just to a lesser degree.

    Quickly, exercise (a part of cals out) plays a big role as well. The kinds of exercises performed makes a big difference, too. While I for one am happy these days to see people get any exercise at all, a combination of progressive strength training, aerobic and anaerobic cardio, and flexibility are key to the most dramatic results for most people. Typically, when the diet is in order, high intensity exercises, especially weights and cardio programs like high intensity interval training (HIIT) are most efficient and effective for fat loss exercises as they raise the overall resting metabolic rate for many hours, even days, after training. Slower to moderate steady-state exercises are good for cardio health and conditioning, but are less efficient over time for fat loss. Both have their place.

    Sorry for the novel guys!

  17. rezistnzisfutlon 12 Apr 2012 at 9:03 pm

    I think there is another category of weight loss issues that is more psychological and has more to do with peoples’ relationship with food than what the best routine/diet is. Those who have lifelong struggles with food typically have psychological issues that incorporates food in an unhealthy way (ie, eating disorders, obesity, “comfort eating”, etc). IMO, those who have not attempted to address the psychological issues will continue to struggle with food and weight. It seems the diet and exercise industry has capitalized much on dealing with the symptoms of these issues rather than the initial problems, and have made a fortune from it.

    One of the frustrations I had as a trainer is that many of the gyms I worked at were more interested in client attrition levels rather than the long-term success of the individuals. I feel that many, if not most, of our health problems these days are either directly or indirectly related being overweight/obese and physically unfit. The successes I’ve seen from people have been when they’ve made it a lifestyle change and choice, not just something they do temporarily and then just continue their old habits once they’ve reached their goals (and most do not reach their goals unfortunately).

  18. rezistnzisfutlon 12 Apr 2012 at 9:19 pm

    jt512: I don’t think his entire argument is invalid. Maybe a little simplistic, but he makes good points. Increased muscle mass DOES increase basal metabolic rate. An imbalanced diet WILL result in lowering of lean tissue percentage and increase of bodyfat percentage, even if overall weight goes down. The most success comes from partitioning macros appropriately for the individual, and making healthy, clean food choices within the macros.

    For instance, there will be different success rates with an individual if their diet consists of simple sugars for their carbs, incomplete amino proteins for their protein (ie, beans), and saturated fats for their fats, than if that individual consumes fibrous veggies for their carbs, lean cuts of meat for their protein, and primarly poly/mono unsaturated fats for their fats. The percentage of each macro may not be as important, granted, as would be the number of calories from them all, but they do need all the macros represented in their diet for a variety of reasons, and the kind, intensity, and amount of exercise will have a big effect.

    And in actuality, you’re both wrong about the number of cals burned with an hour of moderate steady-state cardio (jogging). The number of calories burned is very individual based on age, gender, fitness level, diet, what they’ve eaten before the run that day, weight, body composition, etc. Perhaps the more accurate description of any one number would be the mean average of what a population would burn while jogging for one hour.

    I think a big problem with the weight loss paradigm is trying to consider one model that fits everyone. Successful, healthy weight loss is a very individual thing; no one way works best for everyone. That’s what’s most appealing about this cals in v. cals out concept, is that it’s a VERY generalized concept that does work when considering large populations. It works, yes, but is a limiting factor if it’s the only thing considered.

  19. Macon 12 Apr 2012 at 10:04 pm

    I’m actually testing this right now. After being a high school/college athlete (with very high metabolism), in my mid-late 20′s i sunk into a fast food eating craze (probably eating fast food 15-20 times a week). At 31, i had ballooned up to 343 lbs (on a 6’3″ frame).

    On March 30th of this year, i gave up all fast food, soda, and other “bad” food. I simply eat some combination of almonds, green beans, tilapia (which i bake), asparagus, and mixed berries (blackberries, strawberries, blueberries, raspberries) and some other fruits (pears, bananas) along with copious amounts of water, and no caffeine or added sugar. I also indulge in a bowl of pasta/pasta sauce one or two times per week and have one cheat meal per week where i can eat anything out within reason. I have changed no exercise routine (I do get moderate exercise at work) or anything else except for reducing caloric intake and here are my results:

    March 30th weigh in: 343 lbs.
    April 12th weigh in: 315 lbs.

    Just wanted to report on my semi-controlled experiment into weight loss. On my “diet” I eat whenever I’m hungry, I just eat something from the list above. I always feel full, and since I like all those foods to begin with, I am experiencing no “cravings” for the other bad food I used to eat.

    It really does work if you just reduce calorie intake.

  20. PhysiPhileon 12 Apr 2012 at 10:59 pm

    Steve,

    When they measured prevelance of “followed a special diet” or “at diet foods” do you think this means they asked if they have EVER have done those things? Because if that’s the case the results don’t tell us much because the average age was 40 and I would assume most obese 40 year olds have sometime in the life tried diet food for a diet plan. Most people seem to know they need to eat less food, exercise more, and eat less fat- pretty much what you’re advocating. But BMI>29 is growing substantially, so I think we need a different approach…what do you recommend for your patients with BMI>29? 25-30? Do you order a lipid panel to see what their cholesterol and TAG’s are? Or do you just worry about caloric intake?

  21. ccbowerson 12 Apr 2012 at 11:23 pm

    My understanding of the evidence is that the weight problem in the US is more a product of excessive intake (as opposed to not “burning” enough). Certainly there is a benefit to excercise (in regards to weight, but also CV fitness, mood, etc), but its effect on weight are relatively small compared to over eating. I can eat a 1000 calorie dessert in about 5 minutes, but it would take me hours to exercise that off. Then again one could argue that CV fitness is more important than weight for many aspects of health, but perhaps thats a different topic

  22. PhysiPhileon 13 Apr 2012 at 12:17 am

    ccbowers,

    Yeah, but why are people hungry? How do we make people not hungry? That’s the real question we need to answer because people know diets don’t work. And me telling them that did you know if you eat less you’ll lose weight is silly because they already know that.

    Most people try to eat less more than any other factor. People understand that concept but obesity still climbs because we still eat too much. I think most of them just accept that they may die sooner. Since once your fat cells hypertrophy to the point they divide you’re kinda stuck with the increased number and you have decreased leptin which means you’ll be hungry unless you increase your fat mass so people seem to shift their metabolic set point for good.

  23. PhysiPhileon 13 Apr 2012 at 12:27 am

    For the above I meant decreased leptin sensitivity

  24. steve12on 13 Apr 2012 at 12:48 am

    Totally agree with the conclusions her.

    I’ve used an app called myfitnesspal (I’m sure there are others) that keeps track of the calories you eat + exercise, which it tallies to tell you where you are each day (net gain/loss in calories) for your BMI.

    This sound like a pain in the ass, but the app has a large database of foods and exercises, enables scanning bar codes, and allows you to save entries so it’s actually quite easy and becomes part of your routine. Another benefit is that it tracks your nutrition.

    The point is that once you start tracking what you’re actually eating/burning, it becomes much easier to manage your weight.

  25. greenfrogon 13 Apr 2012 at 12:55 am

    Adjusting one’s eating habits so that the weight stays stable makes a lot of sense. I’ve tried it: eat lots of fiber to feel full, eat little fat, very little sugar, small portions, no desserts. Keep your caloric intake in mind all the time, don’t binge. Exercise a lot. And it has never worked for me. Clearly, I simply end up eating too many calories.

    What HAS worked is a diet where I write down every calorie I put into my mouth, with a hard daily limit, and lose weight at a rate of my choice for a month or two. Sure, the weight comes back over time. Still if the options are 1) something that doesn’t work at all, and 2) repeated dieting, the latter is clearly better. If we accept repeated dieting as a viable long term strategy, it’s perfectly reasonable to ask “What kind of diet makes me lose 10kg now,” without caring if it comes back in a year.

    Framed that way, “The evidence does show that high protein … diets reduce hunger over the short term.” is highly useful information. It hints that a high protein diet might be a good choice, as it doesn’t matter if it only works for 3-6 months.

    I didn’t write this to support low carbing. I wrote this to encourage Steven to consider other strategies besides the ideal “long term eating habits change” in his recommendations. I’ve found the ideal strategy not to work for me, so I’m forced to use a second best option (periodical diets), and would like to know what science says about those, aside from “the weight comes back.”

  26. Captain Quirkon 13 Apr 2012 at 12:56 am

    It gets irritating to hear about how following diet X is going to help you lose weight in one part of the body, or that food Y makes you fat (as in, eating a normal amount of bread will make you obese, not as in observing that eating an ice cream sundae once a week can make your weight climb quickly without doing regular exercise). When I was a teenager, I cut out soda and chips (altogether for a couple years) then I transitioned to eating a small amount like one chip at a meal without eating more, to practice self-control. I lost some weight, and then stabilized, but it’s a lot easier to stop gaining a lot of weight by cutting out a huge source of calories with little to no nutritional value for a well-fed person.

    I have set an upper limit for my weight, so that if I check the scale and it’s 190 lb or above (picked because I feel uncomfortable and sluggish at this weight, and it’s about 15 lb shy of obese BMI for me, so it’s a useful bright line to keep from gradually gaining so much weight as to become obese and have a lot more trouble losing the weight), I monitor and restrict the foods I eat.

    Apart from total calories, I take a look at what I’ve been eating lately. Some foods, when I eat them, I immediately want to eat more food, sometimes a lot more. So I either cut those out or eat a small amount of it at the beginning of a meal, while finishing the meal with foods I tend to feel full after eating. There’s the old standby of waiting about 20 minutes or so after beginning eating, so you start to feel full from the food before deciding whether to eat more. That means paying a lot of attention to portion size, taking the calorie density into account (informally is usually fine). I try to get my fat mostly from things like avocadoes and nuts, and cut down on fried foods (boiling eggs instead of frying, for instance).

