Ok, having discussed far too many tedious physiological details in Part 1 and Part 2, let’s go ahead and get into some of the actual details and practicalities of training the obese beginner. Oh…wait, there’s one more.
Fat Loss vs. Improved Health
.Mainly throughout this series, I’ve focused on fat loss as the primary end-goal for the obese trainee but it’s worth noting that this is absolutely NOT the only (or even necessarily the primary/best) end goal when we talk about exercise and dietary modification.
Certainly it’s the one that most people are concerned about but that doesn’t mean that’s automatically correct. Because there is also the whole health thing to consider.
Yes, yes, I know, “getting healthier” is not nearly as sexy a goal as “looking better naked” (perhaps literally) but that doesn’t make it any less important. There are a lot of things that can make you look better naked that don’t necessarily make you healthier and there are things that make you healthier that don’t automatically make you look better naked.
And in that vein studies clearly show that even small weight losses (as little as 10% of current weight) can drastically improve health parameters. So even if someone never achieves a “norma”‘ or “ideal” (two very loaded words that I’m not touching here) weight or body fat percentage, that doesn’t make that act of losing weight/fat useless; even small losses may still improve health significantly (in terms of reducing the risk of diabetes, heart disease, high blood pressure, etc).
And in that vein, some studies have even suggested that people who remain overweight but are regularly active may be healthier than folks who are skinnier but inactive (generally, losing weight and being active beats both of course).
Please please note my use of the word “may” in that sentence. This is an issue with very mixed data that is contentious as hell. More research is needed so don’t bitch me out in the comments for saying something I didn’t actually say.
In any case, some are now talking about metabolic fitness (in terms of physiological parameters such as insulin resistance of blood lipids or blood pressure) versus things like physical fitness (increased VO2 max or decreased body fat percentage) where it’s possible to influence one without necessarily impacting the second. That is, it may very well be possible to improve health and reduce disease risk even if fitness per se isn’t improved and fat loss per se doesn’t occur.
Summing Up So Far
Irrespective of all of that the fact is that most folks are looking at fat loss as their end-goal and I did start this series from The Biggest Loser (a show strictly about that) and I’ll continue on with that goal as the primary focus. So for those who skipped the earlier parts, here’s a quick summary of the issues I’ve discussed.
In Training the Obese Beginner: Part 1 I looked at the following:
- Insulin Resistance/Metabolic Syndrome
- A high resting/exercise RER (indicating decreased fat use for fuel)
- Impaired Mitochondrial Function
- A low tolerance for activity (as a function of low fitness and the realities of physics)
In and Training the Obese Beginner Part 2, I continued by pointing out:
- That the obese typically have increased muscle mass
- That the obese typically have an increased resting metabolic rate
- Some of the realities or exercise including realities about caloric expenditure and an often lack of enjoyment of exercise (on top of the generally low tolerance for it)
So given these specifics, lets start looking at how to practically approach the training of an obese beginner to either deal with, take into account, or “fix” these issues.
Becoming a “Fat Burning Machine”
I want you to know that typing that heading made me die a little bit but that’s how it goes; it’s just such a trite, clichéd and worn out phrase but it actually applies here.
As I mentioned in Part 1, a common finding is that the obese individual often has a lot of fatty acids floating around in the bloodstream (secondary to insulin resistance at the fat cell).
At the same time they tend to rely more on carbohydrates for fuel, both at rest and during exercise. Basically they have lost what scientists call “metabolic flexibility”, the ability to switch between fat and carbohydrates as needed.
Some of this is certainly genetic (i.e. a low baseline fat oxidation may predispose folks towards becoming obese in the modern environment), some of it is due to low activity/impaired mitochondrial function. A lot of it is related to diet with a chronically high carbohydrate intake promoting high carbohydrate oxidation across the board.
This is caused by a number of mechanisms. One has to do with increased muscle and liver glycogen stores; when those tissues are filled, they shift their overall fuel use to carbohydrate.
