“Metabolic Derangement”- aka why you might not need to lose weight

I could probably spend the next 10 blog posts unpacking information from my first blog post. Don’t worry I won’t. I swear. This one will be a much gentler message then the first, probably more important.

I’m going to spend this post on the very last study in that last post. I think that study (and what I’m about to share here) has much to say about the problem with our “diet culture”. The obvious problem: “dieting” doesn’t work. Study after study has shown that the amount of weight loss people can sustain, even under study conditions with support of counselors/dieticians/study doctors, etc on a diet- is modest at best. And yet….a lot of people have lost weight and maintained weight loss. I for one am myself 35 pounds lighter right now then my highest weight (which probably doesn’t even begin to describe the change in body fat %). Our diet culture however pushes unreasonable weight expectations and unreasonable (or attempts at unreasonable) calorie intakes on people, which leads to recurrent failure. Again the abstract of the study I discussed can be found here: http://www.ncbi.nlm.nih.gov/pubmed/7594141

I have access to the full article from my affiliation with the University of Washington School of Medicine.

First a brief reminder of what the premise of the study was. This study was 10 women (all of whom at study entrance had normal thyroid function- though a few were on replacement) who had struggled with weight loss despite reporting intakes under 1200 kcal. They followed these 10 women over a 14 day period, measured their RMR using indirect calimetry and TDEE using double labeled water technique. Near as I can tell these are appropriate methods. They also used the double labeled water technique to measure total calorie intake. During this 14 day period they had the 10 women record in a food diary what their intake and calories consumed was.

I’d like to begin here by looking at the basic demographics of the 10 women.

Table 1.

Physical characteristics of study subjects

Patient no Age(y)       BMI                Fat (%) Present weight (kg)

1                33             32                   37.5            88.5

2                38             34.4                46.1            82.3

3                17             43.8                49.8            131

4                53             26.8                45.9            75.4

5                51             30.7                44.6             81.3

6                34              27.8                 37.3            84.5

7                29              41.5                43.8            108

8                35              23.1                 33.6            64.1

9                49              36.9                44.2            88.6

10               52             27.7                 44.3           69.8

 

(This is not the whole graph, I was having formatting issues and had to cut some of it. It only showed their max adult weight and minimum adult weight.  – I’ll discuss a few of those later).

 

The first thing that jumps out is that several of these women are at what I would consider essentially a normal weight. Subject 6 and I are close to the same age and almost identical BMI. Subject 8 even has what is considered a normal BMI! Ok so maybe they still have relatively higher body fat percentages, but that’s not the same thing as needing to “lower the number on the scale”. That’s the first point I’d like to make. We have struggled with weight so significantly as a country despite obsession with being thin or lower weight! I see someone with a high body fat percentage but a normal BMI and I tell them they need to exercise more, build some muscle and lose some fat. What is frequently called “recomp” (short for recomposition). You do that by exercise while eating a stable amount over time. Slow progress through an activity supporting intake- not eat 1200 calories a day to try to get to a lower number on the scale.

Invariably when I do tell my patient’s that what they need is more activity, not losing mass, many will then start the parade of how active they are. I have a future blog post on this, but the punchline is that you probably aren’t as active as you think you are. Some people (of course) work construction, farm, or weight tables and do a ton of walking/lifting. I’m not talking about those folks. Most of us however don’t do that. We sit…at a computer all day at work. Then we come home and make dinner for 30 minutes then sit all night at the TV or the computer and stay up late watching those screens, then go to bed late and get up and start the sitting all over again. I think for a lot of sedentary people getting a podometer can really help them start to make “more movement” goals. A recent study on a remaining tribe of hunter-gathers in S. America showed they walked something like an average of 12 miles per day. The 200 feet total you spent walking to your car a few times and then the 20 minutes you spent on the treadmill…that might not be doing it.

