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If You’re Using GLP-1 Meds for Weight Loss, Then You Gotta Do Weight Lifting (Part 2)

GLP-1’s are proving themselves as medical phenoms. They have been in existence for many years in the treatment of diabetes. They have demonstrated themselves as capable of reducing cardiac events, lowering blood pressure, cholesterol, heart failure symptoms, and even strokes. They have shown themselves effective in reducing the kidney problems that diabetes can cause in the long run. And there’s even proof that they might be useful for treating childhood obesity. Ultimately, they may prove valuable for medical conditions we haven’t yet explored. In light of the budding awareness of the strong correlations between our obesogenic diets that are high in fats, sugars, and calories and a variety of diseases ranging from some cancers to musculoskeletal ones, GLP-1’s may be the super-duper drugs that have exploded the weight loss market.

However, if weight loss is a goal and semaglutides and other similar hormone-affecting drugs is your method then, young or old, male or female, preserving muscle mass is critical. As a female, especially, whether pre- or post-menopausal, preserving muscle mass is even more critical as rapid and large amounts of weight loss includes bone density loss, too. Muscle mass training enhances bone mass accrual IF…, and this is a big IF, the weights you lift are heavy enough to be deemed ‘intense’.

The American College of Sports Medicine recommends that, for health, people should do some kind of RT should be done at least twice a week but could be done 3 or more if the program allows for sufficient recovery between sessions. A 2/wk program should consist of at least one exercise for each body part – legs, core, upper body/arms; ideally, you do 2-3 exercises per body part but they do not have to be the same exact exercises. For example, a heel raise gets the calf muscle, a squat and lunge also get the calf muscle, but they also get the upper leg and core.

If you choose to do 3 sessions/wk, be sure to space them out with at least 36-48 hours between sessions. For a more athletic program, it’s not unusual to do 4 or more sessions/wk but intelligent design must be applied to avoid overuse and overtraining, and injury.

What Constitutes a Viable Resistance Training Program

In the realm of RT, there are many models to consider, each with 4 variables: frequency, intensity,  duration, and exercise type. Frequency we’ve already addressed. Duration is a function of how long you want to spend doing the exercises; some quick and dirty routines can last as short as 15 minutes or you can drag it out to an hour or more. But intensity and type are where special attention should be made when the training is being done to minimize loss of muscle and bone.

When discussing intensity, we’re talking about a percentage of your maximal ability. Most of us will never test our max so let’s use a common way of determining intensity: to volitional fatigue. That means that when you feel you can no longer do any more repetitions with good form and no compensations, you have reached volitional fatigue. It is very subjective and varies according to how you are feeling at the moment, including stressors outside the gym. Recognizing that many people with overweight and obesity have not been in the gym in a while or are not comfortable going to a gym, it may take a few sessions with modest weights to figure out what it really feels like to be fatigued at the end of a set of an exercise.

There’s no hard and fast rule but, if bone loss is one of your issues, either due to age, menstrual status, sedentary lifestyle, or poor diet, it is recommended that you try to fatigue in 10-12 repetitions; that corresponds to a heavy enough weight to provide a good stimulus for bone to accrue. With the understanding that most people who do not have RT experience won’t feel comfortable trying to achieve that kind of load/intensity, especially if they’d had any injuries or are prone to some, such as to the rotator cuffs in older adults, the process of ramping up to weights that can mitigate bone loss should be long, slow, and properly designed to reduce risks. See your local trainer….or call us at STEPS.

Exercise type, however, is where the message of RT in combination with drug-enhanced weight loss is most critical. While many people aspire to 6-pack abs (abdominals), that is an unreasonable goal, especially for those who have carried excess fat around their midsections or those who are older. Having a strong core – those muscles from the mid-thigh to the mid-thorax, front, sides, and back – is valuable but not essential for the average person. Having a functional core, on the other hand, is. A functional core is one where all the muscles know how to work together and have sufficient endurance and strength to allow you to perform activities of daily living, work, and recreation.

Exercise Selections and Options

Allow me to provide some specific exercise types that will strengthen muscles and bones that we all need in order to accomplish what a rapid weight loss system detracts from, especially for post-menopausal women.

Bone loss from the hips/upper femur, which contributes to falls and fractures in older people, can be countered with such exercises as a leg press machine, weighted squats, lunges, and step-ups.

Bone loss in the lumbar spine can be slowed with such exercises as weighted squats, lunges, step ups as well as deadlifts, bird dogs, and stability ball bridges or hip lifts. You can make the latter more demanding to achieve volitional fatigue by adding small arm and leg movements during the birddog and doing bridges with one leg rather than both.

Bone loss of the upper spine, which affects posture, especially potential dowagers humps in older adults – which is exacerbated in our texting and computer-based lifestyles –

Finally, wrist bones, which tend not to get much training beyond middle school for most females once PE coaches don’t make you do push-ups, are prone to breaking when falling. They are often the first markers of middle age women’s bone loss at the early stage of osteopenia should they experience a broken wrist from a fall. In fact, though, push-ups or some version of a chest press or bench press are some of the exercises that load the wrist and could help build bone IF loaded sufficiently. However, since the rotator cuff deteriorates with age, and is susceptible to injury from doing those very exercises that could help the wrist bones, it’s wise to train them with caution and avoid the volitional fatigue in 10-12 rep prescription. But it’s also wise to train the cuff muscles to minimize the risk of injury from any kind of RT even if you’re not intending to do these bone-enhancing exercises.

Note that each exercise for each segment of the body is done in a weight-bearing posture, even the chest/bench press. Even something as mundane as a plank in a push-up position constitutes a weight-bearing load capable of producing osteogenic forces that may build wrist bones’ strength.

