In part 1 of “12 reasons why older adults need to do resistance training exercise” I outlined some of the benefits to health that have been shown to occur as a result of partaking in regular resistance training exercise. The scientific evidence supporting the inclusion of resistance training as part of a healthy lifestyle is now indisputable. Whilst improvement of health is an obvious goal of many older athletes, it is the enhancement of sports performance that drives many in a quest to remain competitive, both against fellow competitors, but also – somewhat egocentrically – against their younger self. Even if you aren’t an elite masters athlete these benefits as outlined below can be truly life-changing.
Resistance training exercise remains an integral component of programs of most elite sportspeople. Increased maximal strength and power developed through the application of progressive resistance training has been shown to improve performance above and beyond that achieved by limiting training to sports specific training. This is now recognised by sports scientists, exercise physiologists, strength & conditioning experts and coaches.
Resistance Training Improves Older Athletes Performance (Picture: Pixabay)
Of particular note for older athletes is that the performance benefits may be even greater than that of younger elite athletes. One of the hallmark changes to occur with age is the progressive loss of strength with significant atrophy or loss of skeletal muscle playing a significant role. This fundamental biological change that occurs with ageing manifests in a gradual deterioration of physical function and performance.
However, there is compelling evidence that the trajectory of this decline is modifiable and can be attenuated by lifestyle factors. The data to support regular exercise as a key factor in preserving skeletal muscle and physical function is overwhelming. Resistance training is one of the very best methods currently available for older adults and masters athletes to stimulate the physiological processes required to increase myofibrillar protein synthesis rates, skeletal muscle hypertrophy and muscular strength. These skeletal muscle adaptations lie at the core of why this type of exercise improves the functional performance of older adults and athletic performance of masters athletes.
The following 6 compelling reasons explain why resistance exercise should be included in all training programs of older adults where enhanced performance – for activities of daily living or sporting – are desired.
Resistance training and bone strength (Picture: Pixabay)
Enhance skeletal health. Stronger bones can handle greater training loads and transfer muscular forces more effectively and efficiently. Bone mineral density (BMD) decreases as we age however this can be slowed by regular physical activity and appropriate nutrition. Risk of musculoskeletal injury is increased when bone strength is decreased with age, especially during falls that can cause catastrophic consequences for some.
Resistance training has been shown to be quite a potent stimulus for improving bone mineral density. Some evidence suggests that plyometric-type or jumping activities also provide an excellent training method to stimulate significant and positive bone adaptation which yields increased BMD and therefore stronger bones.
Masters cyclists as a group are unfortunately at an elevated risk of reduced BMD (weaker bones) due to the non-weight bearing nature of cycling. It is strongly recommended that all masters cyclists – in fact, all cyclists – should perform adjunctive resistance exercise in their training program (see links 1, 2, 3, 4 & 5).
Resistance Training And Skeletal Muscle (Picture: Google Images)
Maintain or increase lean body mass (skeletal muscle). Remember muscle is critical to both speed and endurance performance. From age 50 onwards muscle loss accelerates but there is a substantial amount of evidence that this is exacerbated by increased sedentarism (inactivity). Resistance training attenuates muscle mass loss.
Ageing is accompanied by reduced muscle mass and this has been mainly attributed to type II muscle fibre atrophy or reduction in size. It is unlikely that there is substantial muscle fibre loss however this remains to be elucidated. In older adults that have demonstrated substantial lean body mass loss and type II muscle fibre atrophy, prolonged resistance training has demonstrated significant increased muscle mass and this was shown to occur exclusively in type II muscle fibres. Nonetheless, some research has shown both type I and type II muscle fibre hypertrophy so more data is required to ascertain whether such things as age, gender, training status and training program parameters, affect muscle fibre changes and responsiveness to resistance training exercise (see links 1, 2, 3, 4, 5, 6).
Increased muscular strength, power and speed. Research investigating the effects of progressive resistance training programs demonstrate that muscle strength, power and speed improve, and in many case, quite impressively. In fact, even in nonagenarians, skeletal muscle strength and functional mobility assessed by a gait velocity test improved dramatically (>170% and 48% increase, respectively) after only 8 weeks of resistance training.
As mentioned above, the significant atrophy that occurs with age in fast-twitch type II muscle fibres, directly impacts performance of activities that require speed. Resistance training can reverse some of this decline, restore some of the lost contractile protein of these critical muscle fibres, increase maximum skeletal muscle strength and therefore elicit substantial improvements in movement speed of various specific sporting skills.
Older athletes that are avoiding or not adjusting their program to allow a little time to perform some resistance training exercise are missing out on some incredible benefits (see links 1, 2, 3, 4, 5).
Resistance Training And Body Fat
Lose body fat and get leaner. As outlined above, skeletal muscle mass decreases significantly from age 50 with concomitant decreases in resting metabolic rate (RMR). RMR is the largest component of total daily energy expenditure (TDEE) accounting for 60-80%. Whilst reductions in muscle mass account for a significant proportion of the accommodating changes in RMR, decreasing organ mass and decreases to specific metabolic rates of individual tissues also contribute to the decrease in RMR.
These age-related changes in RMR reduce TDEE. This may contribute to increased adiposity as we grow older given that energy intake to maintain body mass decreases proportionally to the degree of reduction in RMR and TDEE. In other words, if dietary habits and energy intake remains constant over time but RMR and TDEE decrease subsequent to the loss of skeletal muscle, positive energy balance may ensue and fat mass may therefore naturally increase.
Resistance training is well known for stimulating muscle hypertrophy or increasing skeletal muscle mass and has been shown to elicit reductions in fat mass in obesity during ad libitum diets. In contrast, aerobic exercise-induced weight loss consistently leads to reductions in lean body mass and RMR which may make the propensity of rebound fat gain more likely.
Inclusion of resistance training exercise in programs of older athletes or non-athletes doesn’t guarantee that there will be body fat loss (nutrition and diet obviously play a key role) but it certainly makes weight management easier and supports weight loss efforts if modifying the diet in an attempt to get leaner. Much of the research that has investigated the utility of resistance training in older adults demonstrates that it is a very effective fat loss strategy when performed with other lifestyle-based interventions aimed at improving physical function and body composition (see links 1, 2, 3, 4, 5).
Resistance Training And Endurance Performance (Picture: Google Images)
Improves endurance. Resistance training that is designed to increase muscle strength and power has been shown to improve endurance performance. More evidence exists to support such exercise in younger adult athletes as there has been limited research exclusively focused on older athletes.
Nonetheless, the research completed to date is strongly suggestive that resistance training enhances endurance in older athletes and non-athletes. A study conducted in 2010 demonstrated that strength training consisting of 10 sets of 10 repetitions of 1RM load, 3 minutes rest between each set, 3 times/week, increased both knee extensor maximal voluntary contraction torque and cycling efficiency. It is reasonable to postulate that had they utilised a program that incorporated more compound, complex, multi-jointed exercises such as squats and deadlifts – such that all major lower body muscle groups were strengthened – significantly greater cycling economical benefit would have been elicited.
When masters endurance runners were studied after following a resistance training program designed to increase maximal strength (4 sets of 3-4 repetitions at 85-90% of 1RM, two times per week), a significant improvement in running economy at marathon pace (6.1%) and dynamic leg strength (16.3%) was achieved.
It is proposed that the following training adaptations may facilitate endurance performance improvement:
the delayed use of the fast-twitch type II muscle fibers;
enhanced neuromuscular efficiency;
increased proportion of more fatigue-resistant fast-twitch type IIa fibres;
improved musculo-tendinous stiffness (see links 1, 2, 3).
Resistance Training and Injury Prevention (Picture: Google Images)
Reduce injury risk. Regularly performed resistance exercise can minimize the musculoskeletal alterations that occur during ageing. It may also contribute to the health and well-being of the older population.
There is strong evidence that suggests such exercise can prevent and control the development of several chronic musculoskeletal diseases. Improvement of physical fitness, function, and independence in older people, plus successful management of musculoskeletal disorders, results in dramatic improvements in quality of life.
Stronger muscles, bones, connective tissue, ligaments and tendons mean our limbs and joints are more able to handle the rigours of training, competing and activities of daily living (see links 1, 2, 3, 4, 5).