    I don’t use any system to figure out whether what I’m eating is balanced. I just pay more attention to how much of my intake is vegetables, fruits, grains, etc. and make sure it isn’t too lopsided. I skip most desserts, but allow the occasional treat. I tie it in with financial incentives: if I let myself have some chocolate once a week, I have to buy the cheaper, less appealing chocolate. If I have it once a month, I get the expensive, good kind. That sort of thing has to be individualized, since some people after waiting a month for dessert would be too tempted to binge, and it would be better for them to have a little bit more frequently. Basically, figuring out how to manipulate your own psychological functioning (having studied behavioral psychology and ameliorated my obsessive-compulsive tendencies through a self-directed variant of CBT, not to mention my penchant for over-analyzing everything I think and do, this comes pretty easily for me).

    I tend to break my caloric intake up into smaller meals, which I started after a GERD diagnosis. The flip side to this is you want to be careful that you don’t consume too much by upping the frequency out of proportion to the size of individual meals. That’s easy to do, and I mostly avoid this pitfall by making my snack/meals ahead of time for a day – it’s much easier to reach into a bag of chips than to get up and wash and chop vegetables for a salad, even if you really like salad. So I prepare hummus (I love dipping carrots in it), vegetables, washed strawberries, and the like ahead of time, so the low-calorie and satisfying snacks are as convenient to access when you get hungry as something you pop in the microwave and eat. Maybe keeping a food log helps the monitoring part. Kind of like when you have problems sleeping, and you keep a log of your sleeping habits and related habits.

    Exercise is important, and what’s more important is finding a way to make it routine. For some people this means a gym, but the street sidewalks are free to use, as well as local parks. Taking a daily walk is a good way to ease into regular, more vigorous exercise, and can be a good way to unwind from stress. I like to walk between one and three miles a day, but other people have time constraints that would mean taking shorter walks and/or doing more running. When the weather is inclement, I pace in my small living room for half an hour to an hour.

    In any case, there’s not a single program that will be a magic bullet. It’s about changing your habits to align with the results you want, and coming up with your own strategies for delaying gratification.

  27. rezistnzisfutlon 13 Apr 2012 at 4:21 am

    CQ: Totally agree about there being no magic bullet and that what works well for one person may not be the best for another.

    I also try to encourage clients/people/myself to find an activity they enjoy, several is even better, and make those their focus for their exercise, be it mountain biking, running, swimming, boxing, wrestling, MMA, etc. There is ALWAYS something fun, different, and interesting to do with a little imagination; it makes it an adventure.

    Exercise is so important not just for weight loss, but for a multitude reasons, and it’s something most people don’t get enough of.

    Good job on being conscientious of your diet, that’s great. Most people have no clue or don’t think about it.

  28. rezistnzisfutlon 13 Apr 2012 at 4:34 am

    PhysiPhile: “Since once your fat cells hypertrophy to the point they divide…” Can you elaborate on this point please? I’m not sure if you’re suggesting that when fat cells atrophy, they divide, then you’re stuck with more fat cells? Also, are you suggesting fat cells are permanent? Would you happen to have any citations on these if it is indeed what you’re saying please?

    I’m not sure I agree that metabolism is a permanent thing, either. Sure, if someone takes their diet and activity levels to extremes they run the risk of hosing their endocrine systems for the lifespan (such as with extreme anorexics). However, I’ve seen so many people turn themselves completely around so much that people couldn’t recognize them, that I don’t think anything is permanent.

    I agree that obesity is an issue, but I think it’s rather complicated. First of all, most people don’t have the first clue about diet and exercise, and many think they’re eating healthy when they’re not. One of the first things I do with a client is have them keep an honest food journal for at least a week. We then sit down and look closely at food choices, portions, frequency, timing, and macronutrients. Nearly everyone is surprised at what they thought was healthy but wasn’t. So the education begins, and that’s key for anyone serious about it. Education, and finding what works best for them. It means knowing exactly what they eat, looking up ingredients, finding nutrition information wherever they can, learning how macros interact with the body, and finally realizing that when eating out or buying prepackaged, prepared, or overly processed foods, they are not in control of what they’re eating.

    Add that to the overabundance of information found on the internet, on TV, and in magazines, and learning how to wade through the junk to find the good stuff, is a daunting task. Plus, being told completely different things from different so-called “experts” who all claim to have the one best way of doing things, it’s a challenge.

    I also think it’s habits they don’t want to break, the ease and convenience of fast food, the pain it is to cook for oneself, physically inactive jobs, and lack of physical activity altogether, does them in.

  29. rezistnzisfutlon 13 Apr 2012 at 4:38 am

    Steve12: There are a LOT of cool apps and tools on the internet, many free, that are very useful, it is pretty awesome. I’ll check out that site, thanks for the reference. Have you heard of fitday.com or calorieking.com? Pretty useful there, sounds somewhat similar…

  30. MikeBon 13 Apr 2012 at 6:20 am

    The university where I work recently threatened to raise insurance rates on those who don’t participate in a “wellness” program, which includes a “screening” right out of the Third Reich.

    My assessment: Obese (just barely). BMI 31. I weighed 198 but my ideal weight is 168. So I began cutting back dramatically on eating: Only one serving per meal, only water, tea or coffee, no junk food snacks.

    I also began a jogging program. I began walking/running 2 miles daily, increasing as I went along. I’m now up to jogging 4 full miles 4 times per week. This comes on top of also being a farmer and working hard on my feet all day.

    I started this program 4 months ago. The result: I’ve lost 4 pounds.

    Losing weight is bullshit. I hate every fricking minute of it.

  31. julieannon 13 Apr 2012 at 7:47 am

    I also feel calories in/out is over-simplistic. I think we ignore the hormonal regulation of our bodies at our own peril, and i’m starting to feel (not very scientific, I know) that the weight regulation hormones are controlled mostly by exercise and activity levels. Eating styles, too, though I think they’re highly individual. Some people seem to thrive on small meals every 3-4 hours, some prefer once a day, some do better low-fat, some prefer higher. Low-fat was a disaster for me, I’m much more content to eat higher fat, less often. High fat being relative, of course, as I eat a buttload of fruits and veggies.

    Anyway, my point being, unless one has an iron will (and I certainly do not), it’s definitely in a dieter’s advantage to find a way of living that doesn’t cause one’s hormones to sabotage any weight loss efforts. I used to be an emotional eater as well, a bit bingey if you will, had to deal with some psychological issues around food before I could make progress.

    I think my highly active lifestyle (not just for weight – I run depressed and need those exercise chemicals) allows me the sanity and self-awareness to eat when hungry, and not stuff myself. Really, it was a combination of learning a bit of nutrition and realistic portion control, getting off the idea of low-fat, and stop using food for emotional reasons. High BMI ~34, currently ~26, been a few years now, and I no longer feel crazy wrt food, that is also very nice.

  32. ccbowerson 13 Apr 2012 at 10:18 am

    “Yeah, but why are people hungry? How do we make people not hungry? That’s the real question we need to answer because people know diets don’t work. And me telling them that did you know if you eat less you’ll lose weight is silly because they already know that.”

    Thats not silly at all, because people don’t “already know that,” and there is some debate about the relative contributions of diet and exercise. I was just pointing out that the recent evidence suggests that overeating appears to be a bigger factor than insufficient excercise when it comes to weight loss. You are bringing up an important factor of hunger (along with some questionable info on fat), but first it would help if we agreed on what is the larger problem. Its not the “duh” point that you are suggesting it is

  33. tmac57on 13 Apr 2012 at 10:55 am

    MikeB- You should immediately contact the physics department of your university,and tell them your story.They should be quite interested to discover how your body is violating the laws of thermodynamics.

  34. mindmeon 13 Apr 2012 at 11:35 am

    I found work is the killer. You get bored. Hungry. And you snack. I’ve replaced all my snacks (crackers etc.) with fruits and veg. I’ll load up on pickles, carrots, cucumbers, etc. I’ve found pickles make a great snack. Pretty much 0 cals and they’re savory. Not sure if I increase my risk of stomach cancer, however.

  35. ccbowerson 13 Apr 2012 at 11:55 am

    To elaborate on my previous point, the more people are aware that caloric intake can be a bigger factor, the less likely a person can rationalize “Well, I probably shouldn’t eat this box of cookies at 1am, but maybe i’ll stay an extra 30 minutes at the gym tomorrow.”

  36. ccbowerson 13 Apr 2012 at 12:20 pm

    “MikeB- You should immediately contact the physics department of your university,and tell them your story”

    In fairness to MikeB, it is hard for people to lose weight, and it is fairly easy to make up for smaller meals in ways that are hard to recognize. It does remind me though of when I was a wrestler in high school and this guy gained 4 pounds overnight and failed to make weight the next morning. He insisted that he did not eat or drink a single thing… that is some kind of denial

  37. tmac57on 13 Apr 2012 at 12:31 pm

    The first rule is, you must not fool yourself. And you are the easiest person to fool. –

    Richard Feynman.

  38. jt512on 13 Apr 2012 at 2:25 pm

    An imbalanced diet WILL result in lowering of lean tissue percentage and increase of bodyfat percentage, even if overall weight goes down.

    No. There is no even remotely sensible diet that would result in body fat percentage increasing even though body weight goes down. I have read scores of studies on weight loss diet, and have never seen this occur.

  39. rezistnzisfutlon 13 Apr 2012 at 3:01 pm

    jt512: Define “remotely sensible”. That’s the key qualifier there now isn’t it?

    Yes, it’s possible for the PERCENTAGE to go up even if weight goes down. That’s because in IMBALANCE would not provide the appropriate nutrient partitioning to keep lean bodymass from being lost as well. The body’s tendency is to prefer to hold onto bodyfat, not muscle; it’s an evolutionary survival trait to store energy for times of famine. If a person goes too low fat, for instance, hormone production is compromised, and though they may lose weight, they won’t tend to lose bodyfat as easily as muscle.

    It is possible to lose bodyfat with overall bodyweight loss and have the bodyfat percentage increase.

  40. PhysiPhileon 13 Apr 2012 at 3:23 pm

    Rezistnzisfutl,

    [ “Since once your fat cells hypertrophy to the point they divide…” Can you elaborate on this point please?]