My next point is the impressions of what their “weight” should be is part of the issue. To put this in perspective Subject 8 is 141 pounds- to get a BMI of 23.1 that means she’s 5 feet 5.5 inches!  Doesn’t exactly sound to me like someone that should be trying to eat under her basal metabolic rate……On the part of the graph above that I had to cut out it lists her low adult weight at 113 pounds. At 5’5.5″!  That’s BMI 18.5- Right at the line of “underweight” medically.  Do you get the impression that she has a healthy idea about weight? Do you have a healthy idea of what “weight” means?  What is your real goal based on? Certainly this patient may not be happy with her body fat percentage, but again, I’ll stress this: that’s not the same thing as needing to see a different number on the scale.  The number on the scale isn’t the issue, the activity level is probably the issue.

For that one patient we’re talking she’s about a few pounds from what is considered medically a healthy weight. Her body fat % is 33% which a lot of people consider to be a nearly ideal place from a curves perspective.  She was trying to eat a 1200 calorie diet while only a few pounds away from being medically normal. That’s disordered thinking right there. That’s the “short term progress at all cost” thinking that has kept us fat, unhappy, sedentary, and tired for so long. Again we have no idea what this person looks like, but based on the information available she might have a few pounds of fat to lose.  Despite that the research paper tells us that she reported eating 800 kcal per day to try to get there.

Long term thinking, movement or exercise nearly every day, small sustainable changes to how you eat (I intentionally didn’t say “diet” there) is how anyone who has made a huge change in their weight/life/health has done it. I’m constantly amazed at how many people think they can change how they eat for a few weeks or months, lose some weight and then go back to how they were eating before and stay at that lower weight.

However you are eating/moving at the weight you are at is the eating/moving that will support that weight. Making a change for a short term and getting progress but then going back to the original eating/moving will result in returning to that original weight. Period. In fact, what we see is that people go on drastic diets 1200 calories, aren’t getting enough weight lifting and protein and large portions of their weight loss is muscle. I saw from one source that it’s about a 1:1 ratio by weight, so if you lose two pounds- one pound would be muscle! But guess what happens when you gain weight back? It’s probably almost all fat. This slows your metabolism, makes it harder to exercise (less muscle= sucky) and usually results in worse aesthetic appearance which further drives the shame and negative self talk that leads to this vicious cycle.

Stop dieting, start living. Just move. You are not your weight.

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3 thoughts on ““Metabolic Derangement”- aka why you might not need to lose weight

  1. I really like this post!
    It takes the information from your last post and the information from Amber’s page and made it all very understandable.
    Could the chronic yo-yo dieting which causes muscle mass loss cause a slow down on metabolism?
    And…is the muscle mass loss that happens when we age why our metabolism slows down…or part of the reason why?
    And why do we lose muscle mass as we age?
    Sorry for all the questions. The more I try to understand the more the more questions I have.

    • Summer- I’m glad you came back, hopefully my answer to your last question made sense also?

      I totally think the chronic yo-yoing and loss of lean muscle mass is a huge part of the reduction in metabolism, but even more so I think the effect is in reduction in exercise- when you get higher and higher body fat % your ability, tolerance, and execise capacity can get reduced to the point of basically not being able to. Amber talks about this also that when she first started, she was barely doing anything and getting drenched in sweat like it was an extreme workout- and when she first started, it was!

      I’m not sure about the second question- I think it just gets slower some because the fires are burning as hot. I do remember reading somewhere some questioning of the old maxim of “you lose 0.5-1 pound of muscle a year”. I don’t remember my source on this, but I recall reading that the studies that this information was based on was done in actual body builders. Those people have huge amounts of muscle and it would make sense it might be difficult to maintain that as you age- especially as it would be hard to keep up on the food and protein needs that competitive body builders have. For the rest of us, if we exercise and get enough food to sustain our mass we might not lose enough.

      Ultimately though you are right- the more you read almost the more question rise, which is why on a certainly level boiling it down to: ETF and LTT is the most important thing- move more, eat enough.

  2. Pingback: Metabolic Derangement- Extreme calorie restriction edition | Go Maleo

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