In conclusion, based on the 12 reasons that I have explored which demonstrate profound benefits to both the health, functional and sporting performance of older athletes and non-athletes, resistance training is a must-do and should be a pivotal component of any exercise program.
To read “12 reasons why older adults need to do resistance training exercise: part 1” that explores the health-related benefits in older adults see here.
For local Townsville residents interested in FitGreyStrong’s Exercise Physiology services or exercise programs designed to achieve the mentioned benefits or to enhance athletic performance, contact FitGreyStrong@outlook.com or phone 0499 846 955 for a confidential discussion.
For other Australian residents or oversees readers interested in our services, please see here.
Disclaimer: All contents of the FitGreyStrong website/blog are provided for information and education purposes only. Those interested in making changes to their exercise, lifestyle, dietary, supplement or medication regimens should consult a relevantly qualified and competent health care professional. Those who decide to apply or implement any of the information, advice, and/or recommendations on this website do so knowingly and at their own risk. The owner and any contributors to this site accept no responsibility or liability whatsoever for any harm caused, real or imagined, from the use or distribution of information found at FitGreyStrong. Please leave this site immediately if you, the reader, find any of these conditions not acceptable.
Several years ago researchers and authors Malhotra, Noakes & Phinney published an article in the British Journal of Sports Medicine titled:
“It is time to bust the myth of physical inactivity and obesity: you cannot outrun a bad diet” (see here)
This created quite a storm in several fields of scientific research including many fitness and nutrition blogs. It was lambasted by some though as inaccurate and misleading – just Google the title of the article and you’ll understand what I mean. Essentially, their article claimed that regular physical activity does not promote weight loss and that excessive consumption of carbohydrates, in particular, sugar, is the primary cause of the obesity epidemic. Whilst excessive sugar consumption has played an important role in exacerbating the obesity crisis, it would be naive and short-sighted to suggest that this is the be-all and end-all in explaining society’s current predicament.
“Why you shouldn’t exercise to lose weight, explained with 60+ studies” (see here)
This article posits that exercise is unhelpful for weight loss and makes very similar claims to the Malhotra et al. paper. Of course, the real question is, are these claims valid? Could it really be true that weight loss is not facilitated by increasing daily energy expenditure and exercise? I think the answer to these questions are not black or white. My main concern with the articles mentioned above is that they are rather myopic, polarising and do not provide a fair and balanced assessment of the current evidence.
Instead, the evidence published to date demonstrates that ‘our’ increasing waistlines are closely related – but not confined to – the interaction of the following 3 factors. Firstly, the sum total of all physical movement performed whilst awake has substantially decreased over the last 50 years. Secondly, activities of a sedentary nature have dramatically increased. What are you doing right now? Thirdly, total energy intake over the last 50 years has continued to increase over and above total daily energy expenditure requirements. If movement levels are low and energy intake high – irrespective of where the excess is derived from – body weight, body fat and BMI will naturally increase. But does increasing physical activity levels via a formalised exercise program and/or non-exercise based physical activities (e.g. leisure time movement, domestic chores/activities) facilitate weight loss by increasing total daily energy expenditure? The answer to this is yes and no.
Today I want to focus on the evidence that was accessible following a brief Google Scholar search that supports exercise as well as other non-exercise increases in daily physical movement as being promoters of weight loss. For anybody not familiar with Google Scholar (https://scholar.google.com.au), it is a search engine by Google that searches for only published, peer-reviewed journal-based research and consequently provides information that is evidence-based rather than ‘opinion-based’ which is largely what would be accessed via Google, Yahoo or any other search engine. So, what did I find?
One of the more interesting pieces of research that directly contradicts the article by Malhotra and co. is that written by Church et al. (2011). They concluded that over the last 50 years in the U.S., daily occupation-related energy expenditure was estimated to have decreased by more than 100 calories per day, and this reduction in energy expenditure could account for a significant portion of the increase in mean U.S. body weights for women and men. What this would suggest is that rather than increased obesity rates being caused exclusively by too many carbs or too much sugar, as argued by the “you can’t outrun a bad diet” article, the current problem has been driven by large reductions in energy expenditure due to changes to occupation-related physical movement. In other words, we have transitioned from jobs that are active and require a lot of physical movement to jobs now that have most of us sitting on our backsides for hours on end.
Doing this all day can’t be helpful
Previous reports based on estimated caloric consumption from food production and food disappearance (food waste) estimates have concluded that increased caloric consumption could account for most, if not all, of the weight gained at a population level in the U.S. Nonetheless, a recently validated differential equation model was used to identify a conservative lower bound for the amount of food waste in the U.S. (Hall et al. 2009). This analysis determined that prior estimates of national food waste were grossly underestimated; indicating that the national average caloric intake was much lower than previously estimated. As such, these results and those of Church imply that increased caloric intake or for that matter, increased sugar consumption, cannot solely account for the observed trends in national weight gain in the US.
The following is a summary of some of the research that has been published investigating whether obesity is related to physical inactivity and what effect increased physical activity has on obesity risk and management.
1. Banks et al. (2010) reported that: “Obesity increases with increasing screen-time, independent of purposeful physical activity.”
2. Goodpaster et al. (2010) found that: “Among patients with severe obesity, a lifestyle intervention involving diet combined with initial or delayed initiation of physical activity resulted in clinically significant weight loss and favourable changes in cardiometabolic risk factors.” In the group where physical activity was delayed, the addition of such physical activity promoted greater reductions in waist circumference and hepatic fat content.
3. Banks et al. (2011)showed that: “Domestic activities and sedentary behaviours are important in relation to obesity in Thailand, independent of exercise-related physical activity. In this setting, programs to prevent and treat obesity through increasing general physical activity need to consider overall energy expenditure and address a wide range of low-intensity high-volume activities in order to be effective.”
4. Villareal et al. (2011) demonstrated that: “…in obese older adults a combination of weight loss and exercise provides greater improvement in physical function than either intervention alone.”
5. McGuire & Ross (2012) reported that: “…light physical activity, incidental physical activity and sedentary behaviour were not associated with abdominal obesity amongst inactive men and women whereas moderate-to-vigourous physical activity predicted lower visceral adipose tissue.”
6. The study by Fan et al. (2013) was: “…to test if moderate-to-vigorous physical activity (MVPA) in less than the recommended ≥10-minute bouts related to weight outcomes.” Both higher-intensity short bouts and long bouts of physical activity related to lower BMI and risk of overweight/obesity whereas neither lower-intensity short bouts nor long bouts related to BMI or risk of overweight/obesity. They concluded that: “The current ≥10-minute MVPA bouts guideline was based on health benefits other than weight outcomes. Our findings showed that for weight gain prevention, accumulated higher-intensity PA bouts of <10 minutes are highly beneficial, supporting the public health promotion message that ‘every minute counts’.”
7. Cleland et al. (2014) found that: “High sitting and low activity increased obesity odds among adults. Irrespective of sitting, men with low step counts had increased odds of obesity. The findings highlight the importance of engaging in physical activity and limiting sitting.”
8. Jakicic et al. (2014) concluded that moderate-to-vigorous physical activity (MVPA > 10) of 200-300 min per week, coupled with increased amounts of low-intensity physical activity (LPA), are associated with improved long-term weight loss. Interventions should promote engagement in these amounts and types of physical activity.
9. Murabito et al. (2015) discovered that moderate-to-vigorous physical activity (MVPA) as measured by accelerometry was associated with less visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) and better fat quality as assessed by multi-detector computed tomography. With increasing MVPA, there was a concomitant decrease in VAT. Higher levels of MVPA were associated with higher SAT fat quality, even after adjustment for SAT volume. They concluded that:
“MVPA was associated with less VAT and SAT and better fat quality.”
10. Mekary et al (2015) reported that: “….over 12 years long-term weight training is associated with less waist circumference increase, whilst moderate-to-vigorous aerobic activity was associated with less body weight gain in healthy men.”
11. Hume et al. (2016) concluded that: “….counter to the energy surfeit model of obesity, results suggest that increasing energy expenditure may be more effective for reducing body fat than caloric restriction, which is currently the treatment of choice for obesity.”
12. Myers et al. (2016)suggests that there exists clear associations among objective measures of physical activity, sedentary behaviour, energy expenditure, adiposity and appetite control. They produced data that indicates strong links between physical inactivity and obesity with this relationship likely to be bidirectional.