While it is necessary to proceed with caution as you pursue a bone- and muscle-preserving workout regimen, to pre-condition the core and the rotator cuff muscles to avert injuries that might result from a RT program, within 4-6 weeks one will start to experience muscle mass changes. It could easily take a year or more to note any bone-building changes; first by some imaging technique or by falling and not breaking something, which we would recommend against trying. Ultimately, though, the effort to enhance lean tissue – bone and muscle – facilitates weight loss, fat loss, and quality of life. And, with the health upsides of GLP-1 meds, there’s a good chance that RT will even extend the health-years of your life.

Which is the main reason we all should be doing some RT in our lives.

Originally printed on STEPS Fitness blog. Reprinted with permission.


Dr. Irv Rubenstein graduated Vanderbilt-Peabody in 1988 with a PhD in exercise science, having already co-founded STEPS Fitness, Inc. two years earlier — Tennessee’s first personal fitness training center. One of his goals was to foster the evolution of the then-fledgling field of personal training into a viable and mature profession, and has done so over the past 3 decades, teaching trainers across through country. As a writer and speaker, Dr. Irv has earned a national reputation as one who can answer the hard questions about exercise and fitness – not just the “how” but the “why”. 

GLP-1

GLP-1 Receptor Agonists: The New, Improved, and Not-Fully-Understood Weight Loss Drugs (Part 1)

Super-duper weight loss drugs (originally they were designed to help those with Type 2 diabetes, or T2D) like Ozempic, Wegovy, Mounjaro, et al. have swamped the marketplace because of their unique pharmacologic actions compared to their predecessors. Earlier weight loss drugs and over-the-counter concoctions (like coffee and other caffeine-derivatives, as well as smoking cigarettes, for example) simply sped up metabolism and boost energy. These, then, provided (ab-)users an artificial mechanism by which to burn calories and even avoid consuming calories since energy levels didn’t require them.

What makes these modern drugs so unique is their effects on hunger and appetite hormones. Essentially, they alter or disrupt hormone signaling that tell the gut to stop demanding food and/or the brain to feel satisfied with the food you’ve consumed, presumably before you overeat. That is, those appetite and hunger messages lead people to eat less without – we hope – causing permanent and as-yet-unknown effects on the endocrine system as a whole.

Caveat: while some of these drugs have a relatively long history due to their use in managing diabetes, 5-10 years on the market may not be sufficient to declare with absolute certainty that long-term impacts are not going to crop up.

The past couple of decades have given scientists and pharmaceutical companies greater understanding about the gut-brain connection. Hormones, which are signaling proteins that course throughout the body, often have multiple outlets and receptors that allow one metabolic process to influence or be influenced by another part of the body. One of the most common hormones that most of us have some awareness and understanding of is insulin.

Insulin, cell receptors, and disease

Pumped out by the pancreas, insulin helps manage blood sugar, an essential substrate that feeds all of our organs, especially the brain. The digestive process breaks down carbohydrates into sugars that the blood stream then carries to organs for energy. Ever feel groggy or slower between meals? Well, that’s your brain saying ‘feed me…ideally, with sugars, or carbs’. Ever feel like your energy is waning on a long bike ride or hike? That’s your muscles demanding calories, especially sugar-based calories. The insulin signals drive both the sugar calories from those foods to their respective locales and even help pull stored glucose (a form of sugar) from glycogen stores (sugar formulations the body keeps around in case they’re needed like the liver) between feedings. When insulin is in short supply (as in Type 1 diabetes), sugar can’t enter cells.

However, without receptors on the surface and within the cells to allow insulin to do its job, it is neutered. These dysfunctional receptors are part of the process that leads to T2D: when insulin is unable to unlock the cells that have disabled receptors, the brain, heart, and other organs including muscles are deprived of energy.

A few digestive and appetite hormones have similar roles. Leptin, ghrelin, PYY, and the big kid on the block, glucagon-like peptide 1 (GLP-1) transmit signals of fullness, satiety, and hunger to and from the gut and brain. Without operative receptors, however, some of these signals get disrupted. Obesity itself, regardless of original causality, be it genetics, diet, or lifestyle, is one of those disruptors. With obesity, some of these hormones fail to signal when you are sated or over-signal that you continue to be hungry. GLP-1 works by messaging the digestive system that you are sated. Therefore, for those who cannot get that feeling, GLP-1 receptor agonists – these super-duper drugs – help reduce food intake by reducing appetite…and increasing weight loss.

All drugs have side effects

One of the oldest drugs which originally came from willow tree bark is aspirin. Well-known and long used to reduce fevers, manage headaches, and more recently thin blood for those folks at risk for potentially-fatal blood clots such as after lower-extremity surgery or certain cardiac conditions, can also lead to excessive bleeding in the event a closed-head injury or gastric ulcers due to its effect on the stomach lining.

Semaglutide and liraglutide, two of the main GLP-1 drugs out there, have been found to reduce food obsessions leading to calorie restriction but, oddly, have been correlated with reducing other addictive obsessions from gambling to sex to alcohol and other drugs. (1) Interestingly, in combination with bimagrumab, semaglutides “led to superior fat mass loss while simultaneously preserving lean mass despite reduced food intake”. (2)

However, a disconcerting unintended consequence of these weight loss meds is that “the potential health benefits of diet-induced weight loss are thought to be compromised by the weight-loss-associated loss of lean body mass, which could increase the risk of sarcopenia (low muscle mass and impaired muscle function)”. (3)  Any time you diet, some of the weight you lose, after initial water weight, is lean tissue – muscle mass and, if rapid and extensive weight is lost, bone mass. A meta-analysis of 18 well-controlled studies that included over 1300 subjects confirmed that these kinds of drugs, which were originally designed to help those with T2D, contribute to loss of muscle mass; metformin, another T2D drug, on the other hand, does not. (4)

Some studies show that, “compared with persons with normal weight”, those with obesity have substantial muscle mass to support and transport their bodies, but poor muscle quality, that is more fatty infiltration generally from lack of a training stimuli. Somehow, though, the “diet-induced weight loss” reduction of muscle mass happens “without adversely affecting muscle strength”. This maintenance of muscle mass that accompanies weight loss improves overall physical function, likely due to the loss of fat mass which otherwise is a drag on performance. While it is recommended, and is very vogue, to encourage a high protein intake – of 1.2 – 2.0 grams/kg of body weight vs the RDA recommendation of 0.8 g/kg – to preserve lean body and muscle mass during weight loss, apparently this does not improve muscle strength; and it could have “adverse effects on metabolic function” if kidney problems are an issue or become one.

