Weight loss, fat loss, and muscle loss. I get many wide-ranging questions on these topics every day. Hence in this post, I will share my thoughts on how to achieve sustainable weight loss, and this will address many questions that people have on highly popular diets like the Ketogenic diet and intermittent fasting.
But what is the point of losing weight when you don’t look healthy? Having enough muscle makes us look healthy. That is why I feel it is important to address one of the trickiest problems to weight loss, which is how do we lose fat without losing muscle.
Before we dive into these issues, let us first look at why weight loss is so challenging for everyone. Medical science has an explanation for us.
Weight loss: Am I unmotivated and lazy, or are my genes to blame?
Weight loss is a very difficult thing to do. Many may dismiss it as people not being motivated or just being lazy, but this cannot be further from the truth. A lot of us have very real problems when it comes to losing weight. While it may often be due to certain factors such as lifestyle, there is also a genetic basis behind an inability to lose weight.
Thanks to certain studies and medical advancements, we have found that the most important part of appetite regulation is our hypothalamus, and this is where genetics are involved. The hypothalamus is a small part of our brain where our appetite centre is. Certain people have an abnormally ferocious appetite, and they do not feel full regardless of how much they eat. For example, people with a defect in their melanocortin 4 receptor gene (MC4R) within the hypothalamus have problems with satiety. That means they do not feel full even though they are full.
We also know that certain gut hormones, such as the GLP-1, which are released when we eat, affect our satiety centres within our brain, especially the hypothalamus, making us feel full.
This implies that being over-weight has nothing to do with weakness in character, being lazy, or not having motivation as our weight is mainly determined by our genes. This is a significant problem as we cannot change our genes, at least not for now. Therefore, when we cannot lose weight despite trying our best to diet and exercise, medical help may be necessary.
How do I lose 5%, 10%, or even 25% of my body weight?
For most of us, losing about 5% of the body weight is not too difficult through lifestyle changes. By just exercising more, being more conscious of what we eat, and the number of meals we have, 5% weight loss is relatively achievable. If 5% weight loss sounds insignificant to you, let me assure you that is not the case at all!
Studies have shown that 5% weight loss can result in improvements to our health, such as lower blood pressure and lower cholesterol levels. Besides, you do not need to lose 100% of the excess weight to look 100% better! With a 5% loss of body weight, people will start to notice that you look better, and you will also find that you are physically fitter. Most important of all, you will also be healthier.
Some of us may have genetic problems or other issues that make it hard for us to lose weight, or our attempt at weight loss plateaus at a certain weight even though we need to lose more. Or perhaps some of us have a BMI that is a little high. Studies have shown that most people, but not all people, who need to lose more than 10% of their body weight are generally not successful. In these cases, medications, such as Saxenda which mimics GLP-1, may work.
Of course, those of us who are severely overweight such that even medications are not enough should consider bariatric surgery. Bariatric surgery reduces the capacity of stomach or slows down the passage of food into the stomach or intestines. The different types of bariatric surgery include gastrectomy which reduces the size of the stomach and Gastric Laparoscopic Banding which reduces the size of the inlet into the stomach. In the right people, these operations are very effective and can help achieve about 25% weight loss.
Understanding energy balance is important for weight loss
Imagine a perfectly balanced “seesaw”. That represents our energy balance, which is typically pretty stable. Unless there is a dramatic change in our lifestyle, the amount of energy we take in and put out—how much we eat, and how much we use for our daily activities and exercise—balances out. When this happens, our weight neither increases nor decreases.
When we eat more, such as during festive periods, or maybe due to stress, our energy intake increases, tipping the “seesaw” or energy balance. Excess energy is stored as fat and our weight increases. As we gain weight, our energy requirement would also increase as a heavier person uses more energy. So, at a heavier weight, our “seesaw” balances again, this time at a higher weight.
When we exercise more or if we eat less, the opposite happens. The energy balance is tipped the other way. The body breaks down fat to make up for the energy deficit resulting in weight loss. We lose weight gradually till a new balance point is achieved at a lower weight. When this happens, we stay at our new weight till changes in our lifestyle changes the energy balance again.
Fat loss vs muscle loss: How do we know which one we are really losing?
Fat is the predominant energy store and is also the go-to energy source to power the body. Although some carbohydrate is stored in our muscle and liver, it is not significant and excess carbohydrate is mainly converted to fat for storage.
Fat is, of course, stored in fat cells! Fat cells function like a warehouse for our body to store energy.
Protein on the other hand is converted to muscle. Generally, our energy is stored in our muscle as protein, or in our body as fat. Muscle is important for bodily functions, which is why the body prefers to use fat for energy.
Losing weight results in a negative energy balance. When we lose weight slowly, such as through the gradual reduction in calorie intake, our body is able to cope and hence uses fat as an energy source. However, when we lose weight too quickly and fat cannot be converted to energy fast enough, muscle will be broken down for energy to keep our essential functions within our brain and heart going.
Wait a minute! Why is preserving muscle so important when losing weight?
Maintaining our muscle mass is important when we lose weight because muscle burns more calories than fat. So, weight for weight, we burn more calories at rest if we have more muscle, making weight loss easier! Besides, having enough muscle makes us look healthy rather than just slim. It is possible to look slim yet look unhealthy.