13. Wu et al. (2017) tested 12-weeks of low- and high-intensity exercise training in Mexican-American and Korean premenopausal overweight/obese women. Results showed that such exercise reduced body mass index, body fat percentage, fat mass and visceral adipose tissue with concurrent increases in lean mass.
14. Quist et al. (2018) examined the effects of 6-months of active commuting and leisure-time exercise on fat loss in women and men who were overweight or obese. Clinically meaningful fat loss of over 4 kilograms was elicited. Vigorous intensity exercise was shown to be more effective in reducing body fat versus moderate intensity exercise.
15. Stoner et al. (2019) concluded that the findings of their meta-regression “lend support to the use of exercise prescription for promoting weight loss and improving health outcomes in adolescents with overweight/obesity.”
16. Zhang et al. (2020) found that 12-weeks of intense exercise (without concurrent nutritional intervention, i.e. ‘put on a diet’) significantly improved cardiometabolic parameters (i.e. fasting blood glucose) and decreased weight, total percent body fat, whole-body fat mass, android, gynoid, and trunk fat mass, abdominal subcutaneous fat and abdominal visceral fat. Reductions of over 15 cm² of abdominal visceral fat were achieved in just 3 months!
17. Berge et al. (2021) produced clinically significant weight loss in people with severe obesity despite the study having no specific focus on body weight reduction. The group that performed moderate‐intensity continuous training combined with high‐intensity interval training lost an average of 5 kilograms in 24-weeks.
Staying strong as we age is critical to health
What does this research tell us?
Quite a lot I would say. Of particular note is that this only represents a very small sample of the evidence that directly counters the claim that widespread societal levels of physical inactivity have little to do with burgeoning obesity rates. What is more, it crystallizes just how contentious Malhotra, Noakes & Phinney’s editorial was. Exclusively assigning blame for the obesity epidemic to the excessive intake of sugar is not supported, I believe, by the current evidence. The dramatic reductions in the sum total of all physical activity accumulated during the day appears to account for a substantial amount of the increased weight seen in recent decades.
Firstly, there is a substantial amount of research which demonstrates that sedentary behaviours, sitting time and low physical activity levels manifestly increase one’s risk of becoming overweight or obese. Secondly, moderate-to-vigourous physical activity compared to light physical activity has been shown to be associated with less visceral and subcutaneous adipose tissue, impacts positive effects on fat quality, is related to lower BMI, lowers risk of overweight/obesity, prevents weight gain following weight loss, promotes greater reductions in waist circumference and produces favourable changes in cardio-metabolic risk factors.
So to conclude, my Google Scholar search unveiled that there is a large body of evidence that demonstrates that there may be no myth to bust regarding obesity and physical inactivity or foundation to suggesting that physical activity plays no role toward promoting weight loss. Others have been critical of this line of thinking too, in particular Dr Steven Blair, so I would suggest that if you wanted to read further on this here would be a good place to start.
My next article will explore the evidence that exercise does not assist weight loss in all exercisers due to various compensatory mechanisms (see here). Until then, stay active, keep moving and don’t forget to include some resistance exercise in your week.
For local Townsville residents interested in FitGreyStrong’s Exercise Physiology services or exercise programs designed to improve health, physical function and quality of life or to enhance athletic performance, contact FitGreyStrong@outlook.com or phone 0499 846 955 for a confidential discussion.
For other Australian residents or oversees readers interested in our services, please see here.
Disclaimer: All contents of the FitGreyStrong website/blog are provided for information and education purposes only. Those interested in making changes to their exercise, lifestyle, dietary, supplement or medication regimens should consult a relevantly qualified and competent health care professional. Those who decide to apply or implement any of the information, advice, and/or recommendations on this website do so knowingly and at their own risk. The owner and any contributors to this site accept no responsibility or liability whatsoever for any harm caused, real or imagined, from the use or distribution of information found at FitGreyStrong. Please leave this site immediately if you, the reader, find any of these conditions not acceptable.
It is often assumed that the best type of exercise – for treating obesity and therefore reducing current widespread levels of societal adiposity – is to preferentially increase aerobic or cardiorespiratory physical activity rather than resistance exercise or training. This assumption is based on the premise that aerobic-based exercise substantially increases total daily energy expenditure (TDEE) compared to the energy cost of resistance training. The argument goes that for the same amount of time invested (aerobic vs resistance exercise), significantly greater energy expenditure will occur in the former.
In fact, a good solid hour of ‘cardio’ can yield a net caloric expenditure of over 500 kcal. This of course varies depending on things like body mass, fitness level, the type of cardio exercise performed, exercise intensity and exercise efficiency. Nonetheless, it makes sense that an increase in TDEE would make it essentially easier to create an energy deficit which would thereby translate into improved body composition and decreased fat mass.
Is Aerobic Exercise The Best For Fat Loss?
However, there are several caveats that must be mentioned which could affect just how successful weight loss and weight loss maintenance is if doing aerobic-only exercise. They include:
Overestimating the energy expenditure of an activity therefore stifling weight loss with erroneous values assigned to a cardio session.
Compensatory adaptation whereby weight loss is curtailed in some individuals with changes to Resting Metabolic Rate (RMR), non-exercise activity thermogenesis (NEAT), fasting appetite, satiety and increased fat consumption (see herefor further information). Professor Neil King, currently based at Brisbane’s QUT Faculty of Health in Australia, has been instrumental in bringing these issues to light (see here).
Recent evidence (see here) also suggests that TDEE may be constrained as aerobic activity levels increase. In other words, it has been shown that a plateauing effect on total energy expenditure occurs in those performing high amounts of aerobic-based physical activity. This lends support to the notion that metabolic adaptation constrains energy expenditure with increased physical activity. Theoretically, it is proposed that this would have probably helped facilitate survival during our evolution.
Research demonstrates that nutritional manipulation combined with aerobic exercise so that an energy deficit exists (a prerequisite for fat loss), causes a loss of lean body mass (LBM) with such loss causing decreases to RMR (see Villareal et al). It is very common to see exercisers lose significant amounts of LBM when only aerobic exercise is undertaken while in an energy deficit state.
The loss of LBM is not desirable for 2 key reasons. Firstly, functional physical capacity could be affected in both the short and long term (see Villreal et al). Secondly, resting metabolic rate will be reduced thereby making weight loss more difficult and weight regain more likely (see herefor further discussion). Such alterations would make continued fat loss increasingly more difficult as energy intake would have to adjust to allow for the decrease in TDEE that would occur concomitantly with decreased LBM.
Some research has shown that appetite is suppressed more so with resistance versus aerobic exercise. Appetite attenuation would help facilitate the likelihood of achieving sustainable weight loss.
Resistance Exercise Is Effective At Reducing Body Fat
Recently Clemens Drenowatz from the Department of Exercise Science, University of South Carolina, headed up a study to examine the effect of different exercise types on measures of adiposity across different fat categories i.e. healthy, overfat and obese.
The term overfat was probably used instead of overweight so that a distinction could be made between high adiposity, low LBM versus low adiposity, high LBM. By that I mean, measuring body weight alone does not discern the proportionate breakdown of fat mass and lean body mass. As an example, you could have 2 men, same height, same weight, but with totally different body compositions in terms of percentage body fat. Increased chances of premature death and health morbidism are correlated not to LBM but to increasingly high levels of adipose tissue, in particular, visceral adiposity (internal fat rather than subcutaneous fat).
The key difference noted for this study was that the researchers did not prescribe an exercise program but rather allowed those involved in the study to self-select what activities to partake in and then assessed what effect those choices had on subsequent measures of body composition.
Three-hundred and forty-eight young adults (n=348) provided valid data over a 12 month period. Body composition, fat mass (FM) and lean mass (LM) were measured via a procedure known as dual x-ray absorptiometry every 3 months. Following this, percent body fat was calculated and then used to distinguish normal-fat, overfat and obese. Specifically, percent body fat ranges were less than 20% and 33% for normal fat, 20%-25% and 33%-39% for overfat, and equal to greater than 33% and 39% for obese in men and women, respectively.
