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The answers ranged from 400 calories to 1200 calories, all the way up to “GET THAT IN MA BELLEH” (with my wife also being a smartass and suggesting that it was 4500 calories – Love you baby).  After taking guesses a dietitian colleague of mine and I independently totalled up the plate using online calorie software.  And interestingly enough, we got totally different answers!

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Her total was 1500 calories whereas mine was closer to 1000.  But when we looked at the reason for the differences they were largely attributable to differences in the estimated sizes of the portions on the plate (we both agreed that the meat was probably pork).  However, the big point here is that whichever estimate you agree with the fact remains that the food on that plate represents far more calories than most people should be consuming in a single meal.  It also means that even trained professionals have a hard time agreeing on quantities when looking at a plate like this.

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With the Christmas season upon us and the number of parties, dinners, and potluck events that will inevitably be a part of it, I think that this plate would actually even be a conservative estimate of intake for a lot of people.  There are almost always pre-dinner treats like veggie trays, hummus, and chocolates kicking around.  An even then a single plate of food might be less than most people eat (you know…try a little of everything and then go back for a second helping of the stuff you really like).  Combine that with the calories from wine, beer, and desserts (you know you HAVE to try at least one slice of each kind of pie right?) and you’ll be consuming a boatload energy that will ultimately be stored as fat.

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Doing this task made me think back to previous holiday seasons where I hadn’t paid much attention at events like these.  This year I think I’ll be a little more attentive to what I’m eating.  If nothing else, when you’re making up your plate this holiday season I hope this task inspires you to be a little more cautious with your consumption to0.  After all, the best way to lose weight in January is not to have gained it in the first place.

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Have a great weekend!

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PS: Today is the last day to save $100 on the Peak Diet and Training Summit and (due to popular demand) there is now a 2 pay option for those who prefer to pay in installments.  This package is a true beast with 15 DVDs, 2 info packed manuals, 2.0 NSCA continuing education credits, and a bunch of other bonuses available only this week.  There is no risk as the product is fully refundable so go and pick it up before the deal disappears.  Order your copy HERE.

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Over the past few weeks I’ve put together an extensive (and I hope valuable) series on training clients with obesity.  In Part I of the series I described the categorization and classification of obesity.  In Part II I shared some resources and very important concepts about obesity management.  In Part III I discussed how I would go about training those with a BMI greater than 35.  In Part IV I talked about the training I would use for those with a BMI below 35, but still above 30.  And in Part V I presented a summary of the various types of bariatric surgery that are most often sought by those with obesity.  Today I want to finally bring the series to a close with a final piece about nutrition for those with obesity.

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What We Know About Diets

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I think some of the largest trials comparing diets in the real world (such as the famous A to Z Study) have demonstrated that while low carb diets generally get the lead for early weight loss, after a year they aren’t really that much better than moderate or higher carb diets.   Granted, there was a statistically significant difference in the A to Z Study, but is it really significant in terms of what it means to you or your clients?  Here are the results from the paper.

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Mean 12-month weight loss was as follows: Atkins, −4.7 kg (95% confidence interval [CI], −6.3 to −3.1 kg), Zone, −1.6 kg (95% CI, −2.8 to −0.4 kg), LEARN, −2.6 kg (−3.8 to −1.3 kg), and Ornish, −2.2 kg (−3.6 to −0.8 kg). Weight loss was not statistically different among the Zone, LEARN, and Ornish groups.

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So basically, the Atkins group lost an average of 10.3 pounds, the Zone group lost 3.5 pounds, the LEARN group lost 5.7 pounds, and the Ornish group lost 4.8 pounds after one year!!!  In this case the “best” diet yielded an average weight loss of approximately 0.2 pounds per week.

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What I feel this study really tells us isn’t that one type of diet is superior to another for weight loss, but that our biggest issue with diets is compliance.  In fact, what I think you’ll find if you talk to any client with obesity is that many of them have tried numerous diets for weight loss in the past and some of them may actually have done VERY well (losing even 100 pounds or more) only to put it back on.  The key here is not to find some magical diet that will elicit the most rapid fat loss possible, but to find a nutrition plan that the client will be able to maintain for life.

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Wait a Minute…

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Isn’t that what I usually say for non-obese clients too?  Gee willikers.  Could we be on to something here?  Does this mean there is no magic diet that will instantly result in ripped abz for only $39.99?  Could it also be that if we simply identified and address the barriers that prevent us from being able to adhere to ANY diet we’ve selected that we’d get better results?  Nah…couldn’t be.  That would make too much freakin’ sense.

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Anyway, the biggest nutritional factor that is required to result in weight loss success is a moderate calorie deficit.  As simple as it sounds, the key is to make sure the calories consumed by the client are less than those that are burned.  I should reiterate again that this should be a MODERATE deficit and your client need not lose weight rapidly and you must resolve to teach them the proper way to lose weight despite their insistence that they’d like it to go faster.  The more severe the plan, the less likely the client is to stick to it for life which (as we discussed above) the single MOST important element of any nutrition plan.

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I should note that in some medical obesity management programs very low calorie diets (VLCD) consisting exclusively of nutritional protein shakes totalling 800-900 calories per day are sometimes used for rapid weight loss.  You should NOT follow this practice with your clients.  Programs like these MUST be medically supervised as there are risks associated with gall stones from rapid weight loss (possibly leading to pancreatitis), low sodium levels, and life threatening blood sugar crashes if the person is on insulin (as many with obesity who have Diabetes are).

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Aside from that, the diet should contain enough protein for muscle maintenance, fiber, and plenty of fruits and vegetables.  But I need to state again that creating a moderate calorie deficit and finding a nutritional lifestyle program that will stick (along with identifying and addressing barriers to compliance) are the two biggest concerns.  Without these, you can pretty much forget about everything else.  And, of course, since these clients often struggle with sudden change and making it stick in the long term (as do most clients actually), it is important to implement progressive behavior change to get the client onto the plan rather than an instant jump to super strictness.  Doing this will empower the client and make them more willing to take further steps as their confidence grows.