Finally, while both endurance exercise, if performed at pretty high intensities such as stair climbing or cycling with high resistances, and resistance training (RT) at moderate to heavy loads “help preserve” lean tissue during a weight loss regimen, only intensive and consistent RT improves muscle strength. This is why researchers are so heavily promoting RT as a way to prevent the inevitable loss of muscle and to restore the low-quality muscle that people with obesity have to a more functional variety. (3)

The mechanisms for these drugs’ effects on lean tissue are under investigation. One group of researchers has determined that the combination of these drugs actually protects against muscle atrophy. The biochemistry is irrelevant here. What might be more relevant is the customary fact that rarely are these drugs prescribed together. So, while they might prevent this adverse effect, it will require more study before they are co-prescribed. (5) There is evidence that shows that oral semaglutide, when prescribed for T2D patients, does help with weight loss and, even alone, does not lead to substantial loss of muscle mass. (6)

Weight loss vs Muscle loss: Inevitable or Preventable?

As we discussed above, any significant amount of weight loss is accompanied by muscle and even bone loss, especially if done quickly over a short period of time. This could be diet-related, disease- or medical treatment-related (think: during chemo or radiation for cancer), or even, shockingly, exercise-related. Yes, if someone engages in intensive and long-duration cardio training such as running or biking, and weight loss occurs, so, too, does muscle loss. (Real News, Nov 2024)

Why? It’s pretty simple: unless sufficient calories are consumed to compensate for the excess energy output, the body becomes very efficient by discarding muscles that are not used in the training (REAL News – Dec. 2024) or simply allowing unused muscle fibers, like the bigger, stronger, more powerful fast-twitch fibers, to atrophy since neural stimulation is withheld. Even young athletes on a hypo-caloric diet designed for weight loss lose muscle mass unless they’re on a significantly-elevated protein intake diet. (7)  Sadly, too, weight loss of 5% or more is accompanied by bone density loss! (REAL News – December 2018)

With studies showing that GLP-1’s can lead to 15 – 24% weight loss, they can be accompanied by 10%, or ~6 kg, of muscle mass loss. (8) Sergeant et al (2019) found in over half of the studies included in their meta-analysis of the same year, the proportion of muscle loss was somewhere between 20% and an astounding 50% of the total weight lost! (9) A more recent study by Bikou et al. confirmed that, while extremely effective for fat loss, these meds can cause up to 40% of the weight lost being lean mass. (10)

All of these researchers concluded that, with intensive RT, not only can patients reduce the muscle loss, they can maintain muscle mass to reduce weight re-gain should they stop taking the medications.

Takahashi et al (11) demonstrated that vitamin D supplementation, and possibly vitamin B12, but not vitamins A, B6, C, and E, might correlate with with the loss of lean tissue in older adults with T2D. Thus, in addition to a vigorous RT program, getting in extra D could reduce the atrophy that accompanies weight loss.

Nunn et al., in a study of diet-induced mouse obesity, found that blocking a particular muscle cell receptor that is known to interfere with muscle growth – ActRII – while being treated with a semaglutide medication preserves muscle mass. It actually induced an almost 10% increase in lean mass!However, this is what you might call a proof of concept study and has not yet been approved for humans taking a GLP-1 drug. (12)

Some studies have found that muscle mass loss does not deteriorate as much in patients with T2D as one might expect. (6) The Japanese subjects experienced substantial health benefits over the 24 months they used a combination of liraglutide and semaglutide, affirming Klausen et al.’s (1) finding. Too, Gurjar et al. found that “drug repositioning” with liraglutide might be the answer to weight-loss-induced muscle loss, at least in mice. (13)

There is a new kid on the block in Phase 3 studies – a combination drug of Amylin + two GLP-1 drugs – semaglutide and cagrilintide – that offers comparable weight loss while helping to “preserve the reduction in energy expenditure” which could help maintain weight loss in the long run. (14)  This could be the game-changer what with all these super-duper drugs that are helping people lose weight, especially for those who are older, more likely to have blood sugar control issues such as T2D, and may already have suffered age-related sarcopenia. However, for all patients who are taking these GLP-1’s, the basic prescription still holds, whether or not it totally reverses years of sedentary living or age-related muscle loss, and that’s RT using loads greater than body weight.

Check out part 2, If You’re Using GLP-1 Meds for Weight Loss, Then You Gotta Do Weight Lifting

Originally printed on STEPS Fitness blog. Reprinted with permission.


Dr. Irv Rubenstein graduated Vanderbilt-Peabody in 1988 with a PhD in exercise science, having already co-founded STEPS Fitness, Inc. two years earlier — Tennessee’s first personal fitness training center. One of his goals was to foster the evolution of the then-fledgling field of personal training into a viable and mature profession, and has done so over the past 3 decades, teaching trainers across through country. As a writer and speaker, Dr. Irv has earned a national reputation as one who can answer the hard questions about exercise and fitness – not just the “how” but the “why”. 

References

1. Mette Kruse Klausen et al. The role of glucagon‐like peptide 1 (GLP‐1) in addictive disorders. Br J Pharmacol. 2022 Feb; 179(4): 625–641. Published online 2022 Feb 2. doi: 10.1111/bph.15677)

2. Nunn et al. Antibody blockade of activin type II receptors preserves skeletal muscle mass and   enhances fat loss during GLP-1 receptor agonism. Mol Metab. 2024 Feb:80:101880. doi: 10.1016/j.molmet.2024.101880. Epub 2024 Jan 11.