An additional factor is increased insulin levels due to the combination of high carbohydrate intake, high fat intake and insulin resistance that results. Basically, as I discussed very recently in Is Fat the Preferred Fuel of the Body, when carbohydrates are available, the body will prefer to burn them (storing fat).
So the obese individual, despite having tons of fatty acids floating around in the bloodstream, isn’t very effective at burning them for fuel. The solution to this is multi-fold.
Changing the Diet
Obviously diet is a clear place to make changes. Reducing carbohydrate intake with an increase in protein and dietary fat (protein raises insulin very well but fat is relatively neutral) is a good first step.
I’m not even saying that a full-blown removal of carbohydrates is required, simply a reduction from the typical chronically high intake will start to accomplish this basic goal. Mind you, this also has the result of reducing total caloric intake which is always required for actual fat loss to occur.
Often times this can be made by making merely qualitative changes in the diet, simply replacing certain foods with others, without having to make actual quantitative changes. This first requires the obese individual knowing what they are actually eating and that means getting a food diary to have them track food.
Less accurate is having the client describe/walk you through a typical day’s eating. Just note that self-reporting tends to be pretty bad as people tend to “forget” or simply not report what they are actually eating.
A food diary not only tends to be more accurate but, perhaps more importantly, makes people aware of what they are actually putting in their mouth. So it’s a double-win even if it’s a bit more of a pain in the ass.
But often this simple approach can identify major dietary red flags and places where simple changes can be made that will have big impacts overall. This approach often has the end result of lowering total calorie/carbohydrate control without the person feeling like they are “on a diet”. This is good because it allows people to start reducing their caloric intake without the mental stress of feeling like they are dieting.
But doing this, lowering carbohydrates and raising protein/fat/fiber (every meal should contain all four nutrients) tends to give better blood glucose and appetite control, lowers insulin levels (improving glycemic control which often helps avoid other problems), generally improves a number of metabolic parameters etc.
Again I’m not even saying a full-blown low-carbohydrate/ketogenic diet is required, even something along the lines of the old Zone/Isocaloric Diet/Etc is an excellent place to start. So in the realm of 25-30% protein (better to put this in g/lb), 30-40% carbs and 25-30% or thereabouts. Years ago this was proposed as the optimal diet for the treatment of the metabolic syndrome and it’s still relevant today.
Don’t get hung up on the percentages, mind you, just get them somewhere in that range. Ignoring the fact that I don’t like percentage based diets, of those numbers, protein should come from mixed sources with most of the fat coming from monounsaturated sources (e.g. olive oil, oleic acid, etc.) and the carbs probably needing to come from lower down on the glycemic index scale (this tends to be less important as the quantity of carbs goes down but many find better satiety/fullness from lower GI carbs).
In some extreme situations, a full-blown ketogenic diet (100 g carbs/day) may be necessary to overcome massive insulin resistance. It can also help by eliminating a lot of the ‘trigger’ foods that cause problems with food control for folks. That is, as I talked about in the Comparing the Diets series, many people just can’t do moderation.
For those folks, if they eat some carbs, they want more carbs (this is highly individual but not uncommon with the obese individual). Cutting out everything but vegetables and fruits can go a long ways towards long-term food control and reprogramming food preferences (just expect them to bitch for about 3-6 weeks as their taste buds and such adapt). Especially in the initial phases of the diet (other foods can be added back in after a dietary baseline has been established assuming food control isn’t lost).
Of relevance to fat oxidation, a lowering of carbohydrate will not only reduce carbohydrate oxidation directly but also help the process of lowering glycogen stores within muscle and liver. As that occurs (and I’ll talk about training next), the body will start to increase whole body fat utilization. Ahem, “Becoming a fat-burning machine.”
The Role of Training
Studies years ago (I cited them in The Ketogenic Diet) found that full body glycogen depletion (via training) enhanced whole body fat use in both the lean and the obese. I used this strategy for very lean folks in The Ultimate Diet 2.0 but it has relevance here as well to start correcting a “defect” that has occurred as a function of diet, inactivity, obesity, etc.