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In short, there is no magic but consistant and slow behavior change and a reasonable diet.  Anything else is just setting your client up for failure.  And if you doubt it, I’ll leave you with this.  Below is an image of the weekly weight values of a client I’ve worked with for the last nine years.  The first year averaged a 2-3 pound per week weight loss and beyond that it was much slower.  But the point to be really taken is that weight loss is easy.  Long term maintenance which is where the truly gifted trainer aims to shine.

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As usual, if you have any questions, comments, or random insults you can leave them below and I’ll make sure to address them.

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Also, if this article has been useful to you please don’t hesitate to share, “like”, tweet, +1, or whatever funky social media thing you can do to spread the word.

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Recently I started writing a series on training obese clients that has evolved into much more than I had expected.  In Part I of this series I described the categorization and classification of obesity, in Part II I shared some resources and very important concepts about obesity management, in Part III I discussed how I could go about training those with a BMI greater than 35.  In Part IV I talked about the training I would use for those with a BMI below 35, but still above 30.

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Today I want to begin talking about nutrition for those suffering with obesity.  However, discussions about nutrition and the obese client would be lacking without at least a brief mention of gastric bypass surgery.  So today I will cover that, and then I should have only one more post on nutrition related stuff that should wrap things up.

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Now before you tune out because you think gastric bypass has nothing to do with you or your clients, trust me when I say you need to hear this.  Even if you are not a believer in this type of surgery, chances are that if you train obese clients long enough you’ll run across one that is considering or has had some form of bariatric surgery.  If or when that happens, you should be informed with the best possible information so that you can provide appropriate guidance and support.

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And even if you never happen to personally train someone who has had this surgery or wants to have this surgery, it will help to inform you that this surgery is by no means “the easy way out” that some may perceive it to be.  I feel that fitness professionals should make an effort to at least understand the basics bariatric surgery as this is part of weight management for many (even if you don’t agree with it).  So…let’s get at it!

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Laproscopic Banding

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The first and least invasive type of bariatric surgery is simply called laproscopic adjustable banding (popularly known as the Lap-Band).  With this surgery, a small adjustable band is inserted through very small incisions and placed laproscopically around the top of the stomach.  This limits the amount of food that can enter the stomach and thereby causes people to lose weight.  This is called a restrictive surgery because of this limitation.  People that have had this surgery also have a port below the skin in the abdomen that allows them to have saline added or removed to make the band tighter or looser depending on their needs.  Of all of the bariatric surgeries available, this is the least invasive and it has the smallest surgical risk.  It is also removable so if some decides it isn’t right for them, the band can be removed.

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From the data I’ve seen at conferences and from hearing surgeons talk about this procedure, it seems as though the weight losses seldom meet the expectations of the patient, weight is almost fully regained in many cases, and the band is frequently removed.  As a result, it seems that gastic banding is losing favor in some circles.  One of the things that strikes me as most interesting about banding is that we’re basically providing a removable (temporary) treatment for what I’ve suggested is a chronic condition.  If removing treatment results in the return of the condition, it might be wise to question the use of temporary solutions.  Of course, I’m not saying that there isn’t a place for banding (they often use them when they feel such a surgery is warranted in children – don’t even get me going here), but the data I have seen on them is generally not promising.  I won’t ignore that some have great success with these, but I think this is the exception rather than the rule.

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Sleeve Gastrectomy

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The sleeve gastrectomy is also a laproscopic procedure in which part of the stomach is actually cut off and removed.  The remaining section of the stomach is actually quite small which limits the amount of food a person can consume and allows them to lose weight.  This too qualifies as a restrictive procedure and it is only slightly more risky than the laproscopic band, but it is permanent.  This surgery generally has greater weight losses than laproscopic banding and (from what I’ve seen) is better in terms of preventing weight regain.  However, the results aren’t as great as with the “gold standard” gastric bypass surgery we’ll talk about next.

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Roux En Y Gastric Bypass

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While there have been many versions of this surgery over the years, the roux en y gastric bypass is now the gold standard against which all bariatric surgical procedures are compared.  In this surgery, like the sleeve gastrectomy, part of the stomach is removed to limit the amount of food that can be consumed except that with the sleeve the stomach can hold 150ml of food while this procedure typically limits food to about 30ml (two tablespoons).  Then, the small intestine is cut part of the way along and attached to the new stomach pouch.  This prevents much of the food that is ingested from being absorbed by the body resulting in even greater weight loss.  For this reason, this procedure is classified as a restrictive and malabsorptive procedure.  It is obviously not reversable.

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The highlights of this procedure is that the weight loss is typically greater than the two previously mentioned.  It also does have some greater weight loss maintenance than the other two as well.  What is more important though (and probably why this procedure gets so much appreciation from physicians and patients) is that it can be an almost instant cure for Type 2 Diabetes.  In other words, you could be a Type 2 Diabetic today, get the surgery, and then you’re pretty much off your meds.  There is even some talk about doing this procedure on non-obese Diabetics whose disease is really difficult to control, but I’m not sure whether this will pan out.

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I want to be clear here with my own perspective in that I don’t think the data on this is 100% reliable as the follow up isn’t the best in many of these studies and some are not randomized controlled trials.  The big issue with follow up is that the people that are probably most likely to make themselves available for this are those that are doing well.  Those who aren’t probably don’t want to be followed up.  For this reason, I think that perhaps this surgery may be good for some Diabetics, but I’m cautiously optimistic.

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I also want to be clear about some of the downsides.  First, the surgical risk is higher with this than the other surgeries I’ve mentioned.  I don’t think it is terrible, but worth noting.  And because the surgery is malabsorptive, there are some major nutrient deficiencies that occur with many patients.  Of course, they are typically told to take certain vitamin and mineral supplements for the rest of their lives following surgery, but some are non-compliant with this and they end up with serious issues.  There are also other issues like increased rates of suicide, divorce, addiction, and other issues following this surgery that make it important to weigh the risks and rewards of this procedure.

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Biliopancreatic Diversion with Duodenal Switch

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This procedure is the most intensive procedure of them all and it is only usually considered for the very obese patient.  Generally it begins with the restrictive component where the stomach is reduced very much like the sleeve gastrectomy.  From there, it becomes difficult for me to describe so I’ll just use a video to illustrate for those who are interested.

