What's up with weight loss?

We live in weight focused society. In a typical week as an outpatient dietitian and personal trainer, I see between 20 and 30 patients a week (that’s 960-1440 / year). Most want to adjust their weight (usually down) in a quest for health [and the others struggle with disordered eating...] The majority have been losing and/or gaining weight for most of their lives. So why can’t we “get it right?” 

I became a dietitian and a personal trainer because I wanted to know the “secret” to weight. I assumed there must be a reason why some people are smaller than others. But over 15 years of counseling has taught me the true secret, and it's not what I expected. 

So read on to understand how food and movement affect our body and what we can do about it.

What is weight made up of? 

Our bodies are complex systems comprised of lean mass and fat mass. Lean mass makes up about 60-90% of our weight (muscle, organs, bone). Adipose or body fat makes up the other 10-40% of a typical human body.
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Adipose / body fat is essential and non-negotiable for hormone production and nutrient utilization. The body has a minimum amount of body fat it must maintain for survival. When that level gets low, the body takes energy from our lean mass - muscle, organs, and bones.

​Science has identified men need at LEAST 3% of fat and women need 12% body fat. Please keep in mind that “minimums” are not goals - they are the least amount required to survive (not thrive). Genetics dictate at what point the body shifts into survival mode. ​

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Weight isn't as clear as it seems...

Fun fact #1 - We are over 65% water.

Depending on our hydration status, the number we see on the scale changes a lot. Sweat is not your fat crying - it’s how your body cools itself. Yes, you will see your weight go down after sweating. But once you rehydrate, your weight will go back to normal.

Fun fact #3 - Our weight changes 3-10 lbs in ONE day.
Food and drinks have weight associated to them. That can change the number you see on the scale. Waste (urine and fecal matter) also has weight. Changing these variables does not mean your fat mass has changed. Weighing yourself multiple times a day will show you how what you put in vs out changes but it serves no evaluative purpose.

Fun fact #2 - 1 gram of glycogen (the way our body stores glucose) stores 3 grams of water.
When you deplete your glycogen stores (by starving, not eating carbohydrate, or doing a crazy athletic event), your weight may change greatly. That’s not because you lost body fat but because you’re malnourished…

Fun fact #4 - There is no such thing as an accurate weight.
Despite our best efforts, “weight” is not a precise science. Most people get a different reading on every scale they step on - this is because 1.) scales aren’t perfect 2.) clothes change weight 3.) hydration changes weight and 4.) food changes weight.

Fun fact #5 - It’s very difficult to figure out how much fat you have on your body.
The most accurate ways to determine your body fat percentage are using a dxa scan, imaging such as CT / MRI, and water/air displacement. These are hard to find and costly. More readily available measures such as skin calipers / skinfold measures, bioelectrical impedance, and body circumference are inexpensive but are not 100% accurate.

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How does weight loss work? ​

The traditional formula is to eat fewer calories (a unit of energy) than what our body uses in a day. The theory then states that your body will “make up” those calories by using body fat for energy.

So for example, if your body needs 2000 calories per day and you only eat 1500. The theory is that your body will use 500 calories of body fat each day. The theory goes on to state that there are 3500 calories in 1 lb of body fat. SO if you create a 500 calorie deficit per day by eating less and/or moving more, you’ll lose 1 lb per week. 

However there are a holes in this overly simplistic theory. . .

• We cannot dictate the kind of weight lost (muscle vs fat vs organ tissue)

• The quality of the calorie makes a difference in how it’s used by the body and how satisfying it is to the body (and mind)​

• Our bodies are flexible. Just because you eat a more than what you need on occasion does not mean it’s stored as fat. The body will increase and decrease metabolism according to what’s provided.

• Body composition changes caloric needs 

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• Physical activity duration and intensity changes calories burned and are difficult to measure​

• Your stress level (emotional and physical) changes your caloric expenditure and body’s efficiency

• How often you eat changes your caloric expenditure. Metabolizing meals burns calories!

 

• Bodies metabolize nutrients differently depending on genetics and GI health

 

• “Counting” calories is not an exact science - apps, labels, and measurement devices leave significant room for error

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• The amount of energy a food has, has little to do with how full or satisfied that food will make you feel. What good is counting calories if you're miserable? 

But isn’t there a weight that I am “supposed” to be?

Clients usually come with a request to weight a certain number. My follow up question is, “how long would you like to maintain that weight?” I’ve helped a lot of people lose weight by counting calories and exercising in order to achieve a certain physique whether it’s for a wedding or a bodybuilding competition or an athletic event. It's what I was originally trained to do. However, for all of these people, the results are short lived - for a day, a week, maybe a month…. After that, the body and mind shift to survival mode - because bodies are not meant to starve.

​In response to severe and / or prolonged starvation, a body will... 