Every 3 months participants reported engagement in aerobic exercise, resistance exercise and other forms of exercise such as tennis or football. Time per week spent engaged in endurance exercise, resistance exercise and other exercise was calculated. TDEE, RMR, physical activity level, and energy intake were also ascertained.
The majority of participants (93%) reported some exercise in the observation period. Surprisingly, differences existed as to what type of exercise showed the greatest benefit – for those either classified as normal-fat, overfat and obese – on reducing fat mass, increasing lean body mass and improving overall body composition.
For normal-fat participants, any type of exercise positively affected lean body mass; however fat mass was unaffected by any type of exercise. BMI and percentage body fat in normal-fat participants held steady. It was not an explicit aim of the study to bring about weight or fat reduction so this demonstrates that in those that are relatively lean, homeostasis for fat mass is robust.
Contrastingly, in overfat and obese participants, fat mass was reduced with increasing resistance exercise but not with aerobic exercise. Even adjusting for objectively assessed physical activity did not alter these results thereby suggesting that the real-world effectiveness of resistance exercise is particularly more potent than aerobic exercise to induce a decrease of fat mass in obesity.
Resistive Exercise Is Beneficial for Men and Women
The findings of this study have some important implications for exercise program design aimed at achieving body fat loss and reducing adiposity. With reliance on aerobic exercise continuing to dominant most weight/loss programs, we now have a growing body of evidence that is questioning this approach despite the fact that there is a greater ‘per-minute’ energy expenditure associated with aerobic compared to resistive exercise.
As mentioned above there are several factors that may constrain just how effective aerobic exercise is for altering body composition. Resistive but not aerobic exercise has also recently been shown to increase non-exercise physical activity (Hunter et al. 2015). Furthermore, resistive exercise was shown recently in a 12-year cohort study to have the strongest association with less waist circumference increase compared to aerobic exercise (Mekary et al. 2015). Taken together, these novel findings suggest that resistive exercise should always be included with aerobic exercise in those considered overfat or obese if the primary objective is to reduce fat mass.
You Don’t Have To Go To A Gym To Find Resistance
FitGreyStrong’s recommendation: To optimise the effectiveness of exercise interventions in bringing about positive body compositional changes in those carrying excessive body fat, resistive exercise should be a pivotal component of any exercise program undertaken. Aerobic exercise remains a critically important component of any intervention for improving health and should still be incorporated on a daily basis if possible or for a minimum total period of 150 minutes/week at a moderate intensity. However, it is important to be mindful that a ‘Goldilocks’ or sweet spot may exist for some people whereby over-doing aerobic exercise may be counterproductive in terms of maximising fat loss due to factors that have been outlined above.
Basic weekly recommendations for a older beginners-to-intermediate resistance exercise intervention designed to reduce obesity would look something like this:
Two sessions per week
30-40 minutes in duration not including warm-up
Focus on working all major muscle groups primarily based on compound, multi-jointed non-machine orientated movements.
1-2 work sets
6-30 repetitions. The load is not important, the effort is. All loads in older adults have shown to be effective and produce comparable changes in muscle strength and hypertrophy, muscle endurance, bone density and physical function.
Controlled tempo (3-4 seconds on the eccentric, 0-2 seconds on transition, 1-2 seconds concentric, 1 seconds pause then repeat; if you are not sure what this mean please contact me)
60-180 seconds rest between sets. If stronger or more experienced, try longer rests on high effort sets.
At least 48 hours between sessions for recovery
Consume 40 g whey protein post-exercise to maximise muscle protein synthesis rates (see here for an outline on the research supporting post-exercise protein).
References
Blundell J. et al. (2010) “Appetite control: methodological aspects of the evaluation of foods.” Obe Rev 11(3): 251-270
Broom, D.R. (2008) “Influence of resistance and aerobic exercise on hunger, circulating levels of acylated ghrelin, and peptide YY in healthy males” American Journal of Physiology. 296(1): R29-R35.
Drenowatz, C. et al. (2015) “The prospective association between different types of exercise and body composition” Medicine & Science in Sports & Exercise 47(12): 2535-2541.
Hunter, GR. Et al. (2015) “Exercise training and energy expenditure following weight loss” Medicine & Science in Sports & Exercise 47(9): 1950-1957
King, N.A. et al (2012) “Exercise, appetite and weight management: understanding the compensatory responses in eating behaviour and how they contribute to variability in exercise-induced weight loss.”British Journal of Sports Medicine 46(5):315-22.
King N.A. et al. (2008) “Individual variability following 12 weeks of supervised exercise: identification and characterization of compensation for exercise-induced weight loss.” International Journal of Obesity. 32: 177-184
King N.A. et al. (2009) “Dual-process action of exercise on appetite control: increase in orexigenic drive but improvement in meal-induced satiety.” Am J Clin Nutr. 90: 921-927
Mekary RA et al. (2015) “Weight training, aerobic physical activities, and long-term waist circumference change in men” Obesity 23(2): 461-476
Melanson, E.L. et al. (2013) “Resistance to exercise-induced weight loss: compensatory behavioural adaptations” Med Sci Sports Exerc.August; 45(8): 1600-1609.
Peterson N.D. et al. (2014) “Dietary Self-Monitoring and Long-Term Success with Weight Management”. Obesity 22, 1962–1967
Villareal D.T. et al. (2011) “Weight Loss, Exercise, or Both and Physical Function in Obese Older Adults.” N Engl J Med 364(13): 1218-1229
For local Townsville residents interested in FitGreyStrong’s Exercise Physiology services or exercise programs designed to improve body composition, reduce body fat, increase fitness and strength or to enhance athletic performance, contact FitGreyStrong@outlook.com or phone 0499 846 955 for a confidential discussion.
For other Australian residents or oversees readers interested in our services, please see here.
Disclaimer: All contents of the FitGreyStrong website/blog are provided for information and education purposes only. Those interested in making changes to their exercise, lifestyle, dietary, supplement or medication regimens should consult a relevantly qualified and competent health care professional. Those who decide to apply or implement any of the information, advice, and/or recommendations on this website do so knowingly and at their own risk. The owner and any contributors to this site accept no responsibility or liability whatsoever for any harm caused, real or imagined, from the use or distribution of information found at FitGreyStrong. Please leave this site immediately if you, the reader, find any of these conditions not acceptable.
In part 1 of “The Ebbeling vs. Hall trials: Re-visiting How Diet Affect Energy Expenditure & Weight Loss” I argued that the conclusions made by authors of the Ebbeling trial – where it was purported that a very low carbohydrate diet significantly mitigated the reduction in energy expenditure subsequent to weight loss compared to diets higher in carbohydrates – were flawed. As stated previously: “The variability in the individual data for diet type and their effect on energy expenditure is discordant to that of the pooled data thus invalidating the generalisability of the results. To truly make the claim that a novel bio-effect exists for a particular diet type, a consistent, reliable pattern of response should be reproducible in a majority of people.”
In part 2 I want to take a closer look at the results of the study headed up by Dr Hall titled: “Energy expenditure and body composition changes after an isocaloric ketogenic diet in overweight and obese men” that was published in the American Journal of Clinical Nutrition. This study was designed to test the merits of the carbohydrate-insulin model of obesity. As mentioned in part 1, a number of unique claims that underpin this model are made by those advocating very low carbohydrate (VLC) diets. Firstly, that by decreasing the proportion of carbohydrate in the diet a concomitant reduction of insulinemia will ensue, and in so doing, cause increased fat mobilisation from the adipose tissue thus causing a greater oxidation of circulating free fatty acids (FFAs). Insulin is viewed in this context as the ‘gate-keeper’ of whether fat is partitioned toward storage (higher insulin) or mobilised and oxidised for energy metabolism (lower insulin). Secondly, as a consequence of reduced insulin secretion and increased availability of FFAs for use by metabolically active tissue, VLC or ketogenic diets will disproportionately increase energy expenditure compared to isoenergetically-matched higher/high carbohydrate (HC) diets. Thirdly, it is concluded that ‘a calorie is not a calorie’ therefore, because energy expenditure and body fat metabolism will be impacted differentially and advantageously by exchanging an isoenergetic amount of dietary carbohydrate for fat.