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This procedure can be done in two parts with more severely obese patients.  In the first procedure, the restrictive part is done to reduce the size of the stomach.  Then, after the patient has lost some weight and is less of a surgical risk, the surgeon can go back in and add the malabsorptive element to continue the weight loss.  While the roux en y is the gold standard, the duodenal switch can also be used for those who have regained weight after this procedure as it is pretty much the only thing left in the surgical arsenal.

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As you might guess, the risks for this surgery are higher than those associated with any of the previous, but the results are also usually pretty darn good too.  Ultimately, the more risky the surgery, the greater the potential weight loss.  However, with all surgical procedures you really have to look at the pros and potential cons of this operation.  Similar to gastric bypass, there are many possible issues that can present.

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I honestly can’t tell you what to do in the case of a client that has had any of the above surgeries because they’ll all present differently.  My primary goal with this post was to bring a basic understanding of surgical weight management to the fitness world in the hopes that it will begin to build a bridge between fitness and physicians as we attempt to understand each other’s methods.

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I can tell you that without lifestyle modification any of the above surgeries can result in weight regain and the reappearance of obesity related issues like Diabetes, hypertension, and so on (remember what I said about obesity being a chronic condition?).  So even if we don’t agree with the methods, it is important that we be prepared to partner with people that have had them (and their physicians) because many family doctors are at a loss for what to do with these patients.  By having at least some understanding, you will be in a position to help.

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If you want more information on this topic I would highly recommend you take the time out to read Dr. Sharma’s series called Why I Support Bariatric Surgery.

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There are 5 parts and they are all fantastic.  They can be found here. 1, 2, 3, 4, 5.

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But before you think I’m totally going to allow only the positives to be highlighted here, Dr. Sharma wrote a 5 part follow up series called Why Bariatric Surgery Can Fail which I think is also solid and provides more information than I can possibly cover here in this single post.

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You can read this series here. 1, 2, 3, 4, 5.

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In the end, I guess I didn’t teach you much about how to handle these clients, but being aware of them, what they’ve had done, and the potential issues can only point you in the right direction.  If nothing else, you probably just learned something you never thought you’d learn in this industry. 

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If this article helped you in any way or you think it may help others you know, please share it on Facebook, Twitter, Google+, or whatever social media outlet is your addiction.  Or if you’re lazy like me just hit the “like” button or +1 button.  Thanks.

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PS: I know I possibly covered a lot of unfamiliar ground here so if you’ve got questions, drop ‘em below.

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PPS: Check out Part VI of this series HERE.

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A couple weeks back I wrote a post in the benefits of writing action plans to implement small behavior changes to bring about long term results.  Frankly, I think that this is the best way to overcome stumbling blocks in getting started with an exercise or nutrition program for the beginner and for reaching new levels of achievement for advanced trainees.

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As a result of that post, I’ve had a few questions and I figured that today would be as good a day as any to one of them.

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Question: If I successfully implemented a behavior last week, do I have to change it or increase it this week?

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Answer: Definitely not.  If last week you decided you were going to exercise 3 times for 30 minutes and you achieved that goal, there is no reason to expect that this week you should attempt to do 4 days per week or increase the time to 45 minutes.  However, the aim of an action plan is to make regular small steps forward in ANY behavior the leads you towards your goal.  So this week you could very well maintain your previous exercise goal and address another behavior instead.

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For example, if your long term goal is weight loss and last week you began exercising as was discussed above, perhaps this week you can begin to address another simple habit like sleep as this can also effect weight management.  If you regularly go to bed late and get up early for work you might set an action plan to go to bed by 9:30 at least one night this week and build on that in later action plans.

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Ultimately, the when thinking about action planning it helps to take a look at what the ideal situation would look like for you to achieve your goal.  For fat loss you’d likely be exercising a few times per week, lifting weights, eating less junk food, maintaining a moderate calorie deficit, eating plenty of veggies and fruit, consuming adequate protein, drinking mostly water and few calorie containing beverages, sleeping 7-8 hours per night, and so on.  Doing all that at once is easily a recipe for failure (which is why most people that try this do not actually succeed in the long term), but breaking it down into very small managable actions will make it possible to implement this over a very long time line and make it more likely that you’ll be able to maintain it.

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So you select the easiest possible remaining behavior that needs to be changed and start working on it in the simplest possible way for you whether it be only one meal per week or one day per week.  Over time, new habits will form and the results will come.  They key is patience and consistency.  If you can accept that it will take time, the wait will pay off and you’ll eventually leave all those trying more severe programs in the dust as they struggle to maintain their new habits and eventually regain the weight they lost.

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And for those who are more advanced, the same thing appliles.  You may have already implemented behaviors that have set you on the path to your goals.  The key now is to identify which ones still lie between you and your intended outcome, pick the easiest one to change…and get after it.

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In the end, it is nice to read this stuff, but unless you’re actually doing it, you might as well have not wasted your time.   What is your action plan this week?  If I get enough people sharing theirs I’ll share my own next week.

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PS: If this post has helped you or you think it might be helpful to someone you know, please don’t hesitate to share it.

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Facebook Arguments - This is How I Roll

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So Sunday I sent out an email to my newsletter subscribers and, as I usually do at the bottom, I invited my subscribers to join me on Facebook to connect and share in the discussions on my wall.  More specifically, this time I mentioned that my Facebook is indeed the place to be to enjoy the rants, arguments, and tirades that take place on my statuses from time to time.

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Interestingly, despite having invited people to add me many times before, it seems that you are all more excited to chat it up if you think there is going to be disagreement and rage filled rants.  In short, ya’ll are sick!    Of course, this is good news because I am also one for such discussions.  For the rest of you who have yet to connect and participate in said discussions (shame on you), please feel free to add me HERE.  I know you’re just as sick as the rest of us.

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While you’re at it, don’t forget to follow me on Twitter and subscribe on YouTube as well.

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Down to Business

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Okay…enough chatter.  Time to get to work.

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Last week I wrote a little bit about the state of the research on refeeds, but I was very careful not to say that they don’t work because the truth of the matter is that just because there isn’t any research to help us determine one way or the other in well designed weight loss studies in humans.  As you could probably tell from the tone of my post, I’m not totally convinced at this point and I don’t often use structured refeeds with my clients.