3. Cava et al. Preserving Healthy Muscle during Weight Loss. Adv Nutr. 2017 May 15;8(3):511-519. doi: 10.3945/an.116.014506. Print 2017 May.

4. Ida et al. Effects of Antidiabetic Drugs on Muscle Mass in Type 2 Diabetes Mellitus. Curr Diabetes Rev. 2021;17(3):293-303. doi: 10.2174/1573399816666200705210006.

5. Xiang et al. GLP-1RA Liraglutide and Semaglutide Improves Obesity-Induced Muscle Atrophy via SIRT1 Pathway. Diabetes Metab Syndr Obes. 2023 Aug 15:16:2433-2446. doi: 10.2147/DMSO.S425642. eCollection 2023.

6. Uchiyama et al. Oral Semaglutide Induces Loss of Body Fat Mass Without Affecting Muscle Mass in Patients With Type 2 Diabetes. J Clin Med Res. 2023 Jul;15(7):377-383. doi: 10.14740/jocmr4987. Epub 2023 Jul 31.

7. Mettler et al., Increased Protein Intake Reduces Lean Body Mass Loss during Weight Loss in Athletes. Medicine & Science in Sports & Exercise 42(2):p 326-337, February 2010. DOI: 10.1249/MSS.0b013e3181b2ef8e

8. Locatelli et al. Incretin-Based Weight Loss Pharmacotherapy: Can Resistance Exercise Optimize Changes in Body Composition? Diabetes Care. 2024 Apr 30:dci230100. doi: 10.2337/dci23-0100.

9. Sergeant et al. A Review of the Effects of Glucagon-Like Peptide-1 Receptor Agonists and Sodium-Glucose Cotransporter 2 Inhibitors on Lean Body Mass in Humans. Endocrinol Metab (Seoul). 2019 Sep;34(3): 247-262. doi: 10.3803/EnM.2019.34.3.247.

10. Bikou et al. A systematic review of the effect of semaglutide on lean mass: insights from clinical trials. Expert Opin Pharmacother. 2024 Apr;25(5):611-619. doi: 10.1080/14656566.2024.2343092. Epub 2024 Apr 18.

11. Takahashi et al. Vitamin Intake and Loss of Muscle Mass in Older People with Type 2 Diabetes: A Prospective Study of the KAMOGAWA-DM Cohort. Nutrients. 2021 Jul 8;13(7):2335. doi: 10.3390/nu13072335

12. Nunn et al. Antibody blockade of activin type II receptors preserves skeletal muscle mass and enhances fat loss during GLP-1 receptor agonism. Mol Metab. 2024 Feb:80:101880. doi: 10.1016/j.molmet.2024.101880. Epub 2024 Jan 11.

13. Gurjar et al. Long-acting GLP-1 analog liraglutide ameliorates skeletal muscle atrophy in rodents. Metabolism. 2020 Feb:103:154044. doi: 10.1016/j.metabol.2019.154044. Epub 2019 Dec 5.

14. From online lecture on Medscape: https://www.medscape.org/viewarticle/1001688_4

scale

The Habits of Successful Weight Losers

In a national television interview with Barbara Walters in 2014, Oprah Winfrey confessed that not being able to maintain her weight loss was her biggest regret. In that interview, Walters asked Winfrey to finish the sentence, “Before I leave this Earth, I will not be satisfied until I…”

“Until I make peace with the whole weight thing,” Oprah replied. Losing weight is hard; keeping it off is even harder. What is unique about those who succeed? The answer is buried deep in the archives at the Weight Control and Diabetes Research Center in Providence, Rhode Island: The National Weight Control Registry (NWCR), the largest database ever assembled on individuals successful at long-term maintenance of weight loss. Founded in 1994, the NWCR includes more than 10,000 individuals who complete annual questionnaires about their current weight, diet and exercise habits, and behavioral strategies for weight loss maintenance.

Habit #1: Live with Intention

Living with intention eliminates the random approach to weight loss maintenance in favor of the systematic and methodical one that leads to results. The NWCR has shown that, when intention is behind weight loss maintenance, 21 percent of overweight people are successful weight losers. [1]

The longer people keep their weight off, the fewer strategies they need to continue keeping weight off. [2] In other words, weight maintenance gets easier. The longer your clients persist in their intention and behave in accord with that intention, the easier it is for that behavior to “stick” and turn into a habit.

What makes one individual persist at a specific behavior while another individual doesn’t? For starters, the persistent individual has a conscientious personality. In the most recent NWCR study published in 2020, conscientiousness was compared between successful weight losers from the NWCR and non-NWCR weight regainers. [3] The successful weight losers were found to be more conscientious than the weight regainers and scored higher on measures of order, virtue, responsibility, and industriousness. The scientists suggest that being conscientious may help individuals maintain their weight loss by improving adherence to specific behaviors.

In a review of 56 studies that contained 58 health behaviors, researchers at Université Laval in Quebec, Canada and the University of Limburg in The Netherlands found that intention remained the most important predictor of health behavior, explaining 66 percent of the variance. [4] In half of the reviewed studies, perceived behavioral control (believing that you have control over your behavior) significantly added to the prediction.

Habit #2: Control Yourself

Being a successful weight loser requires a lot of self-control, delaying gratification now (e.g., dessert) for the more desirable reward later (e.g., a slimmer waistline, better health, enhanced self-esteem, and happiness).

