Now that we understand the why behind obesity or excess adiposity, it’s time to address the dietary and lifestyle changes we can make to help manage it.

I’m going to start with the basics: Macronutrients

Carbohydrates: fruits, vegetables, grains, breads, pastas, sugars, starches, fiber etc

You can think of these as rapid fuel- your body quickly metabolizes and extracts energy from carbohydrates by breaking them down into sugar.

Proteins: meat, dairy, tofu, eggs, fish, soy- your body breaks down protein more slowly, into amino acids, which are the building blocks of muscle, hair, eyes, organs, hormones etc.

There are 20 total amino acids, 11 of which your body can make and an additional 9 that are considered essential (we get these from food).

Fats: butter, olive oil, avocado, nuts, seeds. Fats are the slowest of the three macronutrients to be metabolized. They are essential in providing energy, aid in the absorption of vitamins A,D,E,K, and are a source of essential fatty acids- which control inflammation and support healthy brain function.

Which one is best? Very simply, we need them all. The type, ratio and amounts of each will vary from person to person and are largely based on your age, level of activity and personal fitness goals.

I won’t go too much into detail here- but in general you will want to stick to complex carbohydrates that are fiber rich foods (help with satiety, weight management and avoid spikes in blood sugar).

You will also want to avoid trans and saturated fats- these are the ones that gave all fats a bad reputation and are responsible for excess weight gain and accumulation of bad “LDL” cholesterol.  Mono- and polyunsaturated fats are your “healthy fats”- though you will need to be mindful of consumption as they are energy dense (lots of calories).

In years past we have seen “low fat” diets and then “low carb diets” and even “ketogenic” diets- and I have seen patients on all of these “diets” with wild amounts of success only to be followed by tremendous failure and rebound weight gain.

Because- Diets don’t work and most people that diet will regain the weight, and then some. It has to be a lifestyle change, and there is no one size fits all solution.

Moving forward:

Let’s first look at the energy per gram of macronutrient-

Carbohydrates have 4 calories per gram
Proteins have 4 calories per gram
Fats have 9 calories per gram

Now that you have this information- we will move on to figuring out how much energy you need in a day. To help determine we will first define a few things:

1. Your basal metabolic rate (BMR) (the number of calories your body needs to sustain basic life functions if you were laid up in a bed all day, not moving)
2. Your non-exercise activity thermogenesis (NEAT)- it sounds fancy but is just referring to the calories you burn doing daily activities that are not exercising- like cooking, cleaning, shopping, etc-
   A (not so brief aside) – these calories really are neat– they keep your metabolism up and help you burn energy all day long without significantly impacting your hunger. Think about how you feel after a HIIT class vs. a day that you were just busy moving around a lot. I know you burned more calories in the HITT class, BUT you may have been more likely to over consume afterwards because it made you ravenous. Sometimes aggressive exercise also discourages movement later in the day because you just feel “done” and are less likely to do other things. Lots of studies out there that support more movement throughout the day, rather than a 30-minute gym session and an otherwise sedentary day.
3. Calories burned during exercise- this one is obvious.
4. Calories burned during digestion, absorption and metabolism of food- thermogenic effect of food or TEF– you can’t calculate this one with much accuracy
5. Your total daily energy expenditure (TDEE)- This is basically BMR, plus NEAT, plus exercise, plus TEF! Your TDEE value is the number of calories you need to consume to sustain your current body weight.

Okay fortunately we don’t need to calculate each one- there are plenty of online calculations that do this for you- keep in mind they are not going to be 100% accurate- BUT they do provide a really great starting point for someone that has no idea what their caloric intake should be. You can always start and adjust by 50-100 calories daily (upwards or downwards) based on your results.