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That said, I know that there are many very smart folks who do use refeeds with their clients and I think it is only fair to consider their opinions as well.  I feel that many fitness professionals – myself included - can sometimes become a little too dogmatic about their own methods so I wanted to ask my good friend Erik Ledin (who has worked with many high level bodybuilding, fitness, and physique competitors) to share his perspective on how to use refeeds and when they are most effective.

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*Note – To be clear here, we’re talking about structured higher calorie and higher carb meals.  Refeeds are not the typical “cheat meal” where a bodybuilder will go out to a restaurant and kill a steak, a pizza, and a plate of pasta washed down with a couple Cokes.*

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Here’s what I asked Erik

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“At what point do you feel refeeds become important? Do people at any percentage of body fat benefit from them? In other words, are they valuable for everyone who is trying to lose fat?”

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Erik’s response

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“You could really draw an answer out but just to keep it short, when progress stalls, or when a person is lean.
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Fatter people don’t need refeeds since body fat is protective to the regulatory hormones; it’s when someone gets lean and is further and further away from their metabolic set point that things tend to get all jacked up.
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People can argue this all they want, but the reality of actual PEOPLE going through this is hard to ignore.
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I don’t know what body fat percentage that would be as I could bet it would differ from person to person again based on how far they’ve come from where their bodies want to naturally gravitate towards. Those who have come from further probably will benefit sooner and vice versa.
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So I’ll look at progress, gym performance as well and a general assessment based on what they’re looking like.  Sometimes I’ll put one in, only to pull it back out because maybe my application of it wasn’t timed right.
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My Thoughts

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As most of you know, I like to wait until the dust settles in terms of research before I make a definite conclusions about whether something works or doesn’t work.  However, I am not against trying things in the interm provided that the theory is sound and there is practical evidence suggesting that it works in the applied setting.

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In this case, it appears that if you’re going to try refeeds, you at least need to have hit a standstill in terms of weight loss that can’t be explained by overconsumption of calories or too little activity and likely be relatively lean.  If you’re just starting to follow a nutrition plan and you’re trying to justify using refeeds as a way to over eat on the weekend because you need to maintain your leptin levels you’re probably deluding yourself.  A more moderate calorie deficit is probably the key to success and if you’re going to use refeeds, you should probably wait until they are truly warranted.

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I should also note here, that while we are talking about the effects of leptin on hunger and metabolism, we shouldn’t forget that other hormones like ghrelin and PYY have effects on hunger as well and none of these hormones operate in isolation.  In fact, some of them are actually effected just be THINKING that something is more filling.  So we can’t ignore the possibility that other hormones as well as social and psychological factors can play a role in fat loss.  While refeeds may indeed work, there is still so much more we can learn.

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In my post last week I talked a little bit about how weight gain (and specifically staying at a certain weight) can increase the amount of a hormone called leptin required to prevent hunger and slowing down of the metabolism with subsequent weight loss.

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To reiterate, leptin is a hormone that historically would have protected us from starving to death in periods of famine.  When our body fat levels fall, leptin also falls which slows our metabolism and makes us hungry so losing more weight will be harder and we’ll possibly eat more to bring our weight back up to where it was previously.  In the context of the discussion from last week, gaining weight and maintaining it for some time would make it so we need more leptin (i.e., need to gain more weight or eat more) to restore leptin levels to normal and make us stop being so hungry.

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However, one proposed mechanism to deal with falling leptin levels when calories are restricted is the use of “refeed days”.  In most cases, it is suggested that the refeed consist largely of carbohydrates and that it is actually a full day of refeeding instead of the popular cheat meal that was originally quite common with bodybuilders.

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 The premise here is that insulin increases leptin and carbohydrates increase insulin so logically a high calorie day including plenty of carbs would increase leptin and offset the metabolic slowdown associated with low leptin and low body fat levels.  And since a single meal doesn’t necessarily have this effect, a whole day is typically suggested.

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I think this practice has actually grown increasingly popular with dieters, but the point I want to drive home is that while this is the logical extension of the current research looking at the hormones involved, I’m not sure that there have been any more lengthy studies looking at whether this method actually produces changes in metabolism or, more importantly, allows people to go on to lose more weight/fat than they otherwise would have lost.

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Does this mean that refeeds don’t work?

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Not necessarily.  What it means is that there is just not any research yet (that I am aware of) examining whether this is method is actually effective for staving off metabolic slow down.  There IS research suggesting that leptin injections can help with weight maintenance in those who have already lost weight.  However, the reseach on leptin injections also shows that they NOT effective in promoting weight loss at all (except in those born with a leptin deficiency).

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So where does this leave us?

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Generally speaking, I think that as long as you’re in negative calorie balance (calories in are less than calories out) you’re going to lose weight.  This can be accomplished with an even calorie deficit throughout the whole week or a more severe calorie deficit during the week so you can have a “refeed” on the weekend amounting to the same total calorie deficit.  I also think that the leaner you get, the harder it is going to be to lose more weight/fat regardless of whether or not you do refeeds.

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I think refeeds or cheats CAN be good psychologically for some people, whereas they can lead to all out binges and unhealthy eating patterns on others.  The secret is just to acknowledge which of these types you are.  For now though, I think the research on refeeds is still incomplete and more definitely needs to be done before we can confidently tell people that they are maintaining their metabolic rate (and will thereby lose more weight) by using them.

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If they work for you by enabling you to stick to your plan then that is all that really matters.  However, I’m not sure (based on available research) that their effects on leptin are the cause.  If you have research to the contrary, I’d be happy to be wrong here…so send it my way.

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What are your thoughts on refeeds?  Do you use them?  Do you feel they are effective?  Or is it all about calories?  Drop me a comment below.

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Every so often we tend to let our weight get a little beyond where we might like due to work stress, having kids, etc and we rationalize that we’ll just have to “take it off later”.  However, recent research on leptin shows that perhaps this doesn’t work exactly as we might expect.

