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.
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One More (Irrelevant) Tangent: 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.
Back to the Series
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) but tend to rely more heavily on glucose and carbohydrate both at rest and during exercise for a number of reasons (the obese/insulin resistant individual has also often lost metabolic flexibility, that is the ability to switch between glucose and fat for fuel under different conditions but this is still more detail than I want to get into).
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. 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.”
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.
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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.
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.