Now remember back in Part 2 of this series I talked about the “relative” unimportance of weight training (at least for the reasons typically given: increased metabolic rate, etc.) for obese individuals. But mentioned that weight training could still play other roles? Well this is one of them (there are others I’ll come back to later).
Weight training is one of the best and fastest ways to deplete muscle glycogen and start getting fat burning pathways running again. Generally a focus on higher repetitions (more accurately sets lasting about 45-60 seconds) is the goal here. So you’re looking at 12-15 reps on a slow tempo or 15-20 with a faster tempo. In that range.
Multiple sets would be ideal (to fully deplete the body quickly takes about 12+ sets per muscle group) although it would be a massive mistake to try to do this out of the gate with a beginner unless you never want them to come back to the gym. Start with a low volume, increasing gradually over the first few weeks of the exercise program and this will get the job done. It will take a bit longer but this isn’t a race.
You don’t even need a ton of exercises, pick compound movements like leg press, chest press and rowing or pulldowns and you’ve got most of the body. A routine centered around 3-4 sets of 12-15/15-20 repetitions might take as little as 30 minutes. I’ll talk in much more detail about specific exercise routines later in the series.
Of course, cardio, even with the limited amount that can generally be done by the obese beginner also starts helping with this process. As I’ll talk about on in later parts of the series, while the typical obese beginner trainee has a very low tolerance for exercise (and usually not much enjoyment for it), both can be improved over time with the right approach.
This inclusion of cardio has two effects: one of which is to help to burn fatty acids directly (and this effect will increase over time as fitness improves and glycogen is depleted), the second is to start readapting mitochondria to overcome that physiological “defect” of decreased mitochondrial function I discussed in Part 1 of the series. This is a slow process mind you but it will happen with consistent work.
Is That All There is to It?
In a sense, yes. All of this blabbering to tell you to lower carbohydrates and calories, deplete glycogen with progressively increasing volumes of high-rep weight training and ramp up cardio over time. From a purely physiological standpoint, that’s really the approach that I’m talking about. But it would be silly to think that that’s all there is to this topic.
There are other practical issues that must be addressed and this means going a bit backwards to look at some other issues of relevance to the obese beginner. But since covering it all in this post would make it too long, I’ll cover that next Tuesday in Part 4.
Read Training the Obese Beginner: Part 4.
Similar Posts:
- Are Low Fat or Low Carb Diets Superior?
- Training the Obese Beginner
- Insulin Sensitivity and Fat Loss
- Training the Obese Beginner: Part 2
- Insulin Resistance and Fat Loss
Lyle,
Aside from improving the metabolic syndrome benefits, it seems that the exercise (and even lower carb) portion(s) of your suggestions are only for improved health benefits for correcting these defects. This seems like it wouldn’t improve fat loss per se, but it may make the G.P. happy when he sees improved blood lipid profiles.
Having said that, it seems that merely lowering calories input in the obese is really the only signifcant factor that is going to drop the fat. It may not improve the defects (as quickly), but if the goal is to drop the weight, and not improved blood profiles per se– which is what the average obese person wants–that is all that really matters. That is, in the end it just means closing your mouth and eating less is the only thing is really going to drop the fat. As you said in part 2, the obese have a higher RMR anyways. Also, we’ve seen plenty of studies that show as weight is dropped, improved lipid profiles and a reversing of metabolic syndrome occur anyways. The exercise component may be nothing more than a means of only kickstarting this process, but as you said, in terms of lowering bodyfat, it’s not going to make much of a dent. The only other benefit of exercise, that I could see is the use of it to maintain weight once it is lost and this is more about creating good habits.
Agreed on all points and it’s why I threw in the bit at the start of today on fat loss vs. health. And why I talked about (Part 2) about the realities of fat loss. Basically, there are two separate issues that can be relevant end goals here:
1. Improving metabolic parameters/metabolic fitness
2. Fat loss per se
#2 will require a caloric deficit of some sort. Given the realities of exercise in this population, that means creating most of the deficit with diet at least initially (as exercise tolerance and fitness improve, more of the deficit can be generated through activity; as well exercise seems to play that major role in weight loss maintenance which is just as important). I’ll talk about that in Part 4 a bit.