Hall and 10 of his colleagues (see page title below) essentially concluded that a VLC diet was no more effective compared to a HC diet for reducing body fat. Small increases were detected in energy expenditure for the VLC diet but this was dismissed as clinically irrelevant. The publication of these findings were greeted with an incredible range of reactions ranging from the “I-told-you-so” piece by Anthony Colpo, the excellent analysis by Stephan Guyenet, to the cringe worthy blog of Jason Fung. Indeed, many noses were put out of joint and so dismayed were some, that the rebuttals transcended professional criticism with personal attacks and slurs directed at Kevin Hall himself. What I find most perplexing about this whole thing is that the results of Hall’s trial are some of the most damaging findings to date and provide no support for the carbohydrate-insulin model of obesity.
The results of this study were presented by Kevin Hall at the 2016 World Obesity Federation meeting. He was interviewed during this conference by Yoni Freedhoff (see @YoniFreedhoff on Twitter), a Medical Practitioner and Obesity Specialist from Canada and this was uploaded to YouTube. To cut a long story short, when questioned about his study, Hall claimed that the carbohydrate-insulin theory of obesity had been debunked, with no substantial differences in fat loss between a VLC or HC diet. And whilst energy expenditure had initially increased on the VLC diet, it was a transient change that subsequently decreased linearly over time amounting to nothing clinically relevant (see the interview below).
Following upload of this video to YouTube the Internet went into meltdown with Twitter specifically ablaze with discussion and fierce debate about what it was exactly that Kevin Hall’s study had actually demonstrated – here is just one example of the fascinating discussionthat occurred on Twitter following publication of this trial. There was little to go on apart from the above video, some commentary, some graphs and the poster of the study.
First off the ranks to take aim at this study was Dr Michael Eades, author of Protein Power and his blog of the same name. Eades was applauded far and wide by many on social media as debunking the debunker. After reading his blog, though, it was apparent that there were several flaws in his logic and I subsequently made these comments. My key concerns were, firstly, that there was no effort to appropriately explain why there was no relationship found between the rate of fat loss and 24-hour C-peptide levels (insulin), given that the carbohydrate-insulin model of obesity predicates that lipolysis is inversely proportionately to insulin production and therefore as insulin levels decrease, fat loss should increase. Secondly, there was no acknowledgment that total daily energy expenditure (EE) actually returned back to baseline over the duration of the VLC diet, even though insulin levels remained consistently depressed for the entire VLC diet phase. Given that insulin levels decreased and remained as such following the switch from the HC to VLC diet, it is completely reasonable to expect that EE would remain consistently elevated too if the carbohydrate-insulin model is sound. This simply did not happen and both these findings are monumentally difficult to account for as they completely contradict what would be predicted and expected to occur based on this model.
I had intended, in this blog, to explore and make further comment on some more of the reactions following full publication of this trial, but you’ll have to wait until part 3 of this series as I have decided to dedicate a whole article to that as there is a lot to comment on.
Results published
The paperwas finally published ahead of print July 6th 2016. Kevin Hall’s research group in summary took 17 overweight or obese men and confined them to metabolic wards where they consumed a HC (also high in sugar) for a 28 day run-in period followed by an isoenergetic VLC diet for an additional 28 days. All foods and beverages were provided to the participants and food outside of that on the menu plans was prohibited (this was strictly enforced). Dietary protein was clamped at approximately 16% for the entire duration of the study for both phases. The diets were structured with the intention that energy balance was achieved with sufficient energy intake to maintain participant’s body weight. Daily diet composition of the 7-day, 2400 kcal rotating menus for the VLC and HC diets is shown below.
Subjects were prescribed 90 min (3 x 30 mins blocks) of daily stationary cycling at a clamped intensity. The intensity of the cycling exercise was determined during the third screening visit. Two 30 minute bouts of stationary bicycling at a fixed speed and resistance with a HR greater than 0.3×(220-age-HRrest)+HRrest but not exceeding 0.6×(220-age-HRrest)+HRrest and no signs of arrhythmia. The initial speed and intensity was set to that of the second screening visit and adjusted to stay within target HR during the second 30 minute bout of cycling. The speed and intensity of the stationary cycling determined during the third screening visit was to be repeated on days of scheduled cycling exercise during the inpatient visit to total 90 minutes per day. Overall physical activity was quantified with small, portable, pager-type accelerometers.
Two consecutive days each week were spent residing in metabolic chambers to measure total daily energy expenditure, respiratory quotient and sleeping energy expenditure (SEE). Body composition was assessed by dual-energy X-ray absorptiometry (DXA) and the average EE during the last 2 weeks of each diet was assessed by the doubly-labeled water (DLW) technique.
Overview of Study Design
Other parameters assessed were daily respiratory quotient (24-h RQ), energy cost of cycling exercise at a clamped intensity (EEexercise), energy expenditure when not moving (EEsedentary), physical activity expenditure on days inside the chamber (PAEchamber), physical activity expenditure on days outside the chamber (PAEnonchamber), spontaneous physical activity inside the metabolic chamber (SPA). Relevant blood and urinary biomarkers measured included insulin, C-peptide, urea, ammonia, creatinine, thyroid hormones, nitrogen, ketones, adrenalin and norepinephrine. The daily diet composition is outlined below.
Primary endpoints were changes in EE (total and sleeping) and 24-hr respiratory quotient, and secondary endpoint was changes in body composition.
The key findings of this study in relation to the primary and secondary endpoints were:
EE during the VLC phase was 57 ± 13 kcal/d greater than during the HC period.
Adjusting total EE data for body composition changes resulted in the VLC diet period having 96 ± 12 kcal/d greater expenditure than the HC diet period.
SEE during the VLC phase was 89 ± 14 kcal/d greater than during the HC period.
Adjusting SEE for body composition changes resulted in the VLC diet period having 121 ± 13 kcal/d greater expenditure than the HC diet period.
There was a significant linear decrease over time in EE and SEE following the initial increases outlined above and this occurred irrespective following adjustment for changes in body weight and body composition.
The VLC diet resulted in a slowing or blunting of fat loss versus the HC diet (-0.5 kg in 28 days for VLC vs. -0.5 kg in 14 days for HC).
Following transition to the VLC diet, the loss of fat mass in the subsequent 14 days was not statistically significant.
Respiratory quotient (24-h RQ) decreased significantly from approximately 0.88 during the HC period to 0.78 at the start of the VLC period and remained approximately constant until the end of the study, indicating a rapid and persistent increase in fat oxidation.
Comments and Analysis
It is important at this juncture to state the obvious here but which ironically seems to have been missed by those that have cast aspersions on Kevin Hall. This study was intended to answer the questions as to whether the lowering of insulin levels via an isoenergetic dietary exchange from HC to VLC, translated into: 1) A disproportionate increase in EE and; 2) Greater loss of body fat. From what I can gather his recent work has aimed to uncover the perennial and mechanistic question of whether greater energy expenditure and fat loss can be achieved by altering the proportion of carbohydrates in isoenergtically macronutrient manipulated protein-clamped diets. These are important questions to answer because increased EE and body fat loss – simply induced by decreasing the proportion of carbohydrates for a given isocaloric diet – would have major implications in the treatment of obesity. As such, energy intake and protein were clamped so that the effect of dietary carbohydrate restriction could be isolated as the independent variable with EE and fat loss dependent variables.
This study was not, however, designed to answer the questions as to whether dietary carbohydrate restriction decreases ad libitum energy intake through enhanced appetite satiety – which could account for the efficacy of VLC diets in altering body composition – or whether such restriction generates greater improvements in metabolic health in those suffering from obesity or disorders such as type-2 diabetes. Those claiming, then, that Hall and co are misrepresenting, misconstruing or ‘spinning’ the data of this study – to either “protect one’s reputation”, or perpetuate some sort of “government and industry conspiracy” to maintain the “high carbohydrate diet status quo” and thereby place “people’s health and wellbeing at risk” – are preposterous and offensive. I see no evidence whatsoever that Hall et al. are advocating high sugar, high carbohydrate diets for those suffering from obesity and other metabolic disorders or conditions.
Energy Expenditure
At face value and in support of the argument that VLC diets provide a “metabolic advantage”, adjusting total EE data for body composition changes resulted in the VLC diet period having 96±12 kcal/d greater expenditure than the HC diet period. If we base our conclusions on this figure alone, we should be able to say that this study supports the existence of a “metabolic advantage” that could potentially be harnessed to facilitate obesity treatment. And this is precisely what was latched on to by the VLC diet advocates. In my opinion, however, this does not adequately contextualise the temporality of the EE data and, as such, obfuscates a more nuanced interpretation of what the results show. Let’s take a look at figure 3A and 3B from the trial that track both EE and SEE.