    Sure, modest weight gain effects adipocyte size but when they reach their maximum they recruit preadipocytes and now you have an increased number and so you’ll intake more glucose and have more lipoprotein lipase cleaving more triglycerides from LDL. This creates a new metabolic set point that won’t be changed.

    “Nearly everyone is surprised at what they thought was healthy but wasn’t.”

    What do you think is healthy for someone with BMI>29?

  41. PhysiPhileon 13 Apr 2012 at 7:35 pm

    Rezistnzisfutl,

    “he body’s tendency is to prefer to hold onto bodyfat, not muscle;”

    Where do you get this stuff from? The body holds on to muscle way more than fat. The only time you get into a negative nitrogen balance is if you’re fasting and run out of glycogen for the brain. This is an extreme case of like 2+ days without food.

  42. PhysiPhileon 13 Apr 2012 at 8:02 pm

    “keeping in mind that BMI was originally created in measuring central obesity in populations and was never intended for individual use, but has unfortunately been adopted anyway by general physicians as the primary means, likely because it’s easy and quick.”

    It’s not unfortunate – Its just for the average person and the physician should know when it is applicable. Are you trying to claim that physicians are inappropriately calling people obese? Should me the evidence.

  43. PhysiPhileon 13 Apr 2012 at 8:02 pm

    Show me the evidence*

  44. MikeBon 13 Apr 2012 at 8:27 pm

    tmac57– thanks for the support, you fricking dink.

  45. tmac57on 13 Apr 2012 at 8:42 pm

    MikeB- I apologize for my filppant remark,I did not mean to offend you.

  46. ffsjoeon 13 Apr 2012 at 11:55 pm

    I don’t think that losing weight is as simple as calories in vs calories out. Surely all the hormones that regulate appetite and metabolism react differently to various energy sources. For example all the sugar that you Americans love to eat and the different forms of sugar.

    If you want to lose weight you have to change your lifestyle, a diet implies a temporary measure. Eat more vegetables and fruit, cut back processed meat, red meat only 3 times a weak, dont drink soft drink, just drink water out of a tap. Don’t eat processed snacks and sweets. Takes a week or two for your body to adjust and you’ll probably get withdrawls.

    I’m 6ft tall and the most i’ve weight was 167 pounds then I decided to lose some weight. I have an active job so I only sit down for about an hour at work for meal breaks. First I started a weight training program to increase my muscle mass and my metabolism without cutting back calorie intake, just eating good food. Pasta bolognese, vegetables, lean steak, fish, fruit etc. Then afterawhile started running 2 – 3 times a week and cut back the amount of food i ate, slowly decreasing portion sizes so you get used to not being full before you stop eating, inbetween meals feeling a bit hungry is OK. So you reset your satiety in a way.

    Doing that I got my weight down to 138 pounds so I was lean and had some decent muscle. There is no point just starving yourself because you’ll waste away your muscle mass before you lose fat.
    Since then I sustained a muscular knee injury because I was sold orthotics with a pair of new runners by athletes foot, that I absolutlely didnt need. And I now know that they are a scam.
    So since then i’ve put weight back on up to 154 pounds because I havn’t been running and started eating junk food again. After seeing a physiotherapist who explained my biomechanics and how the orthotics changed the distribution of force through my knees, he suggested I cycle instead. Less impact force. So that has made it possible for me to keep exercising.

  47. NewRonon 14 Apr 2012 at 2:14 am

    As usual, religion has the answer – fast.

  48. rezistnzisfutlon 14 Apr 2012 at 2:47 am

    PhysiPhile: Thanks for the clarification on what you meant by adipocytes dividing. I was aware of the concept, just a little confused about what you originally meant. Though the current research does indicate fat cells are (relatively) constant throughout adulthood, there are still a lot of unanswered questions about whether the population increases. Fat cells do die, so I’m not sure there’s a large body of conclusive evidence one way or another.

    “What do you think is healthy for someone with BMI>29?”

    What I was saying was that when I have clients keep a journal for a time, they are often surprised that what they think is a healthy food or meal, really isn’t that healthy. For instance, instead of getting a Big Mac, fries and a coke, they get some chinese food with rice and a few veggies. Better for them, right? Not really. Furthermore, most people vastly underestimate the number of calories in food items as well as how much they consume, and really are just winging it when trying to eat healthy. Shining a light on what they’re really consuming by nutrient breakdown and actual calorie content is a great way to “shock” them into realizing they have to take steps to change. We sit down and break apart many food items on their menu by ingredient, look up the nutrition profile on a website like USDA.gov, and discuss how the effects different foods have on their metabolism.

    So, what do I think is healthy for someone with BMI>29? I would say a gradual reduction in overall calories, an emphasis on fibrous veggies, lean proteins, and healthy fats, and a reduction in refined sugars, high GI carbs, heavily processed foods, and saturated fats. Honestly, that’s the kind of diet most people can benefit from, IMO. This explanation is, of course, overly simplistic as there would be much more to assessing a client’s dietery/exercise routine.

    As you can imagine, many people get frustrated when trying to lose weight when they think they’re eating healthy when they’re not.

    “Are you trying to claim that physicians are inappropriately calling people obese?”

    Yes, sometimes they are. Of course not always. I’m a competitive bodybuilder; when I’m not showing, my typical profile is 5’9″, 235 pounds, approximately 10-12% bodyfat off-season by hydrolysis or bod-pod measurements (accounting for a slight margin of error). I’ve been told by GPs that I’m overweight and need to reduce my weight. I’ve had to take my shirt of to show them abs, or even go as far as schedule a consult with an actual sports physiologist so they could explain to the GP that I’m healthy.

    BMI is an easy, quick, and convenient method for doctors to make assessments, and sometimes along with obvious signs of obesity or other maladies, it’s enough. However, for otherwise healthy individuals, it’s not informative enough to make an adequate diagnosis. It used to be hand calipers were employed to measure bodyfat when doctors gave physicals, a relatively accurate method that is a lost art in most doctors’ offices.

    The problem with many GPs is that they’ve received very little actual training in healthy nutrition and exercise science; most, if anything, of what they’ve gotten is in dietetics, or the study of nutrition applied to medical patients already with diagnosed illnesses or ailments. While as a trainer I would never go against what a person’s doctor recommends, I’ve heard some terrible advice given by GPs to the point where I (very tactfully) suggested they get a second opinion, or referral.

    My point is, BMI is ok for measuring central obesity in populations for statistical analysis, but was never intended for individual use in healthcare assessment since it doesn’t say anything about body composition, and often is relied upon too much by physicians to diagnose individuals. Wikipedia has a decent article on it if you need to see clarification from another source.

  49. rezistnzisfutlon 14 Apr 2012 at 3:27 am

    “Where do you get this stuff from? The body holds on to muscle way more than fat. The only time you get into a negative nitrogen balance is if you’re fasting and run out of glycogen for the brain. This is an extreme case of like 2+ days without food.”

    The literature is clear on this; I’m not suggesting that bodyfat isn’t lost at the same time, but muscle IS lost and utilized for energy in a variety of circumstances via gluconeogenesis if there is malnutrition, even if a person isn’t calorically fasting. Negative nitrogen balance can easily be achieved simply with inadequate protein intake or intense activity. One does not have to only starve themselves to reach this state.

    Competitive bodybuilders and elite athletes know this intuitively when they diet down for competition and their strength/performance levels go down proportionately. The literature supports it – energy substrates in the body consist of carbohydrates, fats, and proteins. During more intense activity, muscle proteins can be converted energy via aminos after muscle glucose stores are used up. Fat isn’t as readily converted to carbohydrates during high demands for gluconeogenesis, though a combination can occur. If dietery proteins aren’t available for recovery in ANY person, the body WILL utilize muscle protein to repair damaged myocites. This is true for elite athletes and sedentary individuals alike. That’s one situation where insufficient dietery protein/fat intake will result in impaired myocite synthesis and even skeletal muscle wasting, while retaining bodyfat.

    Here is a decent article on energy metabolism:
    http://www.medbio.info/Horn/Time%206/muscle_metabolism.htm

    Here’s an article on insufficient dietery protein intake (citations at the bottom of article):
    http://www.livestrong.com/article/256074-the-effects-of-not-enough-protein-in-the-diet/

    Here’s a pubmed review of inadequate dietery protein in the elderly experiencing sarcopenia (they address how it affects people of all ages):
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2760315/

    This is a good article on how substrates are metabolized during exercise:
    http://www.cellinteractive.com/ucla/nutrition_101/phys_lect6.html

    I think I’ve demonstrated here that there are scenarios other than extreme fasting that result in muscle protein wasting. Furthermore, it can be easily demonstrated by looking at the statistics of extreme anorexics bodyfat percentages; if your assertion is true that the body holds onto muscle much more than bodyfat, then one would expect to see anorexics have very low bodyfat percentages. It’s an evolutionary survival mechanism of the body to store the most calorically dense energy substance for times of fasting and malnutrition.

  50. rezistnzisfutlon 14 Apr 2012 at 3:30 am

    I meant to add that anorexics indeed have high bodyfat percentages.

  51. uncle_steveon 14 Apr 2012 at 9:21 am

    Great advice, Dr Novella.

    It seems that modern methods of measuring obesity may be missing the many people who appear to be slim but are “fat” on the inside – http://news.softpedia.com/news/Skinny-Persons-Can-be-Obese-Inside-54507.shtml

    It’s possible some of these people will avoid doctors and believe they are perfectly healthy, while their internal fat stores continue to grow and their arteries get clogged.

    Also, the “eat less, exercise more” approach is useful but overly simplistic. An overweight person could eat either the same amount or more in terms of volume than they are currently eating, and lose weight, so long as they replace a huge percentage of what they currently eat(which all too often consists of lots of meat and dairy) with high fiber, low calorie foods like vegetables. This is why vegetarians, on average, are slimmer than meat-eaters. But it’s not necessary to become vegetarian; just minimizing meat and dairy can be beneficial, as well as eating a mostly unprocessed diet that includes a lot of vegetables and whole grains. Removing refined carbs and high GI foods can be helpful as well.