Compared to typical unsuccessful dieters, successful weight losers are better able to resist temptation, control themselves, and push back against the environment. They restrict certain foods, [5] weigh themselves regularly, [6, 7] and use digital health technology. [8]

One of the key factors of self-control is disinhibition, which literally means not being inhibited. Some inhibition is good, because it prevents people from not giving into temptation and eating whatever and how much they want. High levels of disinhibition are bad, because it leads to risky behavior. Disinhibited eating is a failure to maintain control over eating. The opposite of disinhibited eating is dietary restraint. Several NWCR studies have found that increased disinhibition leads to regaining lost weight. [9, 10, 11, 12, 13] Other studies have found strong relationships between a lack of self-control—impulsivity—and obesity. [14, 15, 16]

Habit #3: Control Calories

Successful weight losers consume fewer daily calories than the general population. Table 1 shows the number of calories the NWCR members consume per day, from the several studies that have reported it, along with the amount of weight they lost at the time they entered the NWCR.

Table 1 – Caloric Intake of Successful Weight Losers

 Calories Per DayPounds Lost
 1,381 [17, 18]

1,297 (women)

1,725 (men)

66

63 (women)

78 (men)

 1,306 (women) [19]

1,685 (men)

63 (women)

77 (men)

 1,390 [20]69
 1,462 [21]124
 1,400 [22]62
 1,399 [23]73
Average

Women

Men

1,406

1,302

1,705

79

63

78

Successful weight losers consume a low-calorie diet of about 1,400 calories per day, with women consuming about 1,300 and men consuming about 1,700 calories per day. By comparison, the U.S. adult population consumes an average of 2,120 calories per day (women consume about 1,820 calories per day and men consume about 2,480 calories per day). [24, 25]

Successful weight losers control calories several ways, including limiting how often they eat out at restaurants, [26] rarely eating fast food, [27] and limiting how many calories they drink. [28] They are also more likely than normal-weight individuals to have plans to be extremely strict in maintaining their caloric intake, even during times of the year when it’s easy to consume calories, like during holidays. [29]

Want to learn about more of the habits of successful weight losers? Check out Dr. Karp’s book, Lose It Forever: The 6 Habits of Successful Weight Losers from the National Weight Control Registry


A competitive runner since sixth grade, Dr. Jason Karp pursues his passion every day as a run coach, exercise physiologist, bestselling author of 10 books and 400+ articles, speaker, and educator. He is the 2011 IDEA Personal Trainer of the Year and two-time recipient of the President’s Council on Sports, Fitness & Nutrition Community Leadership award. His REVO₂LUTION RUNNING™ certification has been obtained by fitness professionals and coaches in 23 countries. His new book, “Lose It Forever: The Habits of Successful Weight Losers from the National Weight Control Registry” is available on Amazon.

References

[1] Wing, R.R. and Hill, J.O. Successful weight loss maintenance. Annual Review of Nutrition, 21:323-341, 2001.

[2] Klem, M.L., Wing, R.R., Lang, W., McGuire, M.T., and Hill, J.O. Does weight loss maintenance become easier over time? Obesity Research, 8:438-444, 2000.

[3] Gold, J.M., Carr, L.J., Thomas, J.G., Burrus, J., O’Leary, K.C., Wing, R., and Bond, D.S. Conscientiousness in weight loss maintainers and regainers. Health Psychology, 2020.

[4] Godin, G. and Kok, G. The theory of planned behavior: a review of its applications to health-related behaviors. American Journal of Health Promotion, 11(2):87-98, 1996.

[5] Wing, R.R. and Phelan, S. Long-term weight loss maintenance. American Journal of Clinical Nutrition, 82:222S-225S, 2005.

[6] Wing, R.R. and Hill, J.O. Successful weight loss maintenance. Annual Review of Nutrition, 21: 323-341, 2001.

[7] Butryn, M.L., Phelan, S., Hill, J.O., and Wing, R.R. Consistent self-monitoring of weight: A key component of successful weight loss maintenance. Obesity, 15:3091-3096, 2007.

[8] Goldstein, C.M., Thomas, J.G., Wing, R.R., and Bond, D.S. Successful weight loss maintainers use health-tracking smartphone applications more than a nationally representative sample: comparison of the National Weight Control Registry to Pew Tracking for Health. Obesity Science and Practice, 3(2):117-126, 2017.

[9] McGuire, M.T., Wing, R.R., Klem, M.L., Lang, W. and Hill, J.O. What predicts weight regain among a group of successful weight losers? Journal of Consulting and Clinical Psychology, 67:177-185, 1999.

[10] Niemeier, H.M., Phelan, S., Fava, J.L., and Wing, R.R. Internal disinhibition predicts weight regain following weight loss and weight loss maintenance. Obesity, 15:2485-2494, 2007.

[11] Butryn, M.L., Phelan, S., Hill, J.O., and Wing, R.R. Consistent self-monitoring of weight: A key component of successful weight loss maintenance. Obesity, 15:3091-3096, 2007.

[12] Thomas, J.G., Bond, D.S., Phelan, S., Hill, J.O., and Wing, R.R. Weight-loss maintenance for 10 years in the National Weight Control Registry. American Journal of Preventive Medicine, 46(1):17-23, 2014.

[13] Lillis, J., Thomas, J.G., Niemeier, H., and Wing, R.R. Internal disinhibition predicts 5-year weight regain in the National Weight Control Registry (NWCR). Obesity Science and Practice, 2(1):83-87, 2016.

[14] Chamberlain, S.R., Derbyshire, K.L., Leppink, E., and Grant, J.E. Obesity and dissociable forms of impulsivity in young adults. CNS Spectrums, 20(5):500-507, 2015.

[15] Fields, S.A., Sabet, M., and Reynolds, B. Dimensions of impulsive behavior in obese, overweight, and healthy-weight adolescents. Appetite, 70:60-66, 2013.

[16] Amlung, M., Petker, T., Jackson, J., Balodis, I., MacKillop, J. Steep discounting of delayed monetary and food rewards in obesity: a meta-analysis. Psychological Medicine, 46(11):2423-2434, 2016.