Changes In Total Daily EE and SEE
If you eyeball and track EE/day over time in figure 3A, the trajectory of decline from ∼day 10 to endpoint, is ∼100 kcal/day to ∼20 kcal/day, respectively. For figure 3B, the decline is even greater. SEE peaks at ∼200 kcal/day around day 4 and tanks, decreasing to ∼20 kcal/day by endpoint. Therefore, in support of the argument against any sort of “metabolic advantage” of VLC diets, this waning of total EE clearly shows that no clinical difference exists given that:
By ∼day 12 and thereafter EE and SEE for the VLC diet are not statistically significant versus the HC diet.
95% confidence interval for the VLC diet by ∼day 18 contains zero with no statistically significant difference for EE or SEE.
Thus, we should accept the null hypothesis as there is no difference between the HC and VLC diets.
The trajectory of EE and SEE in the VLC diet and waning and return back to baseline demonstrates that these metabolic changes were acute and transient. Whilst I do not want to speculate as to the reasons why, it is fascinating that these findings – that are as clear as the light of day – were either ignored, dismissed or not understood by those endorsing the idea that VLC diets provide a “metabolic advantage”. Interestingly, Hall’s is not the only study to show the phenomena of “adaptive” thermogenesis, as discussed by the POUNDS lost study, where resting energy expenditure (REE) is indeed adaptive over time. Both body weight and REE decreased by 6 months, but were unaffected by diet composition.
Lastly, body composition-adjusted EE would have been overestimated given that such adjustment was not able to discern that much of the weight reduction following transition to the VLC diet came from water losses and not metabolically active tissues. In short term studies investigating VLC diets you will see larger initial decreases in body weight compared to diets higher in carbohydrates due to potassium deficits and the reduction of muscle (water-laden) glycogen as described by Kreitzman et al (1992). The additional data below showing an initial increase in protein utilisation and metabolism, and concomitant blunting in fat loss provides further support for this.
Hall’s data, therefore, strongly indicates that there is no chronic, persistent and clinically relevant elevation of EE and SEE with VLC diets when compared to isocaloric HC diets. As discussed by Hall and co, other controlled, inpatient isocaloric feeding studieswhere dietary protein is held steady, demonstrate that varying carbohydrates from 20% to 75% of total calories found either small decreases in EE or no significant differences with carbohydrate restriction. Taken together, it would appear that dietary carbohydrate restriction as low as 20% fails to elicit any noteworthy changes in EE, but further restriction to a level where carbohydrates supply 5% of total calories results in slight but transient increases in EE and SEE. It should be acknowledged that the study authors anticipated this slight (initial) increase and the results confirm their mathematical model simulations. Such increases seem to be part of an “adaptive” thermogenic response where an increased shift toward ketogenesis is required, but which probably subsides once gluconeogenesis declines following the brain’s shift away from glucose toward ketone oxidation.
Body Weight Changes Over The Study Period
Body Composition
Unintentional weight and fat loss occurred throughout the study and indicated an overall state of negative energy balance. Negative energy balance during the last 2 weeks of the HC and VLC diet periods were not significantly different whether assessed by the measured DXA body composition changes or by calculating energy intake minus expenditure as measured by DLW. However, following transition to the VLC diet, fat loss actually slowed (see below). Moreover, 95% confidence intervals (day 28 of the VLC diet) lends support to this, with the lower range of the interval for body fat loss encroaching upon zero.
Fat Mass Change Over The Study Period
Even if we grant that most of this slowing in fat loss was confined to the first 15 days following transition to the VLC diet, the rate of loss from days 15-30 remained constrained in comparison to that seen in the HC diet (VLC -0.3 kg vs HC -0.5 kg). This occurred despite daily fat oxidation adapting completely within the first week of the VLC diet, as shown by the rapid and sustained maximal drop in respiratory quotient seen by day 4 (depicted in figure 3C below). Such data illustrates that daily fat oxidation adapts very quickly and completely when dietary carbohydrates are dramatically reduced. Indeed, this challenges the argument that many weeks are required to become “fat adapted”. Furthermore, it dispels any notion that fat loss was reduced due to partial fat adaptation. At least from a metabolic perspective, maximal fat oxidation and adaptation occurs quite rapidly. At this stage, I have seen no evidence either to support the idea that if a longer period of time (on a VLC diet) was provided, fat oxidation efficiency would have been further augmented with increased body fat loss.
Respiratory Quotient
Based on the data at hand one could argue the opposite to that proposed by the carbohydrate-insulin model of obesity, with very low insulin levels actually blunting the rate of fat loss. Certainly in the short term at least, the rate of proteolysis was up-regulated as demonstrated by the increase in nitrogen excretion following transition to the VLC diet. Consequently, energy metabolism of participants on the VLC diet required an increased reliance and utilisation of protein from lean body mass to meet energy needs. Over the long-term, negative nitrogen balance and increased catabolism of lean body mass is undesirable but fortunately this change only subsisted until day 11. In spite of this, the blunted rate of fat loss persisted from this point to the end of the study as demonstrated by the DXA results. The nitrogen excretion, RQ, 24-hr C-peptide and DXA data support that the rate of fat loss observed was as good as things were going to get.
Notwithstanding the recent publication and thought provoking work of Professor James Johnson and co (using rodent models and experiments) that proposes a direct causal role for hyperinsulinemia in obesity, results of human studies are less convincing and not conclusive. The current study under review is a case in point, given that the dietary modulation and significant/persistent reduction of insulin did not translate into greater fat loss as would be anticipated if causality was prominent. This is a particularly incongruous outcome that contradicts and questions the fundamental underpinning of the carbohydrate-insulin model of obesity, given that insulin levels did not apparently affect, or were correlated to, the rate of fat loss.
Adipose cell size changes and regional fat deposition as predictors of metabolic response to overfeeding in insulin-resistant and insulin-sensitive overweight/obese human subjects in the McLaughlin et al. (2016) study, also reported results which were opposite to that expected by the researchers. Interestingly, insulin-resistant subjects showed, as would be expected, significantly greater hyperinsulinemia at baseline and at peak weight following the intervention, but surprisingly tolerated and responded better to overfeeding than did insulin-sensitive subjects. The authors state:
In contrast to our hypothesis that IS subjects would demonstrate adaptive adipose tissue and metabolic responses to weight gain, we found the opposite: IS subjects exhibited maladaptive adipose tissue responses and developed clinically significant insulin resistance. Adipose mass expanded in the visceral and intrahepatic depots, and adipose cell hypertrophy was evident. FFA concentrations under steady-state insulin conditions increased by 133%, indicating resistance to insulin suppression of lipolysis, whereas AUC FFA concentrations after a standardized test meal were not increased, likely due to concomitant increases in the insulin AUC. Muscle insulin resistance, as measured by SSPG, worsened by 45% in the IS group compared with 8% in the IR group with similar weight gain. Interestingly, the magnitude of change in all of these variables, including VAT, IHL, adipose cell peak diameter, and insulin suppression of lipolysis, significantly predicted the degree to which SSPG worsened. Further, these associations were independent of weight gain per se, implying that differential cellular and regional fat distribution patterns of adipose tissue may contribute to the metabolic heterogeneity of obesity.
The results of the abovementioned studies and other human trials show, as stated by Hall and co in their study, that “it is clear that regulation of adipose tissue fat storage is multifaceted and that insulin does not always play a predominant role.” Results like these raise another very pertinent question. Just how relevant are experiments in rodents and their related models of disease, when the results of human research is discordant to their postulations?
24-hr C-peptide
Now to the crux of the matter.
The body composition results of the Hall study confirm and add to over 80 years of scientific research that conclusively demonstrates that when it comes to weight or fat loss, the laws of energy balance hold true. Since the early 20th century at least 30 tightly controlled metabolic ward studies have been conducted and they resoundingly find the same thing. Regardless of one’s age, race or gender, for an increase or decrease in body fat to occur, a commensurate positive or negative energy imbalance, respectively, must exist. Whilst there may be some advantage of higher protein diets preserving or increasing LBM (see here, hereand herefor example) and insulin resistance status possibly influencing response to different diets (see hereand herefor example), fat loss achieved by manipulating the proportion of energy derived from carbohydrates and fat in isocaloric diets, is not significantly different.