Macro Calculator

Calorie calculator – Mayo Clinic

Word of caution- people tend to overestimate their activity levels- and most people are not considered “active”

With respect to fat loss: per the CDC 1-2 lbs per week is what is sustainable. One pound of fat is equal to 3500 calories- spread over a week this is a deficit of about 500 calories a day- so you can take the number you got from maintenance and subtract 500 from that- most calculators have this function built in as well.

Now that we have addressed the calorie deficit. It is time address the movement component of this equation.

To lose fat:

1. You can decrease the number of calories you consume (which we just talked about) OR
2. You can increase your exercise calories OR (increases TDEE)
3. You can increase your NEAT (increases TDEE)
   
   Unfortunately, all three of these options can cause metabolic adaptation.

However, there is another way that won’t cause metabolic adaptation- and that is by increasing your BMR!

You can do this by building muscle! Firstly, a pound of muscle weighs the same as a pound of fat. Here is how they differ:

1. A pound of muscle on your body takes up less space than a pound of fat, it looks different.
2. A pound of muscle is more metabolically active than a pound of fat- what that means is that it needs more calories to sustain itself. So when you gain muscle, you need more calories, and if you maintain a slight deficit (while ensuring you have enough protein to support your muscle growth) you will then effectively lose fat, build muscle and increase your BMR- the only way around metabolic adaptation!

Moral of the story: lift things up and put them down, on repeat. Every day, forever.  (Okay, but not actually)

Weightlifting: to begin you will want to start with 3-5 days a week, 30 minutes a session. Take a class, start with free weights at home, however you like. Just make sure that you start slow, and don’t compromise form.

Cardiovascular exercise: is very important for heart health and helps with the TDEE.  Try to pick steady state cardio for the most part, and do it after your lift, or on a different day. HIIT isn’t a bad option, in fact its excellent for cardiovascular training- but remember the intense hunger this can generate, and if it leaves you feeling spent, you are less likely to hit your NEAT goals, decreasing the overall TDEE

Okay we’ve made it through nutrition and exercise, its time to talk about sleep!

Sleep and weight management: It may not seem like it, but your sleep quality is closely tied to your weight. Here is how:

1. Sleep is a time for rest and recovery- if you don’t rest adequately, your muscles will not repair themselves and can’t get bigger/stronger.
2. Poor sleep can increase ghrelin (hunger hormone) and decrease leptin (satiety hormone) leading to over consumption.
3. Poor sleep decreases your metabolic rate
4. It makes you less likely to engage in activity (tired people aren’t running to the gym)
5. It increases the level of stress hormones in your body

Okay, okay, I get it- So how much sleep do I need?

According to the national sleep foundation:

Adults, 65+ years: 7 to 8 hours.
Adults, 26 to 64 years: 7 to 9 hours.
Young adults (18 to 25 years): 7 to 9 hours.
Teenagers (14 to 17 years): 8 to 10 hours.
School-age children (6 to 13 years): 9 to 11 hours.
Preschool children (3 to 5 years: 10 to 13 hours.
Toddlers (1 to 2 years): 11 to 14 hours.
Infants (4 to 11 months): 12 to 15 hours.
Newborns (0 to 3 months): 14 to 17 hours.

Bonus section:

You’re doing everything right, but you’re still not seeing results.

I eat super healthy, but I’m not losing fat- remember eating healthfully is great, but if you’re eating more than you’re burning, or at “maintenance”- you won’t see changes.  

I exercise all the time and I’m still not seeing changes- your body could have a low level of inflammation from inadequate rest OR you may not be engaging in progressive overload (you need to constantly increase the stimulus on your muscles to see change). It could also be that you’re still in a caloric surplus, OR you aren’t eating enough to build muscle. Also, metabolic adaptation- to caloric restriction and to energy expenditure- eventually your body just gets more efficient.

I hope this information has been helpful and I wish you the best on your fitness journey! Please remember that real change takes time. Most importantly- try to enjoy the process.

Sincerely,
Corsano MD, your friendly neighborhood PCP

Resources:
AAFP
CDC
National Sleep foundation