• increase appetite
• reduce available energy (so you feel exhausted and want to move less, hello depression)
• reduce the metabolic rate
• increase fat storage
• change food preferences (crave more sugar and fat)
• increase mental focus on food and weight (hello anxiety)
• reduce desire for reproduction (hello isolation and zero sex drive)
• reduce energy spent on other health services such as immunity

And here’s the thing. The first time we restrict food (aka, starve), the body cooperates. But the more we try to starve, the better the body becomes at fighting it and subsequently the more weight you gain.

​Just because you achieved a specific weight in the past, does not mean you can (or should) return to this weight again.

Additionally, you cannot tell if someone's body is being starved by looking at them. I have many clients in bigger bodies trying to eat fewer calories than a 30 lb toddler. 

Yes, there is a “healthy weight” for you but it cannot be determined by charts and graphs such as BMI (body mass index). BMI is not a foolproof system to determine body fat percentage OR health. But it is the easiest and least expensive way to compare bodies - but that doesn’t mean it’s accurate...and it's unclear what value there IS in comparing bodies. BMI cannot account for genetic differences in frame size and body composition.

​Instead, we have to consider the definition of a healthy weight from a behavioral perspective. ​

So what am I supposed to do?

I’m not saying fat loss is impossible. But instead of focusing on weight or BMI as a measure of success, my job is to help clients find a balanced way to :

1. Fuel the body 
2. Move the body
3. Manage mental and emotional health

Our bodies want balanced, consistent fuel (carbs, protein, and fat). They also want to move regularly (but not too much). #3 can make it hard to achieve #1 and #2 consistently. In order to find a healthy weight, your body and mind need to work together. One is not more important than the other. If you have significant emotional stress you need to cope with that stress and often food if how we cope. If you take that away in an effort to be "healthy" - what's left?  

What's right for your body and mind may not work for someone else (and vice versa). We need to find a place with our behaviors that works for where we are, right now. 

behaviors > weight

Am I balanced? 

The authors of Intuitive Eating (a system I’ve found tremendously successful to help clients find a non-weight based definition of health) outline a few helpful questions to understand if changing your behaviors might result in weight loss:

• Have you routinely eaten beyond your comfortable fullness level?
• Do you routinely overeat when you’re getting ready for your next diet?
• Do you overeat as a coping mechanism in difficult times or when you’re bored?
• Do you only exercise when you are dieting?
• Are you resistant to exercise?
• Do you skip meals?
• Do you wait to eat until you’re ravenous?
• Do you feel guilty either when you overeating or when you eat a “bad food” which results in more overeating?

​Here are some additional questions I consider in counseling and helping clients find a healthy path:

• How often do you ignore your hunger?
  
• Can you recognize mild, moderate, and significant hunger and fullness?
• What percentage of your time do you spend thinking about food?
• How do your friends, family, and social circle live?
• Does eating an “unhealthy” food make you anxious?
• Do you try to “make up for” foods you’re “not supposed to have?” (eg, exercise more, eat less)
• Do you avoid social events that may cause you to deviate from your plan?
• Do you physically, emotionally, and socially enjoy the food that you eat?
• How do you feel physically (and emotionally) after you eat? 
• Do you feel out of control around certain foods?
• Do you use social situations as an excuse to over or under eat?
• How often do you eat with distractions (tv, phone, computer, books)?
• Do you feel “full” but still want more / different food?
• How much sleep do you get each night? What is the quality of sleep? 
• ​What is your level of stress and how do you manage it?
• How much physical and emotional energy do you have to invest in change?

How people answer these questions dictate the extent of change that right for them at this time. 

The moral of the story. . . 

We are all different. We have different bodies, lives, and purpose. Finding a healthy life is about balancing your physical, emotional, and social needs. The balance that works for one may not work for another. We have to look in before we look out. 

Consider dogs - different sizes, shapes, and purpose. Each one with a value all its own. Would you starve a mastiff into a poodle?! So why are we trying to do that with humans? 
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Stay nourished friends!

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a small nugget of research. . . 

• One of the first to document the mental and physical effects of starvation was Ancel Keys (http://www.apa.org/monitor/2013/10/hunger.aspx). Researchers went on to understand how food deprivation affected the children of those starved (in utero and otherwise). These children go on to exhibit the same traits and obsessions.
  
• More recently, some researchers followed up with “The Biggest Loser” contestants: https://www.nytimes.com/2016/05/02/health/biggest-loser-weight-loss.html
  
• Why behaviors (not weight) improve health: https://nutritionj.biomedcentral.com/articles/10.1186/1475-2891-10-9

How the BMI was developed:

• (easy read) http://www.npr.org/templates/story/story.php?storyId=106268439
• (Wiki's take on BMI)  https://en.wikipedia.org/wiki/Body_mass_index
• (why we use the BMI and its limitations) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2065990/
• Pervasive myths about weight: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3606061/
• Excellent table https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3606061/table/T3/