An assessment of the research where study participants are confined to an in-patient metabolic unit/ward/chamber are the most accurate way to scientifically determine the specific energy requirements needed for weight change. Such studies are expensive because they are very resource and equipment intensive. However, what they allow researchers to do is measure what is being consumed (energy in) and what is being expended (energy out) quite precisely – or at least, a lot more precisely than studies that involve free-living subjects.
The methodology of such studies looks something like this. For the duration of these trials subjects’ have to remain in the hospital or unit and in some cases, spend time in metabolic chambers. Participants are allocated and given all consumables (food and drink) for the duration of the intervention. The caloric content of what is consumed is a known entity and has been prepared and accurately measured. The macronutrient percentages of the diet for protein, carbohydrates and fat has been determined. Physical activity is closely monitored, measured and accounted for. Resting EE and total daily EE is measured as accurately as possible based on the equipment available and methods employed in the study.
With energy intake (EI) and energy expenditure (EE) measured as close to actual as possible, investigators can now establish whether firstly, the prerequisite for weight or fat loss is an energy deficit, and secondly, if macronutrient composition exerts differential effects on such loss. Evaluation of such research has shown that no major differences have been found for weight or fat loss when macronutrient diverse isoenergetic diets are compared. Results from these studies show beyond dispute that the fundamental determinant for decreased weight is a caloric or energy deficit, not diet composition. To look at the evidence another way, not one of these trials – not even one – has ever been able to demonstrate a decrease in weight (excluding loss of water weight) or body fat when daily EE is less than daily EI. This remains so irrespective of the macronutrient breakdown. If a “metabolic advantage” of VLC diets truly existed, researchers should be able to show under tightly-controlled metabolic unit/chamber conditions, decreases in fat mass when changing from a isocaloric HC weight maintenance diet to a isocaloric-matched VLC diet (Hall’s study attempted to do this but the unintentional weight and fat loss slightly altered the course of the study). Obviously, such a dietary change will yield decreases in weight due to changes in water balance as described above (see Kreitzman et al (1992) & Yang and Van Itallie (1976)), but there has never been any methodologically sound and robust published research (under ward conditions) to show that greater fat loss is facilitated by isoenergetically swapping out carbohydrate for dietary fat.
Below is a small selection of these metabolic ward-based studies and their key findings to illustrate the aforementioned.
Keeton & Bone (1935) – No difference in weight loss diets low in calories containing varying amounts of protein.
Werner et al. (1955) – No difference in weight loss for the low-carbohydrate, high fat diet versus high-carbohydrate diet.
Yang and Van Itallie (1976) – No difference in fat loss for an 800 kcal/day ketogenic versus non-ketogenic diet. The authors state: “Rate of fat loss was a function of degree of energy deficit.”
Leibel et al. (1992) – No difference in body weight or stability during very wide variations in the fat-to-carbohydrate ratio (fat energy varied from 0% to 70% of total intake) with no significant variation in energy need. Sixteen human subjects were confined to a metabolic ward for an average of 33 days and fed precisely known liquid diets with protein derived from milk, carbohydrate as cerelose and fat from corn oil.
Golay et al. (1996) – No difference after 6 weeks for weight loss, fat loss or waist-to-hip circumference. This study compared diets equally low in energy (1000 kcal) but widely different in relative amounts of fat and carbohydrates on body weight reduction in 43 obese adults during a 6-week period of hospitalisation. The diets were composed of 32% protein, 15% carbohydrate and 53% fat versus 29% protein, 45% carbohydrate and 26% fat.
Stimson et al. (2007) – No difference in fat loss for the isocaloric phase of the study period.
Graves et al. (2013) – No difference in BMI or weight reduction for the 3-week inpatient period for each diet (or for the 48-week outpatient treatment).
Hall et al. (2016) – No difference for body fat loss for the VLC versus HC diet.
There are many other such studies but the overall findings tell the same story, which is that the fundamental arbiter of weight or fat loss is the existence of an energy imbalance where total daily EE exceeds EI. One of the largest meta-analyses and systematic reviews available, the massive 2014 review by Naude and colleagues titled “Low Carbohydrate versus Isoenergetic Balanced Diets for Reducing Weight and Cardiovascular Risk: A Systematic Review and Meta-Analysis”, assessed as many as 228 studies including those with free-living subjects. The authors reached the same conclusion and stated:
The similar reported mean energy intakes in the low CHO and balanced diet groups and the corresponding similar average weight loss in the diet groups supports the fundamental physiologic principle of energy balance, namely that a sustained energy deficit results in weight loss regardless of macronutrient composition of the diet.
So let me put some social media context on this. The next time someone makes the claim that “calories don’t matter” or “the concept of energy balance has been debunked” or “has no scientific basis”, ask them why the most controlled, rigorous and accurate methods used by researchers has repeatedly proven the concept to be valid and hold true over the last 80 years or so.
Before I finish up this section I need to make some clarifying comments.
There will be those that read this and conclude that what I am suggesting or all that I think matters is calories, with diet quality just a cursory concern. I can hear some of you saying right now “….but surely 2500 calories of jelly beans or junk food is different to 2500 calories of atlantic salmon, walnuts, broccoli and berries.” Really? Well, yes, of course it is, thanks for pointing that out. A diet consisting of wholesome, natural, minimally processed and nutrient-dense foods is paramount to ensuring good health. I should state now that I am not suggesting for one moment that the quality of the diet is not important. Irrespective of how good a diet is, the fact remains nonetheless that it is still possible to gain weight eating a wholesome, natural, minimally processed and nutrient-dense diet. It is probably much more difficult to do so, but regardless, you cannot escape the fact that you have to be in a consistent calorie deficit to lose fat or a chronic caloric surplus to gain fat.
With all of the above being said I remain of the firm belief that further research is warranted. Among many issues that remain outstanding and require elucidation, I am particularly interested in seeing more research on such things as:
Does altering the macronutrient composition of the diet (fat for carbs) elicit an inequivalent effect on appetite satiety with an inadvertent spontaneous reduction in food intake? There is certainly some evidence to support this.
Does swapping out carbohydrate for increased dietary fat provide benefit to those with metabolic abnormalities such as insulin resistance and type-II diabetes? Once again, there is evidence to support this also.
The only thing I will say about these questions is that the published research is somewhat mixed. Three meta-analyses and systematic reviews do not concur on whether metabolic outcomes are affected by manipulating the macronutrient composition of the diet. Naude et al. (2014) and Boaz et al. (2015)concluded that there were no differences on metabolic outcomes when the protein, carbohydrate and fat composition of the diet was varied. In contrast, Schwingshackl and Hoffman (2014) suggested the opposite stating that dietary manipulation in favour of increased fat did alter metabolic outcomes. More work is obviously required but I suspect that diet quality is going to have a significant role to play based on the findings of Veum et al. (2016) where consuming energy primarily as carbohydrate or fat for 3 months did not differentially influence visceral fat and metabolic syndrome in a low-processed, lower-glycemic dietary context.
Finally, I would like to suggest that what we cannot and should not invest anymore time or money researching or debating, is whether or not the energy balance model holds true. Based on our best science suggesting otherwise is moot. The jury is in. We can debate, argue and disagree about the ‘why’ in relation to the growing rates of obesity but not the ‘how’. In the words of Stephan Guyenet, “….the evidence suggests a simpler and more compelling explanation: We eat too much food that is obviously unhealthy, and it’s not because researchers or the government told us to, but because we like it.”
Spontaneous Physical Activity
The inclusion of the low intensity cycling was an interesting component of the Hall study which was prescribed, as explained in correspondence to me, to prevent the usual decrease in physical activity that occurs when people spend many days as inpatients on a metabolic ward. The data supports that this was achieved. In fact the physical activity levels and energy expenditure recorded for this metabolic ward study (inside and outside the chamber) are quite impressive. The total daily EE measured during chamber stays (EEchamber) was over 2600 kcal/day for both diets. Physical activity expenditure on days outside the chamber (PAEnonchamber) and total daily EE certainly suggest that the participants were far from sedentary and in fact quite physically active. Assuming sedentary energy expenditure (EEsedentary = SEE + AFT) was consistent and similar inside and outside the chamber – and there is no reason why this wouldn’t be the case – the total daily EE when outside the chamber exceeded 3100 kcal/day and 3300 kcal/day for the HC and VLC diets, respectively.