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You see, leptin is a very interesting hormone that was evolutionarily responsible for protecting our body from starvation.  At our normal weight (i.e., when we are not calorie restricted) leptin levels remain stable and our metabolism plugs along just fine.  However, as we lose weight our leptin levels fall which can slow down our metabolism and make us want to eat more to restore us to our original weight and bring leptin back up to its original levels.  This is normal and anyone who had tried to lose weight in the past will know exactly what I’m talking about.

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But here’s the kicker, when we gain extra weight and carry it around for a while our leptin threshold (the point leptin levels have to reach to keep us weight stable) becomes higher.  In other words, we’ll have to eat more to restore leptin to that higher level and this predisposes us to go right back to that weight.  So basically, once we gain weight and carry it around for a while, it will actually get harder to maintain any future weight loss.  Shit!

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And to make the problem worse, the new leptin threshold (you know…the one we created by allowing ourselves to carry around the extra weight that we were going to take off later) does not appear to go down even if we take off the weight and maintain that new body weight for a long time.  Instead, the higher leptin threshold appears to be permanent and once it is changed there doesn’t appear to be much we can do about it.  Double shit!

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So what can you do about it?

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 If you’ve gained some weight and you’re not where you’d like to be then you need to immediately implement a plan consisting of several well thought out action steps that will carry you to your goal before your body adapts to your current weight.

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Alternatively, if you’ve been at your current weight for a while and you think your body may already have adapted, what you can do is start by taking action today to prevent future weight gain.

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Of course, if you need that extra litte bit of incentive to finally take action I should remind you that today is the last day to Tom Venuto’s Burn the Fat, Feed the Muscle product before the end of day and you’ll have the opportunity to get lean, and defeat leptin, and win an all inclusive trip to Maui all at the same time.

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Whether or not you decide to use Tom’s product is up to you, but frankly, the incentive to go to Maui is pretty convincing to me.  But the very least you need to do is start taking some action today (no matter how small) to start moving in the right direction.

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What good is a Monday morning without zombies right?

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Last Friday the group Sumo Cyco released a totally SICK music video.  The group features Sever (the alter ego of musician Skye Sweetnam), but more importantly I’m totally stoked because my brother in law Brad got to play the blood sucking, brain eating, zombie in the video and his girlfriend Sara did all of the supremely gory makeup…which makes the video totally awesome.  If you missed your coffee this morning, this video will definitely wake you up.  I’m really digging the tune and thinking this one might be a solid addition to the playlist for leg day this week too! 

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*Warning – Video may not (read: is definitely not) suitable for work*

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Okay…now to get down to business.

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Recently I had two people ask me questions regarding things they should be eating to lose fat faster.  The first was a male friend who mentioned that someone had told him he should start eating coconut oil to accelerate his metabolism.  The second was a female friend who had heard from some of her friends that if you eat a certain amount of cinnamon per day (mixed in yogurt of some kinda) that this would help her to lose fat faster.  In fact, some of her friends stated that they were doing this and that it was actually working.

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So what do I think?

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The very real truth is that there ARE some compounds that have a thermogenic effect and result in a (slightly)  increased metabolic rate.  However, the second someone asks what they should be eating to make weight/fat loss go faster I tend to think they’ve been terribly misguided.  In my experience, weight loss isn’t about consuming MORE of anything.  In fact, for most people the real magic is created simply by consuming less.

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In short, I tend to answer questions like this with questions of my own.  In these cases I simply asked “Do you think that if you maintained your current level of activity and calorie intake that adding this ingredient would make a visual difference in how you look”?

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I don’t know whether either person actually took that to mean what it was meant to mean, but the key here is to understand that IF there was a magic ingredient that made for a truly visually noticible change in appearance without any change in diet or exercise it would probably be VERY expensive and you wouldn’t be able to buy it in the store for $10 or less.

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But what about the people who were doing the cinnamon thing and getting results?

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Again…if the scale was changing I’m guessing that this would be more related to subconscious changes in intake or exercise as a result of the act of monitoring weight in the first place.  And, of course, there is the placebo effect that I mentioned here as well.  But most certainly, the main point you should take from this is that there is NO MAGIC.  There are NO SECRETS.  Real and permanent weight loss will always be the result of serious dietary or activity changes (usually both).

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PS: If you haven’t already, don’t forget to find me on Facebook and Twitter.

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PPS: Seats are going quickly for my speaking engagement in June.  If you don’t want to miss it click HERE to find out more.

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A while back I was very fortunate to connect with a very bright guy named Chi Chiu and recently began having a discussion with him about Gary Taubes new book Why We Get Fat.  I meant to get around to purchasing and reviewing the book myself, but given Chi’s passion for the topic (and the fact that he’s an evidence based uber genius) I asked him to do a guest blog about it.  I have to say…he certainly didn’t disappoint.  If you’re thinking about purchasing or have already read Why We Get Fat, you need to read this!

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Take it away Chi!

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This is not your typical review, because at the time of writing it, I do not own the book nor have I read it. It would have been easy for me to simply buy the book, read it, and write you a review, but I chose not to. Instead I’ll let Gary Taubes himself, try to convince me, to buy his book.

Gary Who?

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Gary Taubes is a science writer who has a Masters in applied physics and one in journalism. He has written numerous articles, but became an overnight sensation with the most controversial article of 2002 in the New York Times, ‘What If It’s All a Big Fat Lie” in which the role of (saturated) fat as a cause of cardiovascular disease was questioned. A bestseller “Good Calories, Bad Calories” followed. Taubes has won several awards during his career and recently he published “Why We Get Fat and What to Do About It.”

Where to start?

Most coaches get annoyed when they get advice from people who have no real world experience. I don’t care that Gary Taubes is a writer-only, and is not in the trenches with us. I’ll judge him solely on the information he provides.  He recently started a new blog to promote his book and there are numerous podcasts and YouTube interviews available, so you can get a general sense of what the major concepts in his book are and whether it is worth spending your hard-earned money on.

My first impression of Taubes is that of a reasonable man, posing reasonable questions.  He does not defy the energy balance and he seems to be genuinely annoyed by the failure of the widely promoted low-fat dogma combined with exercise approach to combat obesity. So let’s see what else he’s got to say.
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The Significant 20 kcal

His first post on his blog is about the significant 20 kcal per day. It’s a thought experiment on how eating one or two bites (20 kcal) too many can lead to 2 pounds of excess fat a year and 40 pounds in a period of 20 years (365 x 20 kcal x 20 years / 3500). So when you overshoot only 1 energy percent of your energy requirement, obesity will be inevitable.