Building muscle: What is nitrogen balance? How does it help preserve muscle during weight loss?
When losing weight, besides gradually reducing calorie consumption, we should also ensure that we have a positive nitrogen balance. You’re probably wondering, what exactly is nitrogen balance? Protein is essentially a molecule which contains nitrogen and protein is stored in our body as muscle. Hence, when we have a high intake of protein, we have a positive nitrogen balance.
When we’re aiming for negative energy balance to achieve weight loss, a high protein intake maintains a positive nitrogen balance. This encourages the body to build muscle and utilise fat instead of muscle as a source of energy.
Approximately 30% of our body is muscle, and besides our muscle which helps us move, our heart is also mainly muscle. Therefore, muscle is important to lift weights and for endurance during cardio exercise.
You can look at protein as a building block for muscle. Many people feel that exercise alone is enough to build muscle, but without a positive nitrogen balance, there is insufficient protein to build muscle and the effort put into exercise will not produce the desired results.
This may sound complicated, but simply put: All you have to do is to eat a little less and make sure that you have a balanced diet that is moderately high in protein with plenty of exercise.
Why do I still need to exercise if I can achieve positive nitrogen balance?
Muscle is notoriously difficult to build, just ask any bodybuilder. They spend vast amounts of time training and eating well to achieve a muscular body. As such, having a positive nitrogen balance is not sufficient for us to build muscle.
We build muscle by exercising. For those of us who are unable to spare much time for exercise, doing some form of exercise such as cardio or weight training at least once or twice a week is better than not doing any exercise at all. So please exercise!
High-protein diets: Do diets like the “keto” diet work?
The South Beach Diet and Atkins Diet used to be very popular, and many patients had asked about them. They were fairly good diets because they are low in carbohydrates and high in proteins, which is exactly what we’re trying to achieve!
Another high-protein diet that has been all the rage over the past few years is the Ketogenic (Keto) diet. However, the problem with the South Beach Diet, Atkins Diet, Keto Diet, or any diet that is high in protein, is that protein usually comes with fat.
These diets have a very high content of fat and very low content of carbohydrates, with not much mention of protein. When you have a high intake of fat, the body goes into this state of ketosis whereby it uses ketones, which is the breakdown product of fat, for energy. According to research, people tend to have quite a bit of weight loss when they are on a Keto diet. As good as this sounds, certain aspects of these diets are worrying for doctors.
In that case, are high-protein diets a good idea?
Some diets can help people achieve a decent amount of weight loss, but should we be trying them out? Why are doctors not exactly supportive of such diets?
Firstly, weight loss diets should be sustainable. That means they should last longer than just a month or two. Many of us lose weight just to gain it right back again. This is why a diet has to be sustained for a long period of time.
However, if we maintain a high fat diet for a long period of time, and typically this fat comes from animal origin, that will mean we are getting a high intake of cholesterol. This may affect us negatively in 10, 20 years when we may have a higher chance of heart attack or stroke. The truth is, we do not know exactly how we will be affected in the long term. In the short term, however, there is evidence that these high fat diets work.
The question is, do we really want to have a high fat diet for the next five, 10, 15 years, or even for the rest of our lives?
Are other types of diets, such as intermittent fasting, better than high-protein diets?
Another diet that is rather popular right now is the intermittent fasting diet. While it does work, it is not a good choice for muscle preservation. When we’re on the intermittent fasting diet, we fast from a certain time to a certain time. For most of us, it is typically from the time we wake up until dinner time. While this may be good for weight loss initially, when motivation goes down with time, people frequently take in more calories at night than they would previously, limiting the benefit of the intermittent fasting diet.
Another problem occurs when it comes to maintaining muscle. During the time we are awake until dinner time, our body will think we are in starvation mode. When this happens, our body will tend to use any type of energy it can get to preserve vital functions, which means on top of fat, it will also use muscle. Therefore, you will lose fat and muscle, which is not exactly what we want.
Conclusion about diets: Yes, based on studies, high-protein diets such as the South Beach Diet, Atkins Diet, and Keto diet, and the intermittent fasting diet do work. However, when it comes to health, muscle preservation, and sustainability, it is not so easy.
Sustainable diets: How can we ensure our diets are sustainable?
In my view, when it comes to sustainability, a balanced diet is still the best. It can be something that you and your body can accept. Be mindful of what you eat every time you eat, and think about these questions: Are you hungry? Are you eating because you are hungry? Are you eating because your friends are eating? Are you eating because it’s time to eat? Are you eating because everyone else is eating? When we think about these, then maybe we can reduce our calorie intake whenever we can.
Of course, we cannot forget exercise. Many of us may feel that we do not have time, but everything is relative. For example, if you never did any exercise, then you can start doing some exercise. If you are already doing some exercise, do a little more. However, if you are already exercising as much as you can, try some small changes in your diet for that extra step to lose weight and maintain the weight loss. Studies have shown that regular exercise is the most important factor in maintaining weight loss.
So remember, diet to lose weight, exercise to keep the weight off!