For the HC diet for example, total daily EE when outside the chamber would approximately equate to:
EEsedentary + PAEnonchamber
(1.34 kcal/min x 60 x 24) + (1221 kcal/day) = 3151 kcal/day (See table 2 below).
In my mind, total daily EE and physical activity of this level in similar free-living adults is not representative of sedentary levels of activity. It would therefore surprise me if total daily physical activity EE of these participants, prior to this study, was this high. This may go some way in explaining the unintentional weight loss that occurred during this study. The combination of the daily clamped cycling exercise (∼300 kcal/day) and the increased SPA outside the chamber (>500 kcal/day) appears to have contributed to the overall state of negative energy balance and concomitant body composition changes.
Physical activity EE outside the chamber (PAEnonchamber) was found to be 126 kcal/day higher but was statistically nonsignificant at the end of the 2 month inpatient stay. This was a sum total of: 1) energy expenditure for 90 minutes cycling at a clamped intensity (EEexercise) and; 2) spontaneous physical activity (SPA) energy expenditure.
Components of Total Daily Energy Expenditure
Given that the low intensity cycling was performed at a clamped intensity and based on the data that no difference existed for EEexercise for both diets during chamber stays (see table below), it is reasonable to assume that EEexercise when outside the chamber would be similar for both diets too. The 126 kcal/d difference between the HC and VLC diets in PAEnonchamber can only be accounted for, then, by increased SPA. The authors of this study allude to this in their discussion (pg. 332) saying: “Despite slight positive energy balance during the chamber days, the overall negative energy balance amounted to ∼300 kcal/day and was likely due to greater spontaneous physical activity on nonchamber days.” However, the exact increases in SPA outside the chamber were not directly reported in this paper. Obviously, it is important to recognize and indeed be reminded before exploring the possibilities that could explain this increased nonchamber SPA, that there was no statistical significant difference shown for PAEnonchamber. As such, the discussion below is largely speculative and purely an exercise in intellectual curiosity.
Notwithstanding, the difference may be related to:
The time spent on the metabolic ward caused behavioural-induced SPA alterations.
The VLC diet had a direct modulating effect on SPA.
Increased SPA was influenced by increased fitness and/or fat loss over the course of the study.
Time spent on the metabolic ward led to behavioural-induced SPA alterations
The first explanation posits “that the subjects’ behaviour was affected by the time spent on the metabolic wards” with subjects anxious to finish the inpatient study. However, this explanation whilst appearing sound in theory is not supported by the results of the study. For this behavioural-induced increased PAEnonchamber explanation to be consistent and valid, you would expect to see by the end of the study as well, the same type of relative change in PAEchamber. That is, both SPA inside and outside the metabolic chamber would change in a comparable way, both in direction and relative magnitude. This was not the case though with SPA inside the chamber being lower, albeit minimally, in the VLC phase of the trial compared to the HC diet (0.1963 vs 0.2241 kcal/min; p=0.0102). This corresponds to ∼40 kcal difference over 24 hours – a statistically yet arguably clinically irrelevant difference. In contrast, SPA outside the chamber was non-statistically higher for the VLC vs HC diet. It is this discordance for chamber vs nonchamber SPA and diet type that makes it unlikely that behavioural change drove the increased PAEnonchamber by the end of the study.
SPA was directly impacted and increased by the VLC diet
Supporters of the “metabolic advantage” theory would interpret the higher PAEnonchamber (due to increased SPA) as suggestive that the VLC diet had a direct impact on physical activity levels. But how precisely or by what mechanism(s) decreasing dietary carbohydrates translates into increased physical activity EE is anyone’s guess. I am yet to be convinced and have found no compelling research that altering the macronutrient composition of the diet alters SPA in any significant way. Furthermore and as discussed above, SPA for both diets differed for PAEchamber versus PAEnonchamber. The question then is why would SPA increase when outside the chamber and decrease when inside the chamber when the VLC diet is compared to the HC diet? If diet truly changed this parameter of energy expenditure, a consistent effect would be expected irrespective of setting.
Increased fitness and/or fat loss led to increased SPA
Another possible explanation for the increased PAEnonchamber is that a training effect of the low-intensity cycling and accompanying weight loss affected SPA levels. As such, my proposition is that this is not directly related to the dietary intervention at all. Let me explain. Not knowing how active or inactive the participants were prior to entering this study (I’m assuming given the description that they were not doing much physical activity at all in the lead up to the study), it is plausible that the 90 minute cycling performed each day during the study was over and above what they were doing beforehand.
If that is the case, logic would suggest that it is probable that participants would have increased their cardiovascular fitness over the duration of the study despite the clamping of exercise intensity, being confined as an inpatient to a metabolic ward and spending 16 days over 2 months in a metabolic chamber. As mentioned above the low intensity cycling was included in an attempt to offset the usual decrease in physical activity that occurs during metabolic ward studies. Whilst sedentary-like behaviour can mitigate the positive effects of aerobic exercise, the data for PAEnonchamber and total daily EE suggest that such behaviour was largely curtailed. This supports the possibility that the combination of the cycling exercise and high levels of SPA facilitated increased cardiovascular fitness.
This improvement in fitness and concomitant fat loss may have, then, inadvertently affected SPA with increased expenditure during the 2nd month of the trial. There is some evidence that exercise, improved fitness and fat loss lead to increased SPA in some people. In a study by Manthou et al (2010) which explored the behavioural compensatory adjustments to exercise training in overweight women, the loss of weight/fat mass or lack thereof, was attributable to an increase or decrease in SPA, respectively. Physical function and peak oxygen consumption has also been shown to improve significantly more in older obese men randomized to an exercise-diet intervention (with accompanying weight loss) compared to a diet-only group (with accompanying weight loss) or exercise-only group (with no weight loss), with improved functionality and fitness correlated to increased levels of SPA. This explanation has one major caveat however with an underlying assumption that SPAchamber remained unaffected by improved fitness and fat loss due to a curbing effect of confinement. This is a big assumption which thereby leaves us with our last explanation and basically brings us full circle to what the results originally showed.
That no real difference existed as suggested by the statistical analysis
The final explanation is that PAEnonchamber and SPA did not differ between diets. The most compelling evidence to support this is that no meaningful difference was found between diets for fat loss or body composition. If such a difference in SPA actually existed, a difference in body composition should have been detectable.
Final remarks
The recent study conducted by Kevin Hall, Kong Chen, Juen Guo, Yan Lam, Rudolph Leibel, Laurel Mayer, Marc Reitman, Michael Rosenbaum, Steven Smith, B Timothy Walsh and Eric Ravussin demonstrated that a VLC diet was no more effective compared to a HC diet for reducing body fat. Increases were detected in EE for the VLC diet but the clinical relevancy is of dubious value given that this was a transient phenomena, significantly decreasing linearly over time with EE returning to baseline by the end of the study. The results provide further confirmation of the fundamental physiologic principle of energy balance and reinforce that a sustained energy deficit results in weight loss regardless of macronutrient composition of the diet. Despite insulin secretion and respiratory quotient being dramatically reduced during the VLC diet, no enhancement of fat loss was evident. This provides compelling evidence that the regulation and storage of fat in the adipose tissue is far more complex and nuanced in humans, with insulin not always playing a predominant role. Further investigation and research is warranted to elucidate any appetite attenuating and metabolic benefits of higher-fat diets.
Disclaimer: All contents of the FitGreyStrong website/blog are provided for information and education purposes only. Those interested in making changes to their exercise, lifestyle, dietary, supplement or medication regimens should consult a relevantly qualified and competent health care professional. Those who decide to apply or implement any of the information, advice, and/or recommendations on this website do so knowingly and at their own risk. The owner and any contributors to this site accept no responsibility or liability whatsoever for any harm caused, real or imagined, from the use or distribution of information found at FitGreyStrong. Please leave this site immediately if you, the reader, find any of these conditions not acceptable.