With only such a small margin, it would be impossible to maintain a stable weight for longer periods. He argues that the body does not have such an accurate bookkeeping system and that therefore the laws of thermodynamics, while true, cannot explain why we do or do not get fat.

The 20 kcal per day thought experiment is actually a classic one, with many variations found in textbooks. He uses it to ridicule the counting calories approach as a means to maintain or lose weight. In a podcast Taubes jokes that the laws of physics only make sense, when you apply math skills of an eighth grader. And although it’s amusing, that doesn’t necessarily make it true.

Whether the body has an accurate enough bookkeeping system or not, is actually irrelevant. Thermodynamics controls this process all by itself, because weight change is self-limiting. Those extra two bites lead to more mass, which needs to be maintained and carried around. This comes at an energy expense and quickly leads to energy equilibrium. The other way around is that losing weight will lead to less mass and lower resting metabolism. These natural restrictions create a bandwidth and explain perfectly why a set point can be reached without high precision bookkeeping (Katan MB 2010).

This is a well-known fact and physiologists have developed mathematical models that accurately predict the required energy surplus to gain a certain amount of mass during a specific period. According to one of those models, a woman in her twenties with a BMI of 23 needs an excess of 370 kcal per day to get to a BMI of 29 in a period of 30 years (Katan MB 2010), a far cry from the 20 kcal Taubes suggests. 

In the same post he devotes at least a dozen paragraphs on why thermodynamics does not explain why we get fat, while ridiculing experts in the process. He uses a restaurant analogy to show that the laws of physics will only tell you that a restaurant is crowded because more people went in then there went out.

Well, the restaurant analogy therefore tells you quite accurately why people get fat and even what to do. Hire a door bitch!

[Note from Mark : A door bitch is a person who stands outside of a bar or club alongside the bouncers and chooses which people beautiful people to let in and which to keep out.  Don’t worry…I had to look it up too]

Of course it doesn’t tell you why people want to get into the restaurant in the first place and he ridicules the experts for not knowing the answer. In my experience, authorities that tell you that they do not know the answer are usually the real experts. Unlike the dime a dozen wannabe gurus whom seem to have all the answers. Taubes also claims to have the answer which I will cover in the next section.

Although the laws of thermodynamics don’t tell you the complete story, they give you the boundaries. You cannot create something (mass) from nothing and the calories in / calories out concept is therefore not useless. After reading this post I was wondering whether this was representative for his book. The fact that he mentions that there is a whole chapter on the significant 20 kcal per day, suggests that the book must be filled with incorrect assumptions and useless over bloated analogies.

Why Diets Work, When They Do

While I found the first post somewhat amusing, the second blog post made me wonder whether I was actually wasting my time. The main concept of his post boils down to the following assumptions. 

1. Carbs are bad and make you fat

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2. Restricting calories is restricting carbs

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3. Weight loss through calorie restriction is carb restriction and any weight loss success may therefore be solely attributed to carb restriction. 

He covers a couple diet intervention studies and accuses the authors for not controlling the relevant variables, because they only control calories instead of carbs. The authors of the study actually only set out to control one single variable and that’s (the adherence to) the diet. Nothing wrong with that and for the most part they succeeded nicely. Adherence to the diet is the deciding factor, because it simply makes you eat less.

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Taubes then goes on that the hypothesis of carb restriction as a causal factor for weight loss, has never been tested and that therefore all results of the covered studies are unreliable. He needs more than 3800 words for this rant and fails to mention one of dozens metabolic ward studies (Grey N 1971, Kinsell LW 1964, Krehl WA 1976) that already refuted his unfounded assumption. No significant difference in weight loss has ever been established in studies designed to compare a low-carb with isocaloric high carb diet. The authors of the covered studies did not control the carb variable, because they already knew that particular answer. It would have been as useful as testing whether hot water is indeed warmer than cold water.

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Taubes articles and the increasingly popular paleo diet have fuelled the low-carb interest. They seem to inspire each other and Taubes does mention hunter-gatherer tribes more than once in his interviews. The general idea seems to be that hunter-gatherers eat low-carb.

Taubes mentions in a PODcast that Eskimo’s don’t eat carbs at all, while demonstrating great athleticism. This is a common misconception. I actually own a ‘carbs gone wild’ edition of an Inuit cookbook with no less than 240 pages exclusively with plant based recipes. That’s a whole lot of pages for a non-carb population. It comes as no surprise, that a study found that the Inuit actually have a daily carb intake of 127 grams  (Bang HO 1980). Taubes was of 20 times with the calories in/calories out calculation, but with the Eskimo’s he manages to miss the mark by 127 times. The 127 gram carbs may still be considered low-carb, but the Inuit are not living fossils nor are they representative for all hunter-gatherer tribes. The dietary pattern of the Kitava Indians for example, consists of around 70% carbs and yet obesity, diabetes, heart-disease and exercise for that matter, are non-existent in that tribe (Lindeberg S 1994). Paleo is not low-carb per se and carbs are not the causal factor for all western diseases.

It’s All Insulin, Bro!

In his third blog Taubes cites a couple of biochemistry books. The basic premise boils down to the following.

1. Insulin stimulates fat cells to accumulate fat while inhibiting fat mobilization

2. Chronic high insulin levels lead to insulin resistance and less uptake by the muscles and more uptake by the fat cells

3. Carbs lead to a high insulin response, which leads to B, which leads to A, which leads to why we get fat

He then goes to say that this insulin resistance is the underlying defect of obesity, diabetes and heart disease. Notice that he states ‘the’, not one of them or a risk factor, but the defect. He also states ‘underlying’, not contributing, not shared, not correlated, but he suggests it’s the causal factor. We get fat because we become insulin resistant, seems to be his main message.

This does not explain why more than 25 percent of obese persons are not insulin resistant (Stefan N 2008, Wildman RP 2008). The statement that it is the underlying defect, is at least an exaggeration, but that does not mean that insulin resistance may not be one of the causal factors.

