Training the Obese Beginner: Part 3
Ok, enough tedious ‘irrelevancies’, let’s get to brass tacks and talk about some of the practicalities of training the obese beginner. I gotta keep it snappy, right? Oh…wait, there’s one more.
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One More (Irrelevant) Tangent: Fat Loss vs. 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 training and dietary modification. Certainly it’s the one that most people are concerned about but that doesn’t mean that their approach is the correct one. What I’m getting at is that there is the whole health thing to consider.
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 ‘normal’ or ‘ideal’ (two very loaded words) weight or body fat percentage, that doesn’t make that act of losing weight/fat useless; it may still improve health significantly.
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. 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 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 (VO2 max or body fat percentage). Again, 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.
.Back to the Series
But I started this series with a focus on fat loss as an end-goal and I’m going to continue with that primary focus. So 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 let’s put it together, given these situations, how to practically approach training the obese beginner to overcome this. First let me focus on the physiology a bit.
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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, cliched and worn out phrase. As I mentioned, 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) but tend to rely more heavily on glucose and carbohydrate both at rest and during exercise for various reasons.
Some of this is certainly genetic, some of it is due to low activity/impaired mitochondrial function and a lot of it is related to diet with a chronically high carbohydrate intake promoting high carbohydrate oxidation across the board, secondary to increased muscle and liver glycogen stores (along with increased insulin levels due to the combination of high carbohydrate intake, high fat intake and insulin resistance).
The solution to this is multi-fold. Obviously diet is a clear place to make changes. Reducing carbohydrate intake with an increase in protein and dietary fat (protein can raise insulin 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.
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 is mainly accomplished by getting a food diary (or just having a client walk you through a day’s eating) and looking for major red flags. 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’. Which can help to avoid the psychological stress of ‘being on a diet’.
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), generally improves a number of metabolic parameters etc. Something approximating the Zone as a first step perhaps, 25-30% protein, 30-40% carbs and 25-30% fat; years ago something to that effect was proposed as the optimal diet for treatment of the metabolic syndrome and it’s just as relevant today.
Somewhere in that range in any case. 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 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.
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 weeks as their taste buds and such adapt). Especially initially (often times other foods can be added back in after taste buds adapt and the person is on a good rhythm of eating habits).
Of relevance to fat oxidation, a lowering of carbohydrate will not only reduce carbohydrate oxidation 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.
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.
And this is one of several ways that weight training can play a role (there are others that I’ll come back to below), it’s 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 and do this out of the gate with a beginner. But over the first week or two, with a gradual increase in volume over that time period will get the job done, it will just take a bit longer.
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 about exercise selection in part 4 when I will finish up (promise).
Of course, cardio, even with the limited amount that can be done also starts helping with this process. As I’ll talk about on Tuesday, 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.
And this will have 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 mithochondria to overcome that physiological ‘defect’ of decreased mitochondrial function. This is a slow process mind you but it will happen with consistent work.
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Is that All?
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.
But, as usual, there’s more. 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.
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.
http://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:
http://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.