[17] Klem, M.L., Wing, R.R., McGuire, M.T., Seagle, H.M., and Hill, J.O.  A descriptive study of individuals successful at long-term maintenance of substantial weight loss. American Journal of Clinical Nutrition, 66:239-246, 1997.

[18] Wing, R.R. and Hill, J.O. Successful weight loss maintenance. Annual Review of Nutrition, 21:323-341, 2001.

[19] Shick, S.M., Wing, R.R., Klem, M.L., McGuire, M.T., Hill, J.O., and Seagle, H.M. Persons successful at long-term weight loss and maintenance continue to consume a low calorie, low fat diet. Journal of the American Dietetic Association, 98:408-413, 1998.

[20] McGuire, M.T., Wing, R.R., Klem, M.L., Seagle, H.M., and Hill, J.O. Long-term maintenance of weight loss: Do people who lose weight through various weight loss methods use different behaviors to maintain their weight? International Journal of Obesity, 22:572-577, 1998.

[21] Klem, M.L., Wing, R.R., Chang, C.H., Lang, W., McGuire, M.T., Sugerman, H.J., Hutchison, S.L., Makovich, A.L., and Hill, J.O. A case-control study of successful maintenance of a substantial weight loss: Individuals who lost weight through surgery versus those who lost weight through non-surgical means. International Journal of Obesity, 24:573-579, 2000.

[22] Klem, M.L., Wing, R.R., Lang, W., McGuire, M.T., and Hill, J.O. Does weight loss maintenance become easier over time? Obesity Research, 8:438-444, 2000.

[23] Ogden, L.G., Stroebele, N., Wyatt, H.R., Catenacci, V.A., Peters, J.C., Stuht, J., Wing, R.R., and Hill, J.O. Cluster analysis of the National Weight Control Registry to identify distinct subgroups maintaining successful weight loss. Obesity, 20(10):2039-2047, 2012.

[24] Wright J.D., Wang, C.Y., Kennedy-Stephenson, J., Ervin, R.B. Dietary intake of ten key nutrients for public health, United States: 1999-2000. Advance Data From Vital and Health Statistics, 334:1-4, 2003.

[25] U.S. Department of Agriculture, Agricultural Research Service. Energy intakes: percentages of energy from protein, carbohydrate, fat, and alcohol, by gender and age. What We Eat in America, NHANES 2015-2016, 2018.

[26] Wing, R.R. and Hill, J.O. Successful weight loss maintenance. Annual Review of Nutrition, 21:323-341, 2001.

[27] Thomas, J.G. and Wing, R.R. Maintenance of long-term weight loss. Medicine & Health Rhode Island, 92(2):56-57, 2009.

[28] Catenacci, V.A., Pan, Z., Thomas, J.G., Ogden, L.G., Roberts, S.A., Wyatt, H.R., Wing, R.R., and Hill, J.O. Low/no calorie sweetened beverage consumption in the National Weight Control Registry. Obesity, 22(10):2244-2251, 2014.

[29] Phelan, S., Wing, R.R., Raynor, H.A., Dibello, J., Nedeau, K., and Peng, W. Holiday weight management by successful weight losers and normal weight individuals. Journal of Consulting and Clinical Psychology, 76(3):442-448, 2008.

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Genetics & Weight Problems: The Role of Genetics for that Number on the Scale

There are a number of factors that influence obesity. These include behavioral choices, environmental circumstances, and genetics. Genes don’t always predict someone’s weight future, but science has shown that genetics play a role in obesity. Genes increase a person’s susceptibility to become overweight, but this is not an isolated causality due to behavior and environment. 

Take for instance the number of people living in a certain environment with all the same living conditions. How is it so that in an environment that promotes inactivity and high calorie foods that not all of these people become obese? Not all these people will have the same resulting health problems or body fat distribution. Even people in the same family, of the same race, and of the same ethnicity, will not all become obese given this environment. The diversity in body types leads one to believe that genetics do play a role in weight. 

Genes are what instruct the body. They map out how the body will respond to a given environment. Genes dictate behaviors including a person’s choice to be sedentary, to overeat, and their metabolic functions. Genes tell the body how to store fat and how to use food for fuel as energy. Both hunger and food intake are associated with genes. For example, take two siblings or twins raised in very similar environments — they still may not have the same body weight distribution. 

For now, science does not have genetic testing which would determine one’s weight future. There is no science that shows a personal diet plan or exercise regimen will result in exact body types. Bardet-Biedl syndrome (BBS) and Prader-Willi syndrome are the only two directly related obesity causing genetic factors. BBS is associated with increased body fat in the abdominal area, poor functioning kidneys, eyes, and genitalia, as well as intellectual impairment. Prader-Willi syndrome is associated with a constant desire to eat. This causes dangerous weight gain, stunted growth, and poor health. Research is still being performed on genetic response to weight gain. Knowing one’s family history won’t change the path to obesity, but lifestyle behavior and environment can be adjusted as a proactive and preventable method. For example, children of obese parents are more likely to become obese themselves due to their lifestyle and environment. Marketing has also become a strong influence for eating patterns. 

The finger can’t be pointed at genetics alone for weight problems. However, we do know that even under exact circumstances, two bodies can react entirely different. The research is not entirely there YET, but hopefully in the near future we can have helpful answers to help fight the obesity epidemic. 


Megan Johnson McCullough, owner of Every BODY’s Fit in Oceanside CA, is a NASM Master Trainer, AFAA group exercise instructor, and specializes in Fitness Nutrition, Weight Management, Senior Fitness, Corrective Exercise, and Drug and Alcohol Recovery. She’s also a Wellness Coach, holds an M.A. Physical Education & Health, and is a current doctoral candidate in Health and Human Performance. She is a professional natural bodybuilder, fitness model, and published author.