There is also the issue that, almost irrespective of diet composition, weight/fat loss improves metabolic parameters.
Basically, just dicking around with macros may improve metabolic parameters but not necessarily cause fat loss (if no deficit is generated). Generating fat loss (by creating a deficit) will pretty much always improve metabolic parameters as well.
This has been an interesting and very informative article series, Lyle. Thank you.
Lyle,
“creating most of the deficit with diet at least initially (as exercise tolerance and fitness improve, more of the deficit can be generated through activity”
I wouldn’t say even initially. The most we are going to see in the majority is 30-60 minutes of some sort of activity…3-5 days a week at best. This isn’t much to work with in creating a significant deficit even after significant training and improved fitness. Which is why, IMO, the majority of the focus has to be on eating less and controlling appetite strategies for fat loss. Your free meals and time off maintenance strategies are excellent ideas for psychological control as well as getting enough protein and balanced ratios for appetite and blood sugar control on the physiological side. Focus on exercise can wait until one get’s closer to maintenance.
The other thing about exercise that is scary is that it creates a dangerous illusion of the creation huge deficit and “I can go out and eat a big meal McDonald’s super size meals because of all that hard work I did.” The other problem is it often increases appetite. Another potential bomb.
Lyle, I’d be very interested in hearing your thoughts on training and nutrition for persons on the other end of the spectrum – that is, those suffering from eating disorders. The various behaviours (e.g. starving, binging/purging, excessive exercise, use of laxatives/diuretics) and accompanying physical symptoms (e.g. low weight, reduced muscle and bone density potentially with osteoporosis, irregular heartbeat) present a unique challenge.
What types of training would you recommend to get such an individual “healthy” again? And yes, I know that “healthy” is difficult to define and means different things in different contexts… I do read your articles very thoroughly! Even among eating disorder sufferers, some will be severely underweight and others overweight, so goals will depend on the individual. And also, can you detail some of the long-term physical damage that can be done to the body, and how to correct it? I recall in the Biggest Loser segment, you commented that very low calories diets plus excessive amounts of exercise slows fat loss, and I’d imagine that doing this for prolonged periods of time (as many anorexics do) would wreak havoc on the body.
All good questions, I’m not the guy. In the case of real eating disorders, your dealing with a massive psychopathology that is potentially fatal and needs professional therapy, drugs, etc. It’s simply not my area of interest (outside of superficially in that it relates to what I am interested in) nor expertise and I’m not qualfied to comment on it or deal with it.
Neither is the average personal trainer.
One thing that everyone eventually needs to learn: know when you’re out of your league and when to refer out in a given situation.
True eating disorders of the anorexia/binge purge variety is one of those situations.
Lyle,
While you may or may not agree with the specifics of all the sentiments expressed in the following post, Tim Vagen recently wrote a piece highlighting the importance of having a “total care network,” and I think it segues nicely with your comment about knowing when you’re out of your depth, for one reason or another, and referring out.
https://tjvagen.blogspot.com/2010/05/establishing-total-care-network.html
Personally I think a willingness to refer out is the hallmark of any truly great professional. Plus it is a great decision both from an ethical and business standpoint.
For all of the extensive information you provide, perhaps your most critical contributions of all are your repeated reminders to people about the importance of context and this simple yet profound revelation about knowing when to direct a client to someone who can fulfill a particular role far more completely.
Lyle, Thanks for the great and challenging (for my tiny brain) read.
I was wondering if any of this changes your view on exercise when performed on an extremely low carb diet (<10 grams a day). Can we still go for glycogen depletion through weight training as suggested above and moderate aerobics?
I think you mentioned moderate to intense exercise is actually detrimental to metabolism when on a protein sparing fast. Does this still stand or does this research change that view?
I guess my angle is this: If an individual is classed as obese is it better to go for the extreme calorie and carb deficit of a protein sparing fast or a slightly more moderate ketogenic diet with more intense exercise (both weight training and aerobic) all things being equal (which they never are)?