    Every little bit of exercise helps, but make it fun. Even juggling and dancing can burn a lot of calories. But make sure you keep track of NET calories burned, rather than TOTAL calories burned; the former is more accurate and therefore more useful, since TOTAL calories burned can trick us into thinking we are burning more than we think during exercise. Strength training is also important. However, while it is true that having extra muscle can burn calories even while we rest, the effect is very modest in most people.

  52. PhysiPhileon 14 Apr 2012 at 10:56 am

    rezistnzisfutlon

    “Fat cells do die, so I’m not sure there’s a large body of conclusive evidence one way or another.”

    Yeah all cells die and eventually the universe will be too cold to sustain any life. That to me is you saying that you don’t want to change your previous perspective so you’re claiming to be agnostic.

    “look up the nutrition profile on a website like USDA.gov, and discuss how the effects different foods have on their metabolism.”

    Why? Just look up nutritional density (% daily recommended intake / daily kcal) and try to get it above 1.

    I find most people that claim to be nutrition experts don’t understand metabolism and I can promise you that the people you’re explaining nutrient metabolism to won’t really understand making that time better spent on something else.

    “I would say a gradual reduction in overall calories, an emphasis on fibrous veggies, lean proteins, and healthy fats, and a reduction in refined sugars, high GI carbs, heavily processed foods, and saturated fats. “

    This is bad advice. If you want to support a diet you can just say fruits, veggies, whole grains, and low fat dairy. That’s it in terms of nutritional substrates. Your carb, processed food and saturated fat (except trans) is superfluous and part of the problem.

    I am thinking of ways to change eating habbits and sometimes I have to resort to new ideas that I’m unsure of the efficacy but seem plausible.

    Eg: a big factor with the obesity rate is letting business control portion which is driven by profit not health so we need to learn to just buy a hamburger or just buy fries. Also, know what you’re going to buy before pulling up to the drive through and never accept additional calorie offers (would you like X w. that?).

    “As you can imagine, many people get frustrated when trying to lose weight when they think they’re eating healthy when they’re not.”

    Absolutely, that’s why not only do I disagree with your nutritional recommendations but I think it causes harm.

    “ I’ve had to take my shirt of to show them abs,”

    Interesting lol.

    “The problem with many GPs is that they’ve received very little actual training in healthy nutrition and exercise science; most, if anything, of what they’ve gotten is in dietetics, or the study of nutrition applied to medical patients already with diagnosed illnesses or ailments. While as a trainer I would never go against what a person’s doctor recommends, I’ve heard some terrible advice given by GPs to the point where I (very tactfully) suggested they get a second opinion, or referral.”

    Uhh this is crammed with nonsense. Just from my short conversation with you I am confident you would fail a medical school nutrition exam. I would bet there are more trainers give worse advice than physicians.

  53. PhysiPhileon 14 Apr 2012 at 12:47 pm

    I’ve mostly been skeptical against other arguments here and most decent arguments (like steves) don’t really do anything to help the problem just state why some ideas don’t help.

    Here is a hopeful tip.

    Trap your future self. Example: Today I want chicken fried rice from PF changs. I will order no veggies because it just adds calories. I will not eat it out of the container, I will take 1/3 and put it into a bowl. I will drink it with walmart bought single serving flavoring packages (today I’m trying the hawaiian punch but they have tons of different flavors). They also have packages with 120mg of caffeine (still only 5-15 kcals) that’s good for you caffeine addicts.

    This meal is cheap, low calories, and you aren’t being controlled by businesses you are eating at. Also, stop eating out as much. Friends/colleagues often comment and find it kinda funny (I’m a very strange person lol) that I order everything to go – ihop, steak restaurants, pf changs, etc… This allows me to control portion sizes much easier and consume food while do other activites (replying to comment here, studying, music production, etc…)

    Steves right about mainly calories – healthy heart guidelines recommends < 30% fat but that's what my papa johns pizza has so I'm still good there if I get pizza besides pf changs.

  54. PhysiPhileon 14 Apr 2012 at 12:57 pm

    “so long as they replace a huge percentage of what they currently eat(which all too often consists of lots of meat and dairy) with high fiber, low calorie foods like vegetables. This is why vegetarians, on average, are slimmer than meat-eaters.”

    Problem is we are hungry for calories not volume. Vegetarianism would be an extreme where they are not just thinner because of low kcal per volume but also because they have created a situation based on their ideology that limits their food access. We need to think about the obesity epidemic (type 2 diabetes is the most common endocrine disorder) in terms of psychology and less in terms of physiology.

  55. ccbowerson 14 Apr 2012 at 10:09 pm

    “We need to think about the obesity epidemic (type 2 diabetes is the most common endocrine disorder) in terms of psychology and less in terms of physiology.”

    I agree that this aspect of the overeating problem in modern society is one of the most overlooked. With very easy access to inexpensive calorie dense foods we are able to overeat much more easily than in the past. How can we as a society address this problem?

    Perhaps addressing the mental aspect fell out of favor when concepts like ‘discipline’ and ‘will-power’ fell out of favor, because there seems to be an implicit judgement hiding behind those words. Perhaps we threw the baby out with the bath water

  56. rezistnzisfutlon 15 Apr 2012 at 5:12 am

    PhysiPhile:

    “rezistnzisfutlon” Really? We’re now down to flame wars now? Or is this simply a typo on your part?

    I left a post that’s awaiting moderation that addresses your comments on muscle atrophy, I’m guessing due to the links I posted.

    “Yeah all cells die and eventually the universe will be too cold to sustain any life. That to me is you saying that you don’t want to change your previous perspective so you’re claiming to be agnostic.”

    Yes, I am agnostic about it because the science isn’t conclusive. Just read any number of studies on the subject and they’ll essentially say the same thing. It’s not a fully understood process yet. I’m not sure what you think my previous perspective was on this subject – I don’t think I mentioned one way or another about what my thoughts on the quantity of lipocytes in the human body for the lifetime.

    “Why? Just look up nutritional density (% daily recommended intake / daily kcal) and try to get it above 1. ”

    First of all, the % recommended daily intake isn’t going to apply to everyone – all people have different requirements. Again, you’re oversimplifying the issue in that there’s a “one size fits all’ approach to the number of calories consumed/required. The reason I walk clients through the USDA/Fitday websites with their food choices is to make them aware of what they’re eating and get them thinking about the foods they consume. Most people don’t realize how many calories they are consuming or what’s in the foods they’re eating, just guessing, and that’s why many people struggle even when they are trying.

    “This is bad advice. If you want to support a diet you can just say fruits, veggies, whole grains, and low fat dairy. That’s it in terms of nutritional substrates. Your carb, processed food and saturated fat (except trans) is superfluous and part of the problem.”

    Why is it bad advice? Fibrous veggies, lean proteins, healthy fats, etc, are superior foods to high GI carbs, processed meals, and saturated fats (though we need some saturated fat in the diet, most people consume WAY more than needed). For instance, if you think that high GI carbs caloriewise is the same as low GI carbs, that it doesn’t make a difference, then you’re ingoring the facts of the matter. Low GI will have a lower insulin response than high GI carbs, and most low GI fibrous veggies are much more nutritionally dense, are less calorically dense, have high amounts of soluble and unsoluble fiber. Lower insulin response means reduced tendency for fat storage. Furthermore, the increased fiber will increase gastric emptying time. That’s just an example of how those kinds of foods are superior to other choices that contain lower quality nutrients.

    “fruits, veggies, whole grains, and low fat dairy”
    Here’s why these are bad recommendations, just saying these foods:

    Fruits: While nutrionally dense, for most people the increased fructose/sucrose levels in fruits will impede fat loss if too many are consumed. Personally, I can recommend these for morning and post workout when the body is insulin sensitive, but not so much the rest of the day. Fibrous veggies are far superior in this regard.

    Veggies: Not all veggies are created equally. A good example is iceberg lettuce, high in fiber but not much else nutritionally; as opposed to leafy green lettuce or spinach, which are much more nutritionally dense. Specifying which veggies are preferable and for what reason is how we inform the clients on their future food choices.

    Whole grains: Whole grains are NOT the best choice for fat loss because they are typically high GL foods. The same goes with potatoes and other tubers.

    Low Fat Dairy: Again, overall as a group not the best choice of proteins because of the relatively high lactose content, a simple sugar. Exceptions to this would be unsweetened greek yogurt and low fat cottage cheese. Overall, dairy contains a relatively low biological value and protein density compared to other forms of protein. It’s fine to supplement the overall diet, but not as the sole protein source.

    “I am thinking of ways to change eating habbits and sometimes I have to resort to new ideas that I’m unsure of the efficacy but seem plausible.”
    This is cool, within reason. Sometimes individuals have to experiment a little to find what works for them. Research only takes a person so far because what works well for one person isn’t always suitable for the other, barring some basic rules that do apply to everyone.

    “Eg: a big factor with the obesity rate is letting business control portion which is driven by profit not health so we need to learn to just buy a hamburger or just buy fries. Also, know what you’re going to buy before pulling up to the drive through and never accept additional calorie offers (would you like X w. that?).”
    This is exactly what I’ve been saying about advising clients. If they had McDonald’s for lunch one day, we’ll sit down and look at the nutritional profile of the meal they’re eating. This is to make them think about what they’re eating and make them aware of how it may affect them.

    “Uhh this is crammed with nonsense. Just from my short conversation with you I am confident you would fail a medical school nutrition exam. I would bet there are more trainers give worse advice than physicians.”

    Um, no, it’s not nonsense. Seeing that I have degrees in both exercise physiology and sports nutrition, I feel confident that with a little preparation, I’d pass their nutrition exam with flying colors. We covered pretty much the same material in classes. While you’re right that there are trainers out there who do give worse advice, but my advice isn’t bad, YOURS is. You’d do horrible as a trainer with your mindset and attitude, and I’ll tell you why in the next post.