 

References

  • https://www.cdc.gov/healthyweight/calories/other_factors.html 
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2636925/ 
  • https://www.ncbi.nlm.nih.gov/pubmed/12127777
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Creating Welcoming, Inclusive Health & Fitness Environments for People with Obesity

Each year for the past several decades, the health & fitness industry has served approximately 20% of the population, primarily helping the fit get fitter. Eighty percent of the population joined a health & fitness center but did not stay, or never joined because they decided it was not the right fit for them. A movement is gaining momentum to change that, and to make the health & fitness industry more inclusive and welcoming of people of all different ages, shapes, sizes and abilities. 

Worldwide, rates of obesity have tripled in the past 45 years. More than 42% of Americans have obesity, with the prevalence in the United States rising over 12% in the last 18 years. This presents an untapped opportunity for fitness professionals with specialized knowledge and expertise in working with clients with obesity. 

Dr. Rachele Pojednic and I have developed a MedFit Classroom Specialist Course. Presented in 10 modules and requiring 10 hours to complete, the Obesity Fitness Specialist course defines obesity and weight bias and identifies the biological, developmental, environmental and lifestyle factors that contribute to obesity. It explores solutions to obesity using the Socioecological model and empowers fitness professionals to be a part of individual-level, as well as institutional- and community-level, solutions. 

Learners will be able to position themselves as obesity fitness specialists separate and distinct from weight management and weight loss specialists. They will be able to create safe and effective programming for clients with obesity and inclusive environments that can lead to sustained client behavior change and health outcomes. The course culminates in a 10-step roadmap with one end goal—obesity fitness specialists who can help their clients reduce their risk of obesity-related risk factors and associated disease, discover the joy of movement, and reap the many health benefits of physical activity. 

People with obesity who find health & fitness environments where they feel welcome and included are likely to stay. Fitness specialists who are able to lead with empathy and build trust are likely to make their clients feel understood and heard. Obesity Fitness Specialists have an important role to play in helping their clients with obesity achieve their health & fitness goals.


Dr. Amy Bantham, DrPH, MS, MPP, is the CEO/Founder of Move to Live More, a research and consulting firm addressing physical inactivity, chronic disease and social determinants of health through cross-sector collaboration and innovation. A certified health and wellness coach, personal trainer, and group exercise instructor, Amy holds a Doctor of Public Health from the Harvard School of Public Health. She can be reached at movetolivemore.com or @MovetoLiveMore

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Youth Obesity: An ounce of prevention is worth a pound of cure

“An ounce of prevention is worth a pound of cure.”

This sentiment from Benjamin Franklin is as true today as ever.  Especially when it comes to fitness and health.  The past 50 years has seen a nearly triple increase in obesity rates for adults and youths.  According to the website USAFACTS.ORG. this costs the American people $147 Billion annually.  They also state that “roughly have of all medical cost associated with obesity are financed by Medicaid and Medicare”.  

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Still Joking About Obesity, Even Now?

No, I’m not on a rant. But I sure could be. What’s funny about a chronic disease that impairs health and renders people more sensitive to deadly co-morbid factors associated with COVID-19? Nothing. Nothing is funny at all.

I write about obesity a great deal, have been caring for those with emotional and behavioral components related to the disease, speaking and teaching about it since the early 1970s, and won’t stop. When it comes to promoting health…

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Your Weight and the Pandemic

During a recent interview on a talk radio show, a caller told me she had gained seven pounds since living in lockdown; her friends also had gained weight, she said. A few days later, a colleague who has been conducting what she calls “telephone clinics” with her obese patients wrote: “All were telling me how lockdown is causing further weight gain and how they feel unable to do anything about it.” She continued: “I think that the lockdown affects disproportionately people who were already struggling with obesity and unhealthy eating habits.”

As most of you know, it is not just select “obese patients” who are struggling with overeating and ensuing weight gain. This is because overweight and obese people are not a small subset of the population. Rather, almost 70% of Americans are overweight or obese; indeed, by 2030 the percentage is expected to be closer to 100%. This means that the lockdown may be speeding up our obesity stats, but it is not the cause of our overweight pandemic: The fat-track train left the station decades ago.

The Obesity Link to Covid-19

Today, with the threat of coronavirus infection, there is yet another reason to be concerned about being overweight: As Americans reel from the shocking and devastating health, mental, emotional, economic, and social impact the coronavirus pandemic has wrought, the virus continues to disproportionately harm those who are already struggling with obesity and other diet-related conditions — from heart disease and diabetes to high blood pressure and a weakened immune system. This is an alarming situation given that (1) almost 45% of adults in the United States are obese — we rank #1 in obesity among international OECD (Organisation for Economic Co-operation and Development) nations, (2) and one in two Americans — over 133 million people — suffer from chronic health conditions, many of which are linked to poor food choices.

In my opinion, the coronavirus pandemic is a wake-up call; a stunning event that is sounding the alarm we need to take action NOW to remedy the struggle that millions of overweight and obese people live with day-to-day. Clearly, we are being alerted to change — really, really change — what we eat and how we eat. Each day and every day. Starting now. For the rest of our lives. My vision is that we accomplish this by halting and turning around the obesity pandemic without dieting; rather, by losing weight and keeping it off with what I call a dietary lifestyle, meaning, a way of eating that leads naturally to weight loss, health, and healing…for life.

The Whole Person Integrative Eating (WPIE) Weight Loss Rx

What if…

…it were possible to overcome overeating and to lose weight and keep it off without traditional dieting? (Note: Almost 50% of Americans are “on a diet” at any one time; and typical dieters will try between 55-130 diets in their lifetime!)

…you could nourish yourself physically each time you eat? But also emotionally, spiritually, and socially?

…your relationship to food, eating, and weight was based on a way of eating that leads to a pleasurable relationship to food and eating—with weight loss as a natural “side effect?”