Looking forward to Tuesday addition to the series. Thanks
Lyle,
Just to add to my above comment: When I ask which approach is “better,” I am looking at the goal of the quickest fat loss with a view to switching over to more intense weight training to put muscle on after a “normal” body fat range is reached. Thanks.
Luke: you’re getting a bit ahead of me here and low carbs and low calories are not synonymous. IN a lot of ways, low carb diet + glycogen depleting weight training would probably be the fastest way to get the body into full blown fat burning mode. Note that lowcarb doesn’t say anything about calories. A moderate deficit ketogenic diet + weight training would accomplish this. But as noted in Part 2, a ketogenic diet needn’t be the automatic default.
Also, as noted throughout the series, more obese beginners aren’t going to be able to do intense activity so your question is kind of meaningless, it’s not a matter of lowcals + intense activity. They can’t do it.
A reasonable compromise (and I discuss this specifically in the Rapid Fat Loss handbook if I remember it right) is to use primarily diet initially to get things moving (you can pretty much always create a bigger deficit with diet than activity in this situation) and then raise calories as activity levels come up. This would be easier to show graphically.
Lyle, Thanks for the response.
So if the trainee was able to manage exercise the choice for the fastest fat loss would be low carb + glycogen depleting weight training? Otherwise low carb and low cal (ie Rapid Fat Loss Handbook) would be best. Does that sound right or am I over complicating things (which is very likely)?
Regardless, thanks for the great post.
Luke.
Excellent and informative article, both trainer/coaches and trainees can learn a lot from it.
In terms of glycogen depletion, what are your thoughts on high reps, vs low reps but with a quicker workout pace? eg supersetting?
Hi Lyle
Please forgive me if i am getting ahead of the game and this question will be answered in pt 4.
You said that it takes about 12+ sets per muscle group to completly deplete glycogen.
I assume you mean at 45-60 secs tut, but with what rest interval and percentage of rep max?
Great series as usual!
Martin
Luke: As I said, simply lowering carbs will do some of the work, as I discussed in Part 2, you needn’t automatically go to full blown keto (read the comparing the diets series, please). Using RFL to kickstart things until activity is ramped up is another option. Better is context dependent. What’s right for one won’t be right for another and you need to stop looking for ‘better’ as if it is an absolute situation.
Martin: In UD2, the depletion workout is sets of 12-15 with 60 seconds between rest and 50-60% 1RM. Doing that with a beginner would KILL them. You have to do the glycogen depletion over the first WEEKS of training in this situation by ramping up volume as they adapt (wait for Part 5).
Beyond that, patience both of you.
Yea, exercise as a matter of creating a deficit is not that great. I have found in myself and others who have successfully lost more than Cosmo’s summer guide to great abs and being bikini-ready lbs (in my case, 135 lbs) that exercise at the start reinforces the diet. That is, the dieting and exercising helps with dietary compliance. If they/I have exercised that day (or the day prior, or will be today or tomorrow), then they/I feel like it would be such a waste to blow the diet. Of course, this sentiment made by the people I have talked to, and myself, are testimonials. Clearly, as shown by those who blow their diet after exercising because they think they created a HUGE deficit, not everyone feels the same way.
Robert: Yes and this is a benefit of exercise that I have talked about in my books and intend to talk about in the last part at least briefly. People tend to focus on the physiological impact of activity without considering the psychological benefits. And for some, the mere act of doing some activity on a day to day basis tends to make them adhere to their diet better. There’s a mental set of “I trained, why would I screw it up by messing up my eating.”
Of course, it can also backfire as you readily point out as some fall into the “I worked out, I must have burned 1000 calories, I deserve the milkshake.” Which is bad since they really only burned 300 and end up doing more damage with the food they justified based on a misunderstanding of what they actually did with the workout.
That gets into a whole separate issue of different psychologies and what are called restrained and unrestrained and situationally unrestrained eaters that I’m really not going to/don’t have space to get into.