    GPs traditionally receive minimal training in nutrition, especially how it applies to healthy individuals, and even moreso with athletes. I’ve heard some doozies in my day. You think it’s good advice when a GP tells a patient to eat a couple raw potatoes before bed because the raw potatoes “bind with your fat cells and helps you lose weight”? How about when the GP tells me that I’m eating too much protein and it’s going to kill my kidneys, when I have very healthy kidneys? On more than one occasion I’ve had to get a blood panel done and have an MD who is board certified in exercise physiology explain to them how it works with athletes and otherwise healthy people.

    Perhaps instead of just saying “it’s crammed with nonsense” and leaving it at that, explain to me why you think it’s nonsense and we can have a conversation about it.

  57. rezistnzisfutlon 15 Apr 2012 at 5:21 am

    PhysiPhile:

    “I find most people that claim to be nutrition experts don’t understand metabolism and I can promise you that the people you’re explaining nutrient metabolism to won’t really understand making that time better spent on something else.”

    Many so-called nutrition experts don’t, I agree. Unfortunately, you haven’t had the opportunity to read my post that’s still awaiting moderation; it specifically addresses your comments on metabolism and how different food types affect it.

    The reason why we explain nutrient metabolism, and how it affects them, is so the client is EDUCATED on the subject. Then, they can make better informed decisions about it in the future. Simply relying on what a person tells them what is best isn’t going to be a good solution in the long term when they no longer have that resource available. A good trainer is going to strive to have a lasting effect on the client so that when they leave them, they have a solid foundation to build upon and can learn for themselves what works best for them. The time they spend with a trainer, unless they’re rich enough to employ one for years, isn’t going to be enough to find what’s ultimately going to work best for them.

    “Trap your future self. Example: Today I want chicken fried rice from PF changs. I will order no veggies because it just adds calories. I will not eat it out of the container, I will take 1/3 and put it into a bowl. I will drink it with walmart bought single serving flavoring packages (today I’m trying the hawaiian punch but they have tons of different flavors). They also have packages with 120mg of caffeine (still only 5-15 kcals) that’s good for you caffeine addicts.”

    Now this is bad advice. It again harkens back to the “cals in v. cals out” concept, with no thought to the food choices. The idea of “everything in moderation” is not a good strategy for fat loss and healthy lifestyle. Some food choices are better than others, and the only way to make those good food choices is to become educated on the different types of foods out there and how they are metabolized, as well as what the body needs and doesn’t need.

    And I’m here to tell you now, chicken fried rice is a TERRIBLE food choice. And why forego the veggies? Those are a better food choice, just have a little less rice and add a few veggies, that would be a better strategy with what you’ve given.

  58. rezistnzisfutlon 15 Apr 2012 at 6:01 am

    PhysiPhile:

    There is good reason why trainers recommend what they do and don’t just stick with the grossly oversimplified “cals in v. cals out”. Our job is to help a client reach their health and fitness goals in the most efficient and healthy way possible, in such a way that’s sustainable in the long term. For professional reasons, we cannot in good conscience recommend low quality food items (eg, fried rice) because items like these are less than optimal for meeting those goals, as well as being less healthy than other alternatives. We aren’t going to “give permission’ for people to make bad food choices, unless it’s part of a strategically planned “cheat meal” or refeed day.

    What I’m saying there is that, as a matter of fact, food choices DO play a role in meeting the goals of optimal weight loss (bodyfat loss while retaining lean muscle) and good health (nutrition density, reduction in undesireable ingredients, best overall metabolic response).

    It’s part of our professional ethics to always recommend the healthiest food items possible using the latest and most solid scientific resources available. This is with the understanding that most clients will not adhere to the recommendations fully (some better than others), but at least they’re aware of what they’re eating, and hopefully are at least putting forth an effort to do better and realizing that the bad food items, when consumed excessively, is impeding their goals.

    We are going to recommend a total diet that gives the body exactly the amount of nutrients needed to build and maintain lean muscle tissue, reduce bodyfat levels, and optimize overall health and fitness levels, based on the individual’s BMR, RMR, AMR, height, weight, gender, fitness levels, age, attitude and inclination, and goals. This means the overly simplistic “cals in v. cals out” mantra isn’t going to work so well and that they won’t achieve their results as completely or efficiently by consuming a lot of empty calories.

    For most people, their goals include building and maintaining lean muscle tissue while reducing bodyfat levels. Making bad food choices like your chicken fried rice is going to impede that goal, when compared to eating, say, a medium skinless chicken breast and some lightly steamed broccoli drizzled with some fresh olive oil. The former has few quality nutrients (empty calories), very little fiber, and will cause a prolonged insulin spike. The latter is nutritionally dense, has all the macros represented in their healthiest forms, and will actually aid more in fat loss (thermogenic effect of food, time released uptake of nutrients, low insulin response). Furthermore, your method of guesstimating portions isn’t going to help anyone with their fat loss goals; that’s why it’s important a person knows what they’re consuming and how it affects them.

  59. rezistnzisfutlon 15 Apr 2012 at 6:05 am

    “Steves right about mainly calories – healthy heart guidelines recommends < 30% fat but that's what my papa johns pizza has so I'm still good there if I get pizza besides pf changs."

    Really? You think Papa John's pizza is good and healthy? Wow, just wow. I'm beginning to see that you're either a troll, yanking my chain, or really clueless about nutrition.

    Here's a breakdown of probably the healthiest, least fatty pizza you can order there, a Garden Fresh thin crust pizza (information is by the slice from a 14" pizza):
    Total cals: 220
    Total cals from fat: 100
    Total fat: 11g
    Saturated fat: 4g
    Protein: 8g

    Here's one of a slice of pepperoni pizza, regular crust:
    Total cals: 330
    Total cals from fat: 130
    Total fat: 14g
    Saturated fat: 6g
    Protein: 13g

    These are just one slice each from a medium pizza. Are you going to tell me you only eat one slice? Are you going to tell me that the cheese and pepperoni are just as biologically valuable (BV) and available as, say, a chicken breast? Are you going to say that the prolonged insulin spike due to the high fat content (slow gastric emptying) and crust (high GI carb) has no effect? Are you going to tell us that a couple slices of pepperoni pizza, a total of 660 cals and 130 fat cals, is the exact same metabolically as a medium grilled skinless chicken breast, a cup of lightly steamed broccoli, and 2 tablespoons of EVOO drizzled over it? And for your statement about the 30% fat, are you saying a) it doesn't matter the kind of fat consumed, b) you're eating all your daily fat recommendation in one sitting, and c) it makes no difference doing that as opposed to divying up fat intake throughout different meals per day?

    You would make a terrible trainer; your clients will have a very hard time reaching their goals and would achieve mediocre results at best, and would leave you with very little knowledge gained as a result.

  60. jwrayon 15 Apr 2012 at 6:58 am

    cbowers:

    Address the problem of easy access to junk food by not buying it in the supermarket. Hyperbolic discounting and anchoring make it much easier to not put it in your shopping cart than to resist eating it when it’s already in your fridge. One can’t just keep everything in stock and trust oneself to choose wisely without the benefit of hyperbolic discounting.

    Dr. Novella:

    Balanced diet is a rather fuzzily defined thing, so in practice it equals haphazardly eating a semi-random assortment foods that are prevalent in one’s culture. One ends up with a diet roughly similar to most others in the same culture and thus not grossly pathological, but not optimal either. Not all “balanced diets” within this random range have similar effects.

    http://www.ingentaconnect.com/content/adis/smd/2004/00000034/00000005/art00004
    money quote: “There is evidence that a relatively high protein intake (~30% of energy intake) will reduce lean mass loss relative to a lower protein intake (~15% of energy intake) during energy restriction”

    Also, the Governator, in his encyclopedia of modern bodybuilding, p. 727, recommends 40% protein, 40% carbs, and 20% fat, as opposed to the McGovern committee’s 12-58-30 recommendation and some bodybuilders’ more extreme use of protein.

    Not enough studies have been done, since the medical profession regrettably is far more focused on what causes far-below-average characteristics rather than what causes far-above-average characteristics. The latter is really more important as sort of an investment in the future of mankind which will pay enough dividends later to deal with the former.

  61. PhysiPhileon 15 Apr 2012 at 11:41 am

    “Again, you’re oversimplifying the issue in that there’s a “one size fits all’ approach to the number of calories consumed/required. “

    For the exception of extreme conditions like body building, it is a one size fits all. You need to show evidence that it isn’t. You need to demonstrate that normal people are nutrient deficient.

    “Low GI will have a lower insulin response than high GI carbs”
    “Lower insulin response means reduced tendency for fat storage.”

    Glycemic index does not change how many calories you get only the curve of blood glc to glc in gut with respect to time. Also, it’s hard to make generalizations about GI which is why the dietary guidelines for americans set up by panels of physicians and expert NUTRIONIST recommend AGAINST GI for making food recommendations. There is no consistent evidence that GI foods affect weight management and evidence is inconsistent that GI affects diabetes risk or heart disease.

    Athletes can benefit knowing when and which foods to consume to maximize performance. Eg high GI foods should be consume during and after while low GI foods before. But again, this is not for the average person going through their daily routine.

    “I feel confident that with a little preparation, I’d pass their nutrition exam with flying colors.”

    I am taking a medical school nutrition exam next week and you seem to be going against most of what my nutrionist phd/professor/researcher is teaching (as well as what I know from basic physiology).

    “ I’ve heard some doozies in my day.”

    I can’t speak to your anecdotes, all I know is what they are teaching in medical school and from my own conversations with physicians.

    ““rezistnzisfutlon” Really?”

    that was a typo, I won’t get caught up in that kind of petty bullshit.

    “These are just one slice each from a medium pizza. Are you going to tell me you only eat one slice? Are you going to tell me that the cheese and pepperoni are just as biologically valuable (BV) and available as, say, a chicken breast? Are you going to say that the prolonged insulin spike due to the high fat content (slow gastric emptying) and crust (high GI carb) has no effect? Are you going to tell us that a couple slices of pepperoni pizza, a total of 660 cals and 130 fat cals, is the exact same metabolically as a medium grilled skinless chicken breast, a cup of lightly steamed broccoli, and 2 tablespoons of EVOO drizzled over it? And for your statement about the 30% fat, are you saying a) it doesn’t matter the kind of fat consumed, b) you’re eating all your daily fat recommendation in one sitting, and c) it makes no difference doing that as opposed to divying up fat intake throughout different meals per day?”