What I am describing is the Whole Person Integrative Eating (WPIE)® dietary lifestyle, an evidence-based, scientifically sound model and program that treats the root causes of overeating, overweight, and obesity. It is also a way of eating that may prepare your immune system to fight viruses, bacteria, and other pathogens.1-3 And the WPIE dietary lifestyle can also help you prevent and reverse a plethora of other diet-related chronic conditions.

After 25 years of research by behavioral scientist Larry Scherwitz, PhD (transparent disclosure: Larry’s my

husband) and me, the well-documented message in Whole Person Integrative Eating is that it is possible to overcome overeating, overweight, and obesity by replacing the newly identified, new-normal overeating styles Larry and I have discovered with their antidotes: the ancient/new, science-backed elements of our Whole Person Integrative Eating® model and program.4-6 FYI…WPIE is a “whole person” program that address both what you eat (your food choices) and how you eat (your eating behaviors); and in turn, how your food choices and eating behaviors nourish you physically, but also emotionally, spiritually, and socially. As a first step, this article offers the WPIE what-to-eat guidelines for weight loss.

What-to-Eat Rx: Fresh, Whole, Inverse

What Larry and I, and hundreds, perhaps thousands of other researchers have discovered, is that there’s a simple way to eat that provides the antidote to the Fast Foodism overeating style our WPIE research identified that leads to overeating and obesity. It is a time- and science-tested what-to-eat guideline that has nourished humankind for millennia—and it is how people who are naturally thin and healthier eat today: Eat fresh, whole food in its natural state as often as possible.Please keep in mind the phrase “as often as possible.” This means making fresh, whole foods your most-of-the-time way of eating; it is not a rigid, regimented way of eating you start, then stop.

To get you, and your waistline and immune system, started on the road to health and healing, here are the three words that describe the WPIE what-to-eat guidelines that lower odds of illness: Fresh. Whole. Inverse.7 This is what I mean.

Fresh. Whole. The optimal way to eat for weight loss, health, and healing is to consume mostly unrefined, unprocessed, real food that has all its constituents (such as the fiber and germ in grains) intact. This means choosing lots of fresh fruits, vegetables, whole grains, legumes (beans and peas), and nuts and seeds, with lesser—or no—amounts of free-range, grass-fed, and/or wild dairy, poultry, meat, and fish that is free of antibiotics, hormones, pesticides, herbicides, GMOs, and additives and chemicals (you often can’t pronounce).

Inverse eating. Along with “fresh” and “whole,” the third WPIE “ingredient” for optimal eating is to eat inversely. What do I mean by “inverse eating?” Whether you’re looking at the traditional diets of Mediterranean, Asian, South American, African, Indian, or Native American cultures, they all have one way of eating in common: meals are mostly plant-based foods (fruits, veggies, grains, beans and peas, and nuts and seeds), with lesser amounts of animal-based foods (dairy, fish, poultry, and meat). In other words, the diets of most cultures worldwide are—and have been for thousands of years—mostly plant-based foods as the centerpiece of the meal, and animal-based foods as a condiment or side dish.

Clearly, this is the inverse of the almost 40 percent—approximately 84.8 million Americans—who eat fast food every day and the 91 percent—at least 290 million Americans—who completely miss the mark of meeting the U.S. dietary guidelines of a half to two cups of vegetables per day. Same with fruit: only 12 percent of Americans consume one-and-a-half to two servings per day. In other words, most Americans eat the standard American diet (SAD) of mostly processed animal-based foods with few, or no plant-based foods.

With SAD as a starting point, I use the term inverse eating to describe the antithesis, or inverse, of the standard American diet: the opposite way of eating that evolved naturally over thousands of years and includes mostly fresh, whole, plant-based foods supplemented with small, occasional servings of fresh, whole, chemical-free animal-based foods.

The WPIE Dietary Lifestyle: If Not Now, When?

I know. Change isn’t easy. Especially when it comes to food and eating. I understand; truly. Since the social-isolation policy that has gone into effect for most of us, I’ve talked with people who are turning to high-carb, high-sugar, high-fat “comfort foods” to cope. And they are gaining weight. And weakening their immune system. And making themselves vulnerable to a plethora of diet-related conditions.

The antidote? Commit to, and adopt a dietary lifestyle that empowers you to eat to prevent, even reverse, a multitude of food-related ailments and increase odds of boosting immunity, which in turn may decrease your risk of becoming ill from the coronavirus. And it lowers odds of being overweight and obese. Or developing diabetes. And heart disease. And some cancers. And depression and anxiety. And other mind-body, diet-related chronic conditions.

In other words, we know that the WPIE fresh, wholeinverse way of eating ups the odds of helping you lose weight and keep it off, lessens the risk of Covid-19 symptoms, and can prevent and reverse food-related chronic conditions; that the Whole Person Integrative Eating® dietary lifestyle holds the key to transforming your relationship with food and eating so you can reclaim your health…for life. If not now, when?

 

Article originally printed on integrativeeating.com. Reprinted with permission from Deborah Kesten. 


Deborah Kesten, M.P.H., is an award-winning author, specializing in preventing and reversing obesity and heart disease. Her expertise includes the influence of epigenetics and diet on health, Lifestyle Medicine, and research on the Whole Person Integrative Eating dietary lifestyle to treat overeating, overweight, and obesity. She and her husband, behavioral scientist Larry Scherwitz, Ph.D., collaborate on research and writing projects. Her latest book, “Whole Person Integrative Eating” was named the “Winner” in the Health category by the 2020 Book Excellence Awards.

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Whole Person Integrative Eating: A Dietary Lifestyle for Attaining and Maintaining Weight Loss

At the beginning of our Whole Person Integrative Eating (WPIE) coaching sessions, Alison was a 64-year-old woman who weighed 235 pounds and wore a size 3x. A former businesswoman turned professional meditation practitioner, Alison’s obesity began as a teenager. She had tried many “diets-du-jour” over the decades. Each time she would lose some weight—sometimes a lot; then she would return to her preferred “go-to” foods and gain back the weight…