Taubes mentions a lot of rodent studies, because human studies on the subject do not exist, for good reasons. To study it, you need to shut down the insulin receptors, but then you’ll die within days, which is an inconvenience. The fact that there is not enough time to get you obese, is of course the major obstacle. The next best thing is to shut down the liver insulin receptors and that’s what researchers have done with the so-called “knock-out mice”.

Having no receptors will of course lead to 100% local insulin resistance, which progressed into systemic insulin resistance with these mice. This was an interesting finding, but even more interesting was the fact that the mice did not get obese (Cohen SE 2007, Michaels MD 2000). So the little evidence that actually exists on the topic, suggests that insulin resistance is not the causal factor of obesity. 

If the insulin hypothesis is the heart of his book, it’s flawed. Not to mention all the nitpicking I can do on the claims he makes on insulin physiology, but it would take multiple posts to debunk all of them, like carbs being the sole driver of insulin response or his rather incomplete picture on how fats get stored and oxidized, etc. I can only add that I find it shocking, how many of his ideas seem to be based on conflicted or even refuted theories.

Saturated Fat, Can You Handle Me Baby?

The last part of his third blog post and the main topic on his fourth is the diet-heart hypothesis. He refutes the idea that saturated fat (SFA) causes heart disease and I have to agree with him. A recent review (Mozaffarian D 2010) containing intervention studies, suggests that saturated fat increases coronary events, but they were mostly JADAD level 2 studies. In other words they were poorly controlled. If you have no idea what that means, may I suggest purchasing Mark’s product How to Read Fitness Research.

In the same year another publication (Ramsden CE 2010) showed no causal relation between SFA intake and coronary incidents. The authors were rigorous in obtaining missing data and shed new light on well-known studies. They also suggest that coronary incidents increase when you replace SFA with omega-6 oil. A practice that is actively promoted for deep frying and may get people killed.

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An invitation-only symposium last year in Denmark, lead to a recent consensus statement  (Astrup A 2011) shedding even more doubt on the contributing role of SFA in coronary disease. Even Dr. Daniel Steinberg, a world-renowned cholesterol specialist with over 400 published articles, states in his book that he does not support the diet-heart connection.

What to Do About It…according to Taubes

The subtitle of Taubes book is ‘What to do about it’ and that seems obvious. Stay off the carbs, don’t worry about the increase of dietary fat and the obesity epidemic will soon be over.

I counsel ‘how to lose the love handles’ clients, elite athletes, and bodybuilders (two of whom happen to be national champions) so I know a thing or two about weight loss. I have been involved in various nationwide multicenter lifestyle programs for obesity, diabetes, COPD, pregnancy, kids, low back pain, and RSI.

In most cases I co-developed the programs with experts, trained the practitioners and collected the data. In a 2-year multicenter (n=80) obesity program I’ve seen the results of thousands of obesity clients. I’ve seen the effect on weight, on physical, emotional and social functioning. I’ve seen the joy, the pain, the envy, the relapses and the recoveries. I’ve collected data through SF-12 surveys, the MHI-5, diaries, HRV measurements, weight scales and other health related tools. So, I know a thing or two about obesity.

I was shocked by the McKinsey report (2011) on the ‘real’ cost of obesity, which estimates a stellar sum of 450 billion dollar annually in the US alone. I find that hard to believe, because I found the report very limited. We have no idea what causes the obesity epidemic or whether it’s even bad for your health. There is no mention of the obesity paradox, a phenomenon where obese people are healthier and live longer than their slimmer counterparts.

So what about the unnecessary costs of overtreatment of obesity? No mention of confounding variables either. Most studies are from the United States, where the income gaps are huge. We know that low income is correlated with obesity, but most studies have not corrected the relationship of social economic status (SES) on disease endpoints. This is not a minor issue, knowing that in the US around 50 million (!) people lack health insurance (during any period of time).

So do poor obese people die from fat accumulation or from insufficient, but unrelated treatment? Or do poor obese people eat more cheap calorie dense food, deep fried in so-called heart-healthy omega-6 oil, which may get them fat and killed at the same time?

We also know stress kills and obese people have a lot to stress about like negative self-image issues, ridiculing, and even discrimination. On top of that, most of them weight cycle their whole lives, adding more to the stress, while increasing inflammation, which seems to be an integral part of weight cycling.

So what is it, that makes the obese sick? Is it fat accumulation, is it excess omega-6, is it lack of health-insurance, is it a negative self-image, an increase of inflammation, discrimination and therefore the McKinsey report itself? The interventions to heal the obese may actually contribute to the sickness, the increased mortality and therefore to the cost of obesity.

Obesity is not a simple problem that can be solved by buying a book, based on some serious flawed theories. If you think you are actually helping your obese clients with a low-carb diet and high intensity interval training, you may in fact have shortened their lives by a couple of years. Working with the obese requires specific knowledge and commitment, so if your program is an overweight XXL version of the program you have for your non-obese clients, please quit and give your clients a refund!

Not Your 23 Dollar Bill

From a hypothesis point of view, I’ve seen nothing novel in Taubes vision in Why We Get Fat. fat. Anyone who has some notion on alternative nutritional views will notice the familiar concepts. And of course some of it has merit, but some of it is out of context or even downright wrong.

If you already bought the book, or were sold on the concept, don’t feel bad about it. It’s like accepting counterfeit money. Nobody will blame you for it. It’s not like you accepted a 23 dollar bill and Taubes book is not as obvious as a 23 dollar bill. It looks like real money, it feels real money. it may even smell like real money, but that doesn’t make it real.

Then there is the ethical question. If it can pass for real, because people do tend to lose weight when following a low carb diet, what would be the harm in embracing the book? The same holds true for counterfeit money. If it looks real and you can pay with it, why should you stop using it?

There are actual several reasons. First of all is that someone gets hurt further down the line, because it will come out eventually. This will reflect badly upon you, which is of course your problem. But mind that it will reflect badly on our profession as well, which concerns us all.

The second reason is that we make progress, because we have rational in-depth theories that we turn into great experiments with outcomes we learn from.  Storytelling without conclusive evidence however, has kept us in the dark ages for centuries.

Do you really want to return to medieval ages where science had no place and babies died for what we now consider trivial reasons? I don’t think so!