    Jesus, I feel you have been entrenched in this pseudoscientific culture for so long I don’t know if we will ever come to agree. Or I would basically have to walk you through hours of class work material to even get you up to speed for me to have a reasonable conversation like I do with my colleagues.

    I don’t have time to answer all the questions but if you can think of a point or question that really gets to the heart of our disagreement I can address it.

  62. ccbowerson 15 Apr 2012 at 2:18 pm

    “Address the problem of easy access to junk food by not buying it in the supermarket. Hyperbolic discounting and anchoring make it much easier to not put it in your shopping cart than to resist eating it when it’s already in your fridge.”

    This is the way I actually operate…I almost never go down the cookie section of the supermarket (except when I occasionally buy nuts at the Wegmans by where I live). If I lived alone I would be fine, but other people can (and do) choose food items, and I can (and do) eat them. Personally I do better if I think in terms of discipline, but I usually don’t.

    rezistnzisfutl –

    The things you say, if followed, would result in a healthy diet… however you often make inferences from physiological studies that may not be important from a broader perspective that incorporates a person’s overall diet.

    If you look around the world for the people who live the longest, you will see highly varied diets (e.g. Japan, Monaco, Macau, Hong Kong, Sweden, Isreal, etc) Japanese people eat white rice several times a day (only relatively recently has brown rice been promoted as healthy and had a stigma for a while), France and Sandanavian countries eat among the most dairy in the world. Both of these things you criticize, yet it seems to be far from detrimental from the people in the world who live the longest.

    My point is not to say that we need to emulate any of these things, but that there are many types of diets that can result in a healthy person, and having these somewhat arbitrary rules based upon basic science level evidence is not that convincing to me. It can be interesting and useful information at times, but taken too far it reads like Prevention magazine… and that is not a good thing

  63. rezistnzisfutlon 15 Apr 2012 at 4:14 pm

    ccbowers:

    I agree with you, there is definitely a psychological/cultural component to diet. The examples I give are just that, examples, not representative of a wide variety of foods that are healthy and good choices for fat loss.

    I will have to disagree on the example I made of the chicken fried rice, which is a far cry from the white rice most asian countries consume with meals. I didn’t specify about the chicken fried rice, but it’s more the oils and high salt content of the fried rice I balk at, especially when it’s not accompanied by anything healthy.

    I spent time in France, Belgium, and the Netherlands, and though they do eat dairy, it’s probably not as much as you’d think. Also, what I’ve observed them consumed more of is yogurt, which tends to be relatively low in lactose. They don’t drink a lot of milk at all; that’s a uniquely American phenomenon. They also include a lot of other fairly healthy proteins in their diet. The big differences in those countries is that not too many people drive and everyone uses public transportation, which means there’s a lot of walking going on. Their diets are composed of pretty fresh ingredients, at least traditionally, and not as much fast food as we consume (though that’s changing, and if you were to see many Europeans now, many of them are becoming obese). One other thing I saw over there is that obesity isn’t as culturally accepted as it is here.

    I think I was pretty clear earlier that there’s not one specific diet that works for everyone: I was actually dissenting about that I believe in that it’s a very individual thing, for what works best for fat loss and good health.

  64. ccbowerson 15 Apr 2012 at 4:50 pm

    “I spent time in France, Belgium, and the Netherlands, and though they do eat dairy, it’s probably not as much as you’d think.”

    Well, it isn’t just based upon what I think, since I really don’t know the diet of the various countries that well. There are among the highest in the world with any number of references I could find, including:

    http://www.foodsci.uoguelph.ca/dairyedu/intro.html

    What did we do before the internet and answers were at our fingertips?

  65. rezistnzisfutlon 15 Apr 2012 at 7:32 pm

    Unfortunately, some of my posts aren’t coming through with my citations. It’s hard for me to have much of a discussion when I can’t post responses.

    Anyway, you’re right, it does appear that some of the European countries do indeed consume more liquid milk, so that trumps my anecdotal evidence. Thanks for the correction and link…

  66. jcsoutoon 15 Apr 2012 at 10:22 pm

    Dear Dr. Novella.

    I have had (and repeated) the exact same opinion you have expressed until a year ago. After trying a low carb diet and having an unbelievable success with it (lost 15 Kg of fat in 3 months without hunger and kept it that way), I have been thinking and reading a lot on the subject.

    First of all, nobody is trying to prove the firts law of thermodynamics wrong. It just happens that this law has no cause and effect built into it. If you decrease your mass, you necessarily expend more calories than you take in. If you increse your mass, the opposite will be true. But this says NOTHING about the cause of this increase or decrease. It is a necessary condition, but it is meaningless. Everyone agrees that if you have a condition (like untreated diabetes) that increases the production of urine, it will also make you thirsty. By the same token, if you drink a lot of water (for whatever reason), you will urinate a lot. But this says NOTHING about cause. If a person urinates 5 liters a day, this may be because he or she has uncontrolled diabetes, or has diabetes insipidus (a completelly differente cause), or it could be that the person intentionally ingests a lot of water. Water in, water out, right? If you don’t care about cause, what is to prevent you to treat diabetes by restricting water intake? It will decrease urine production, and you can then write about “the THIRST problem” (as opposed to the “hunger problem” of diets). The best analogy I know is the growing child (it could be the growing anything). For a boy to grow, he HAS to eat more calories than he expends. That’s a truism. However, no one would argue that the boy grows BECAUSE he eats a lot. He eats a lot BECAUSE he is growing. The firts law of thermodynamics is as valid here as it is valid everywhere. However, again, it says NOTHING about causality. The boy grows BECAUSE he has a hormone (GH) that directs his body to do so. And, in order to mantain energy (and mass) conservation, he NEEDS to eat more to compensate. Now, why would (human) fat tissue be the only tissue that is not controlled by hormones, but acts as a passive deposit of excess calories?

    You cannot treat food and calories as if people are simple calorimeters that incinerate food in order to generate heat. Different foods have different endocrine actions, and this is crucial. Let’s look at another example, type I diabetes. In this disease, the person makes no insulin. Of course, that means an impaired glucose metabolism. But this disease highlights another important function of insulin: fat storage. Before the discovery and clinical use of insulin, type 1 diabetics became emaciated as a result of accelerated fat breakdown. Fat storage requires insulin, and lack of insulin leads adipocytes to release fat into circulation. Physicians know that what usually kills an untreated type I diabetic is not so much the hyperosmolar coma due to very high sugar levels, but the metabolic acidosis due to massive amounts of fat being dumped into the bloodstream because of an absolute lack of insulin.

    So, are all calories equal? In a calorimeter, sure. In a human body, well, 4 Kcal will still be 4 Kcal wether it is from fat, protein or carbohydrates, but they have different ENDOCRINE consequences and, hence, the ENERGY PARTITIONING can be quite different. Carbohydrates increases insulin and, as every biochemestry 101 student knows, this partitions calories towards storage (insulin is a storage hormone). In contrast, by avoiding carbohydrates and thus keeping insulin levels down, you end up having more lipolysis. Now your hunger decreases, because you are burnign more of your own fat as energy. The end result is you eat less. But you eat less BECAUSE you are loosing wheight, you are not loosing wheight because you are eating less. This is no semantic trick. This is a huge difference. It means loosing wheight by deliberately starving yourself versus doing it without hunger. In both cases, you eat less, so I agree with you, Dr. Novella, that calories in, calories out, applies here, but this is concept is incredibly obvious and, at the same time, useless.

    Having said that, my interpretation of the literature is pretty different. All prospective randomized comparisons of low carb diets consistently show greater wheight loss and better cardiovascular markers when compared to low-fat diets. And those of us that have the clinical experience (I have been applying this to my patients for a year now) see a huge difference in terms of lack of hunger and compliance with a properly formulated low carb diet.

    There are many other aspects that I could write about (satiety of proteins and fats, insulin resistance, leptin, etc.) in which different macronutrient ratios will have completely different implications in spite of having the same total calories in a diet. But I hope I made a point that calling a dieting strategy that has been around since the 19th century a “fad” (name that logical fallacy!) is not the best approach. Nothing in biology makes sense outside of evolution theory. And we have good evolutionary reasons to suppose that (most) humans are not genetically adapted to having very high insulin levels 24/7 due to foods that weren’t around when we evolved.

  67. ccbowerson 16 Apr 2012 at 10:28 am

    “All prospective randomized comparisons of low carb diets consistently show greater wheight loss and better cardiovascular markers when compared to low-fat diets.”

    Perhaps in the first few months those numbers look better for low carb, but the longer the follow up, the smaller the effect until we see little to no differences between groups. And by longer follow ups we are talking 1 year or less for most studies. Also, in this type of comparison, I am less concerned with “markers” in the short term than I am with actual outcomes in the long term. In addition, short term weight loss is not helpful, and is possibly harmful, so I do not see the benefit of low carb diets as you do. The data just isn’t there as far as I can see (but please share if you have a good reference that I have missed )

  68. Steven Novellaon 16 Apr 2012 at 11:08 am

    jcsouto – I did not discuss other health issue in this post, but have in others. I was just talking about weight control. Yes, there are effects on cardiovascular health and glucose metabolism from different types of calories. I never said that all calories are equal in all ways – only to weight.

    I also acknowledge that the body is a complex metabolic organ and that different types of calories might be handled differently or have different effect on the body, even beyond hunger. This is all reasonable.

    My point is that when you look at the actual clinical evidence – the net effect of all this in people – the only variables that seems to affect weight are calories in and calories out. Other effects appear to be either temporary or insignificant. Perhaps the body just adjusts or there are other compensatory mechanisms. That’s why we cannot take basic science principles and reliable extrapolate the net clinical effects – the body is just too complex.