Very good post Lyle!
I was just reviewing some data on growth hormone and other hormonal responses to exercise the other day, and put up a graph on my blog, with some text around it:
https://healthcorrelator.blogspot.com/2010/05/growth-hormone-may-rise-300-percent.html
It seems that growth hormone may rise as much as 300 percent with exercise. And growth hormone, together with other hormonal responses (e.g., adrenaline), seems to strongly promote body fat catabolism.
One thing I am still unsure about is whether growth hormone elevation is a response to glycogen depletion, or whether both happen together in response to another stimulus or related metabolic process.
GH levels change in response to tons of things. Thing is this: GH is at best a secondary effector on lipolysis, with the effect not being seen unti a couple of hours later. So it’s not really that relevant in the big scheme of things especially not compared to the primary controllers which are insulin and the catecholamines.
Loving this series of articles so far, Lyle. Before I read part 4 I have a question about something you said:
“..in some extreme situations, a full blown ketogenic diet (100 g carbs/day) may be necessary…many people just can’t do moderation….If they eat some carbs, they want more carbs.”
I’m interested in this because you could call me one of those people who can’t do moderation. My question stems from a thought I had:
When you’re on a program to lose body fat, your calorie-restricted diet is theoretically being supplemented by 1-2 pounds of body fat/week, which works out to about about 70-140 grams a day of fatty acids. Given this, the dietary requirement for fatty acids in a person losing body fat would drop and therefore calories from fat in his or her diet could be displaced with something else, like carbohydrates, without putting their health at risk–at least, that’s what I was musing.
My question is, if you had a subject (like me) who couldn’t do the carbohydrates-in-moderation thing, instead of putting him or her on a ketogenic diet, could you put them on a very low-fat diet (like 20-30 grams a day, sufficient to allow them to absorb fat-soluble vitamins and such), and then replace those extra fat calories with carbohydrates, thus feeding their craving for carbohydrates while still maintaining enough of a calorie deficit for them to lose fat?
Hope all that makes sense.
I’m not sure I entirely understand the question. You seem to be saying that you can’t do moderate carbs on a diet but can you do moderate carbs on a diet?
What I mean is that I love my carbs, right, and going on, say, an 1800-calorie diet with 33% f/c/p is too much “moderation” for me, and I’ll tempted to cheat. The solution you were proposing was just going on a ketogenic diet and getting rid altogether of the carb aspect.
I was wondering if doing the opposite would help: decreasing % of fat to the minimum necessary level (like, 10% of calories) and then increasing carbohydrates (in this case, from 33% to 56% of calories). This would have the effect of letting me eat my carbs while still maintaining a calorie deficit.
This is a really informative article. It’s helping me to see where I need to start, as I am an obese female, who has type 2 diabetes. There are so many bro-type articles out there regarding weightloss and how to properly get into physical fitness, but very little for people like me who have absolutely no idea where to start with my level of health.
I also have mild autism, and everything has to make sense to me. I have to be able to piece the puzzle together and know WHY I’m doing what I’m doing, otherwise I will just sit on the sidelines in confusion. This article has given me leaps and bounds more understanding than most anything else I’ve come across.
I went to a nutritionist who specializes in type 2 diabetes, and I’m assuming her approach is that any adjustment to a diet is better than none. She advised to eat smaller meals, more times per day as opposed to the one giant calorie rich meal I used to eat, which aided in metabolic damage. She still recommended I eat carbs, but to limit my carbs to 4 servings of 15 grams per meal with 1 protein, 1 healthy fat, and as many “free” foods (non carb veggies) as I like, 3 times per day with a 1 serving carb and protein snack an hour before bed to keep my blood sugar levels steady. I have lost 25lbs this way, but she advised to eat whatever I want with these meals, so long as I stuck to the guidelines. While I lost the weight, my cholesterol shot up. So now I’m looking to balance that out as well. I’m still not anywhere near where I need to be, as far as fat loss goes, but I’m getting there.
Anyway, thank you again for the article. It’s been very helpful.