Conclusion

Believing is accepting without proof, which is not a bad thing by itself, if you’re open to non-supporting evidence. Taubes selective citations and inappropriate examples suggest that he is more than just a believer, he seems to be a radicalist, ridiculing anyone opposing him. Judging Taubes own blog posts and interviews, I can only conclude that his book is unreliable. It’s not all bad, but if you cannot separate the good from the bad information, it will make you unreliable.

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The many flaws in his hypothesis make it impossible to answer the question of why we get fat. The subtitle ‘and what to do about it’ offers no real solution and does not take into account the complexity of (treating) obesity. This is the reason why I did not buy this book and will not recommend it to anyone else.

References

• Astrup A (2011), Dyerberg J, Elwood P, Hermansen K, Hu FB, Jakobsen MU, Kok FJ, Krauss RM, Lecerf JM, Legrand P, Nestel P, Risérus U, Sanders T, Sinclair A, Stender S, Tholstrup T, Willett WC. The role of reducing intakes of saturated fat in the prevention of cardiovascular disease: where does the evidence stand in 2010? Am J Clin Nutr. 2011 Apr;93(4):684-8. Epub 2011 Jan 26.
• Bang HO (1980), Dyerberg J, Sinclair HM. The composition of the Eskimo food in north western Greenland. Am J Clin Nutr. 1980 Dec;33(12):2657-61.
• Cohen SE (2007), Kokkotou E, Biddinger SB, Kondo T, Gebhardt R, Kratzsch J, Mantzoros CS, Kahn CR. High circulating leptin receptors with normal leptin sensitivity in liver-specific insulin receptor knock-out (LIRKO) mice. J Biol Chem. 2007 Aug 10;282(32):23672-8. Epub 2007 Jun 7.
• Grey N (1971), Kipnis DM. Effect of diet composition on the hyperinsulinemia of obesity. New England Journal of Medicine, Oct 7, 1971; 285 (15): 827-831.
• Katan MB (2010), Ludwig DS. Extra Calories Cause Weight Gain — But How Much? JAMA, January 6, 2010—Vol 303, No. 1
• Kinsell LW, et al. Calories do count. Metabolism, Mar, 1964; 13: 195-204.
• Krehl WA (1967), et al. Some Metabolic Changes Induced by Low Carbohydrate Diets. American Journal of Clinical Nutrition, Feb, 1967; 20: 139-148
• Lindeberg S (1994), Nilsson-Ehle P, Terént A, Vessby B, Scherstén B. Cardiovascular risk factors in a Melanesian population apparently free from stroke and ischaemic heart disease: the Kitava study. J Intern Med. 1994 Sep;236(3):331-40.
• McKinsey Quarterly (2011) The real cost of obesity, January 2011
• Michael MD (2000), Kulkarni RN, Postic C, Previs SF, Shulman GI, Magnuson MA, Kahn CR. Loss of insulin signaling in hepatocytes leads to severe insulin resistance and progressive hepatic dysfunction. Mol Cell. 2000 Jul;6(1):87-97.
• Mozaffarian D (2010), Micha R, Wallace S. Effects on coronary heart disease of increasing polyunsaturated fat in place of saturated fat: a systematic review and meta-analysis of randomized controlled trials. PLoS Med. 2010 Mar 23;7(3):e1000252.
• Ramsden CE (2010), Hibbelna JR, Majchrzaka SF, Davisa JM. N-6 Fatty acid-specific and mixed polyunsaturate dietary interventions have different effects on CHD risk: a meta-analysis of randomised controlled trials. British Journal of Nutrition (2010), 104: 1586-1600
• Taubes G Blog post 1 to 4 on www.garytaubes.com

Chi L. Chiu has a master’s degree in nutrition, one in health sciences and is currently a grad student psychology. He is the owner of Chivo personal training, Chivo physical therapy, Chivo sports performance and Chivo Continuous Professional Development center for lifestyle professionals. He is a member on various government en non-government funded advisory boards and works with clients on a daily basis.

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PS: Leave a comment below and let me know what you think.  Agree?  Disagree?

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PPS: No…he doesn’t have a blog.  I’m trying to push him into it…trust me.

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A while back I did a guest post for my buddy Bret Contreras where I basically stated that the acute rise in hormones like testosterone and growth hormone from certain types of training protocols has no additional  effect on muscle hypertrophy (growth). 

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Then, just a couple weeks ago, one of my friends emailed me a recent study showing exactly the opposite with the primary difference being the timing of the “hormone inducing” workout.

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In both studies the authors had the subjects train one arm in a low horomone condition and the other arm in a high hormone condition on alternate days.  In the first study though, the authors had the subjects perform additional leg exercise AFTER the arm training to increase anabolic hormones in the high hormone condition.  In the more recent study, the subjects  performed the leg exercise to increase growth hormone and testosterone BEFORE the arm exercise in the high hormone condition.

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In the first study they found no difference in strength and muscle growth between the two conditions and in the more recent study they found that the higher hormone condition increased the strength and muscle growth to a greater degree.

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At first glance, it appears that boosting hormones via training BEFORE training your smaller muscle groups (like biceps) can increase your results.

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However, one other major difference was that in the first study they gave each subject a drink containing protein both before and after the workout.  In the more recent study, they “encouraged” subjects to consume something afterward, but nothing was formally provided.

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Previous studies have demonstrated that there may be a maximum level of protein synthesis that can be achieved and that giving a bolus of protein in conjunction with exercise would make this easily achievable.  Because they didn’t give a peri-workout beverage at all in the second group, it is hard to know whether the differences would have been seen if protein synthesis had already been maxed out.

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So it MAY be that doing hormone inducing exercise before your smaller muscle groups can accelerate muscle growth.  Or it may be that doing hormone inducing exercise before training your smaller muscle groups can accelerate growth when protein synthesis isn’t already maxed out from pre or post workout nutrition.

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The moral of the story though, is that since the second study didn’t control peri-workout nutrition, we just don’t know.  For now, I’m still leaning towards the conclusions of the first study since the second study lacked the appropriate control to really answer this question.

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If you’d like to review studies like this for yourself, check out my product How to Read Fitness Research.

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