    As ccbowers already pointed out, the advantages to low carb are tiny (really, clinically insignificantly) and temporary. The consensus of research is that the advantages, at best, go away after 6 months, and at worse may even be a net negative (in some studies, if you carry them out to a year toward the end the low carb group was gaining more weight than the low fat group).

    Further, if you look at people who have had long term success a few studies show that predictors include regular exercise and low fat diet.

    I have no reason a-priori to prefer any one dieting strategy over another. I am just relaying the research.

    I would further caution strongly against relying on personal anecdotes. Everyone seems to have one when it comes to weight control, and they are all over the place.

  69. rezistnzisfutlon 16 Apr 2012 at 11:52 am

    “the only variables that seems to affect weight are calories in and calories out”

    I think this is really the only problem I have with your analysis. There are other factors that contribute to weight beyond purely calories in v. calories out, including insulin response and varying metabolic responses to certain food types. For example, 200 calories of broccoli will have a different metabolic pathway than 200 calories of jelly beans. Both are carbs containing 4 calories per gram. Also, it varies from individual to individual. There are a glut of studies indicating specific food types playing a role in weight loss, along with the number of calories.

    I’m not sure anyone is disagreeing that, statistically within populations, calories in v. calories out does trend with bodyweight. Other variables do play a role, though, is what I’m getting at.

    I agree with the assessment on low carb diets which is why I’m not a big fan of them. I don’t think eliminating any macronutrients altogether is conducive for long-term results.

    “low fat diet” Just for my curiosity, can you elaborate a little what you mean by this please?

  70. Steven Novellaon 16 Apr 2012 at 12:39 pm

    rez – as I said, I acknowledge that there are metabolic difference between different foods, even if they have the same calories. But I disagree that the clinical data shows that this makes a difference long term. I am only aware of short term studies that show this. My guess is that long term the metabolic effects all average out, and it’s only the total calories that matter. I have to remember to add, that this assumes you have a reasonably balanced diet. Extremely narrow diets are likely to have health consequences that would affect weight indirectly.

    “low fat diet” in the studies I am talking about is just that – people self-report that they avoid fat in their diet. This seems to correlate with better long term success, probably because it also correlates with lower overall calories. It may also be more sustainable than low carb.

  71. jt512on 16 Apr 2012 at 2:03 pm

    rez wrote:

    Yes, it’s possible for the PERCENTAGE [of body fat] to go up even if weight goes down. That’s because in IMBALANCE would not provide the appropriate nutrient partitioning to keep lean bodymass from being lost as well.

    It’s not a question of whether it is mathematical feasible, the fact is it does not happen in free-living individuals on ordinary weight-loss diets (and probably not even in complete, extended fasting). If you insist that it does, show me the data. Show me one peer-reviewed diet study that shows the % body fat increasing while consuming a calorie-deficient diet.

    Fat is the body’s main source of calories when caloric expenditure exceed caloric intake. Lean body mass is almost always lost when dieting (Steven was basically wrong on this point), but body fat is always lost faster. As I have said, I have read scores of papers on controlled weight-loss trials that separately report the change in fat mass and body weight, and have never once seen body fat % increase. I don’t think you know what you’re talking about. So, if you have data, let’s see it. Otherwise, I simply do not believe you.

    Jay

  72. ccbowerson 16 Apr 2012 at 3:19 pm

    “Lean body mass is almost always lost when dieting (Steven was basically wrong on this point), but body fat is always lost faster.”

    You are correct for a single attempt at a new diet, but I’m not sure where Steve says otherwise.

    The one perspective that is lacking on this topic is that repeated dieting can have this effect to some degree, because a person can repeatedly lose some muscle with each new diet, and then gain back the fat when resuming their previous diet. Some muscle mass will be regained as well, but it may be less than when the person started the diets. There are many other variables of course, such as lifestyle and exercise changes. I realize that this is a slightly different point, but has some importance since people usually try multiple times to lose weight

  73. nybgruson 16 Apr 2012 at 8:02 pm

    my apologies – normally I tag the RSS feed for a thread I’ve commented on to keep up with it. I forgot to do it for this one.

    # jt512on 12 Apr 2012 at 12:53 pm
    nybrgus wrote:
    I went from 255lbs to 175lbs in 5 months. I drastically cut my dietary intake (and at that time was hardcore zero carb—more on that in a sec) and worked out 30+hours per week.
    That’s 4 lb/wk! I would normally say that that was implausible, but with with 30 hr/wk of exercise it is plausible! How were you able to spend so much time exercising?

    Many people thought I had contracted some horrible illness because I lost so much weight so fast. I was almost concentration camp skinny at that point since I basically had no muscle mass either.

    I was always hungry for those 5 months. Literally not a second passed that I wasn’t starving. I kept extremely lean, low fat, beef jerky on hand always as a snack. Sometimes I would wake up in the middle of the night from sheer hunger pangs, nosh on some jerky, and go back to sleep.

    I was actually unemployed for the first 2.5ish months of that 5, and after that I was working in an ER as a trauma tech. I worked 3×12 hr shifts per week, so I kept up my exercise habits then as well. I basically ate, worked, and went out to parties when I had a chance. And I would work out for 4-5 hours per day, no matter what. Many times I would be hung over from the night before and vomit 3 or 4 times during my workout, but I never relented. Yes, perhaps that was a bit pathological. But for the first time in my life I was slim and becoming extremely fit.

    It was cycling that I became addicted to. And then I added weight lifting, running, surfing, and yoga to round things out. I started out having never once in my life run an entire mile without stopping to running a sub-6 minute mile and doing a half marathon inside of two years. When I first started cycling I managed to do about 15 mile rides in 70ish minutes. By a year out I did a 100 mile race with 7,000 feet of vertical ascent in 5h34m (which was my all time record for a century). Oh, and I needed roughly 5,000 kcal/day to maintain weight.

    In my 1st year of med school I was alone (GF was in a different country and I lived by myself) and so I studied and work out about 15 hours per week. In second year I had less time, but still did about 10 hours per week and would run to school (5k each way). Since then though, I have had some medical issues and much, much less time (stupid board exams) and as such have not had a chance to work out more than 2-3 hours per week, if that. As such, I no longer have my 6-pack. C’est la vie.

    In any event, some very interesting comments in my absence. I’ll comment that indeed, a very narrow diet can cause issues and that a workout by itself is not that huge an impact to weight loss.

    However, the majority of weight loss/gain is calories in. The calories out becomes a very useful function by working out regularly. It is much more beneficial to work out less intensely for 45 minutes every single day than to do 2 intense workouts of 2.5 hours each per week. Your metabolism rises for hours after a workout, and doing regular exercise keeps your mean metabolic rate higher. And of course, having more muscle mass means high basal rate.

    So I would say that with those two caveats it really does essentially boil down to calories in and out. But when my friends who knew me when I was fat asked how I lost the weight and I told them, they were quite upset. “What do you mean you just ate less and worked out more?? I thought you had a secret!

  74. rezistnzisfutlon 16 Apr 2012 at 9:02 pm

    jt512:

    “but body fat is always lost faster”

    I already addressed this above and included links to material. In short, malnutrition, aging, and hormone imbalance can lead to muscle wasting while retaining bodyfat. So, if a person has too little protein and fats in their diet, but has enough carbs to retain or even lose a little bodyfat, muscle tissue will be atrophied. The same goes with very low testosterone levels.

  75. jt512on 16 Apr 2012 at 9:31 pm

    rez: No one here is talking about aging, malnutrition and hormone imbalances but you. The rest of us are talking about intentional weight loss strategies via diet and exercise. Many controlled studies of weight loss through diet or exercise that report both body weight change and fat mass change have been published in the scientific literature. Find us one to support your claim that % body fat goes up while weight goes down while on a weight loss program. If you can’t, then stop arguing what you can’t support.

  76. SimonWon 16 Apr 2012 at 10:29 pm

    Just to annoy ccbowers thought I’d mention that my recent weight loss has included regular consumption of deep fried chicken with fries ;) At least one big chain of deep fried chicken vendor displays calories on their menu.

    In my case the primary change was more exercise, but then I was doing pitifully little and am still below the UK government’s recommended minimum level (2.5 hours/week).

    I see a lot of people suggesting exercise burns calories slowly, this can be overstated, it burns calories about as fast as your body can comfortably burn calories plus other health benefits. Sure my exercise regime is only the equivalent of three or four doughnuts a week, but if that means I can have the odd bit of deep fried chicken and still lose weight that will have to do.

  77. ccbowerson 16 Apr 2012 at 11:30 pm

    “Just to annoy ccbowers thought I’d mention that my recent weight loss has included regular consumption of deep fried chicken with fries”

    Hmm. Not sure why I would be annoyed at that. Sounds delicious to me. Eat what you want, but if you want to lose weight you’ll have to eat less of whatever that is. My recent weight losses have come from a viral gastrenteritis, and several months before that, recurring tonsilitis (strange because I never had tonsilitis as a kid). I’m not sure that I would recommend either of those, despite their short term effectiveness.

  78. rezistnzisfutlon 17 Apr 2012 at 2:06 am

    jt512:

    I think one can easily conclude that there are instances where too little dietery protein, or even fat, calories can impede bodyfat loss and cause muscle atrophy, when dieting. Too little protein IS a form of malnutrition, that’s what I was getting at. The studies I posted before are suffice to illustrate that.

    My point overall, in this entire thread, is that cals in v. cals out isn’t the best method for fat loss. Simple reduction in calories, if the food choices are bad, will be a slower and less efficient means of fat loss, will not retain lean tissue as well, and will result in overall weight loss that includes lean tissue. While calories play a role, optimal health and maximal fat loss/lean tissue retention is found when food choices are considered, as well as nutrient timing.

    I cannot concede that a diet of pizza, cookies, and soda is going to provide equal results in health and body composition as a diet of fibrous veggies, lean proteins, and healthy fats, when calories are the same. Yes, weight loss will occur when reduced enough, but it won’t be the same kind of weight that’s lost, and health will be compromised, and I contend that a clean diet as such will result in higher success rates.

  79. nybgruson 17 Apr 2012 at 6:10 am

    @rez:

    I disagree.

    So does the nutrition professor who lost weight and body fat percentage eating almost nothing but twinkies. Oh and his LDL went down and HDL went up by 20% in the same time frame.

    It really does boil down to calories in/out.

    Now, to make it sustainable and be otherwise healthy, of course you need to have a decent and varied diet as well. And I will add that when training intensely (as I once was) what you are eating and when really matters. A lot. But for the average Joe or Jane, just trying to lose some fat and gain a little muscle, eating exactly the same things they eat right now, but at significantly less portion size (i.e. reduced total caloric intake for the day) with 45 minutes of jogging and lifting weights most days of the week will prove very effective.

  80. ccbowerson 17 Apr 2012 at 9:14 am

    rezistnzisfutl-

    You keep conflating weight loss with other things, and you ocassionally make assertions that have little/no clinical evidence. No one (here) is saying that what you eat doesn’t matter in an absolute sense, or that what people eat never matters for anything, but you are complicating a more simple discussion about weight loss by introducing other considerations that are only related topics.

    You mention diets with too little protein, and that is pretty rare in the population we are talking about here… overweight people on a “Western” diet. I agree that for most people adding vegetables would help: it is at least a 2 fold effect of reducing calories and displacing less healthy foods, but for the weight loss aspect of it- the important factor is how many calories less the new diet is. This will help, but only if it is a diet that the person enjoys… more restrictive diets fail from that angle and almost always become temporary

  81. rezistnzisfutlon 17 Apr 2012 at 12:57 pm

    ccbowers:

    “You mention diets with too little protein”
    I only bring this up because I was challenged on the point about bodyfat percentage. I’ve been trying to get away from that because it’s off topic, and I do feel I’ve demonstrated that enough with the links I provided above.

    I don’t think I’m conflating anything here, and here’s why – the suggestion here is that ultimately the most effective form of weight loss is simply reduction in calories, that ultimately, the types of foods eaten don’t really matter (ultimately meaning over time in the end with all other things being equal). It’s my contention, however, that food choices do matter and people who focus on the kinds of foods they eat will typically have better fat loss success and healthier outlooks. Not only are there plenty of case studies to this effect, there is clinical evidence it’s true. It’s perhaps the case that the misunderstanding of the clinical data in dealing with overall populations, varying macronutrient intake doesn’t have an overall net effect, it’s the calories only that count, which I’m not disputing – it’s the kind of foods chosen WITHIN those macros that makes a difference.

    Just eating whatever a person likes because it tastes good is a terrible strategy and one reason society has such a problem, and I can and have provided clinical evidence for this in the past when this subject has come up, and can do so now if need be. Furthermore, different people respond differently to different foods. While this may seem to be making a simple issue more complicated, there are considerations that need to be taken into account for more optimal fat loss/lean tissue retention.

    One of the problems, IMO, is that as a society we’ve gotten too used to eating whatever we like wheneverwe like and we tend to choose foods that are calorically dense and low in quality nutrients based on taste preference, and that’s what we’re used to getting all the time. So then there’s a psychological component to deal with of habit change when trying to add more healthy foods that gets people in trouble by sabotaging their weight loss indulging in the foods they like. It’s been my experience with clients that when they’re serious about permanent fat loss and good health, cleaning up the diet is a big factor, and there is clinical evidence to back this up, loads of it.

  82. ccbowerson 17 Apr 2012 at 1:55 pm

    “One of the problems, IMO, is that as a society we’ve gotten too used to eating whatever we like wheneverwe like and we tend to choose foods that are calorically dense and low in quality nutrients based on taste preference”

    I disagree here. You are missing the most important factor: the problem is not “whatever” or “whenever” it is “how much of whatever.”

    You also keep saying here that there is clinical evidence to back this up, but for the most part I am in agreement with Steve’s perspective on this (and nygbrus, I think) and I haven’t seen anything compelling from your posts that indicate that we are missing somehting.

    That is not to say that on an individual basis you can not pinpoint particular approaches that would be helpful… I am sure that that is true. Perhaps for a given person cutting out their tendency to buy cookies or soda would make a big difference for that person (because a disproportionate amount of calories for this person comes from these foods), or incorporating more vegetables for a person who always eats fast foods (to displace some of the high calorie foods), but beyond this I think you are overinterpreting the basic science beyond what it can say when applying advice to a population.

  83. jt512on 17 Apr 2012 at 2:07 pm

    rez writes:

    I think one can easily conclude that there are instances where too little dietery protein, or even fat, calories can impede bodyfat loss and cause muscle atrophy, when dieting.

    That’s not what you said before, and it’s not what I am objecting to. You said that when on a weight-loss diet you can lose weight while gaining % body fat. I have asked you twice to present evidence—data—not conjecture, to support your claim. You have utterly failed to do so.

    I cannot concede that a diet of pizza, cookies, and soda is going to provide equal results in health and body composition as a diet of fibrous veggies, lean proteins, and healthy fats, when calories are the same.

    That is utterly banal; no one would argue with that. But that was not your only point, and not what everyone has been arguing with you about.

    Jay

  84. PhysiPhileon 17 Apr 2012 at 4:31 pm

    Rezistnzisfutl

    “While this may seem to be making a simple issue more complicated, there are considerations that need to be taken into account for more optimal fat loss/lean tissue retention.”

    Maybe we will understand you more if you give us more information about your recommendations.

    Case study: 38yo 5’10” 195lbs BMI=28 (normal muscle tone), looking to lose weight and reduce risk of heart disease

    First you would probably get his dietary habits which will probably be fast food, eating out, snacks…etc. You’ll add up the calories and realize that it’s about what you’d expect for a person with a BMI 28. From here I would talk mainly about behavior changes to address caloric intake and a little about fats (eg. chick-fil-a is good because they use canola oil)

    While I believe you would spend much more time talking about nutrient distribution (eg amino acids, carbs, fats amounts)…tell me if I’m mistaken. Can you please tell us the macronutrient distribution you would give?

    The problem is his macronutrient distribution could be many things because it depends on culture, dietary beliefs, and is difficult to change where focus should be on food access or calorie intake. So in order for me to be convinced your macronutrient distribution is important I need you to demonstrate a tight correlation between specific nutrient compositions and weight. You have not shown that.

  85. nybgruson 17 Apr 2012 at 7:12 pm

    Just eating whatever a person likes because it tastes good is a terrible strategy

    Of course. Because people tend to overeat massively.

    Furthermore, different people respond differently to different foods. While this may seem to be making a simple issue more complicated, there are considerations that need to be taken into account for more optimal fat loss/lean tissue retention.

    They respond differently… psychologically. In terms of weight loss (fat loss specifically) they don’t. We aren’t talking about cardiovascular or other health here. I agree that eating a strict 1000kcal diet of absolutely nothing but pure lard would have very bad health consequences – first hypovitaminoses, then (if you managed to live long enough), cardiovascular disease, and probably colon cancer. However, you would still lose fat.

    One of the problems, IMO, is that as a society we’ve gotten too used to eating whatever we like wheneverwe like and we tend to choose foods that are calorically dense and low in quality nutrients based on taste preference, and that’s what we’re used to getting all the time.

    I fully agree. It makes it much easier to eat too many calories. And that’s the point.

    I think we all agree with you that a varied diet with lean meats, fruits, and veg is overall the healthiest. And that sticking to a low-calorie diet while still eating low-nutrient calorie dense foods is hard and distinctly sub-optimal.

    But that in no way contradicts the notion that the ultimate crux of fat loss is calories in and out. If your vitamin, mineral, and protein needs are met, it does not matter one whit where they come from as long as your calories in are less than out. And once you are at ideal weight, it continues not to matter where they come from as long as calories in is equal to out.

    There is no compelling evidence or logic for anything else.

  86. goldfinchon 21 Apr 2012 at 10:05 pm

    There is nothing like the anecdotes from dieters, we all think we know the best way. The current thing to say is that you are not on a diet, you are changing your lifestyle. Sorry, whenever you eat less than your body needs to maintain its current weight you are on a diet. You are starving yourself to one degree or another. That will be your lifestyle.

    But, whatever.

    I lost more than 1/3 of my body weight at the rate of a pound a week, going from obese to a BMI of 21. I reduced the calories in and increased the calories out through exercise, so that I ran a deficit of about 500 calories a day. I am now working to maintain my weight. And it is work. I think about food a lot. I want to eat more than I eat. Every single day. Maintenance is where most people fail. There are things a person can do to improve their odds, but no matter what the odds are not good. I count my calories, keep a food journal, keep a moving average of my weight so I can catch slips quickly, I exercise 6 to 7 hours a week, primarily cycling and weight training. I pay attention to triggers (stimuli) that lead to an eating response. I think that many have to have a single-minded focus on their weight to keep it off. And even then, biology may very well trump tenacity.

    I am considered a nay-sayer on a forum that has weight loss and exercise a topic. Maybe that is true. But being aware that the battle is not over when the weight is lost, but may continue for the indefinite future can help you be prepared. And to decide if you want to have a lifestyle that may require you to be a bit obsessed.

  87. Mecandeson 30 Jun 2012 at 12:49 pm

    My wife just picked up “The Skinny Rules” by Bob Harper (of The Biggest Loser fame). The advice within seems on track with this discussion — it was co-written by a science writer, I believe. It’s nice to think that a popular and trendy diet best-seller can be science based — has anyone read the book, or care to comment on whether there are any obvious problems in it?

  88. Helgeon 11 Feb 2013 at 12:24 pm

    Low carb does work:

    http://www.dietdoctor.com/a-low-carb-diet-superior-for-overweight-children-once-again

  89. nybgruson 11 Feb 2013 at 1:54 pm

    talk about necromancy!

    Helge – nobody here actually claimed it doesn’t work, merely that it doesn’t work any better than any other diet. It is the restriction of caloric intake and watching what you eat that makes low carb work – not the fact that it is low carb.

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