Wednesday, April 13, 2011

Why exercise may be crucial to weight management

Don't worry folks, I'm OK.

Saw a lovely patient the other day. She'd been doing great with our program, had lost 7% of her body weight, and was thrilled to pieces.

About a month ago however, she developed an injury, and as a consequence, her exercise dropped down to nothing.

Wanna know what else dropped down to nothing?

Her healthy eating behaviours.

She stopped food diarizing, snacking, including protein, and having enough calories for breakfast. As a consequence, she's started struggling in the evening again and has gained a few pounds.

As far as her exercise regime went, it wasn't marathoning. She was walking some, and doing short group fitness classes 2-3x per week. I'd be surprised were she burning more than 750 calories a week through intentional exercise.

Yet that small bit of intentional exercise was sufficient to help fuel her healthy living attitudes and behaviours as a whole.

I've seen this pattern hundreds of times.

That's why despite raging against the notion that exercise alone is sufficient for significant weight loss, and regularly stating that exercise should never be promoted singularly for weight management, I include exercise as an integral component of our office's program. It's also why I think that for most, psychologically and practically, exercise has a crucial and relatively unexplored scientific synergy with dietary caloric reduction.

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  1. Amen. Not only can it help with weight loss, it is part of a healthy lifestyle - gives us energy, good for the heart, blood flow, etc. and helps us generally feel better,.
    When you feel good, you do good. What's not to love about activity?

  2. If nothing else, when I'm exercising, I'm not mindlessly eating out of boredom!

    Still, I wouldn't discount the contribution of the 750 cal/week even if it's just that and no other changes due to preservation of LBM and all that. That's one rather nice treat a week, or several small ones - like one of those Starbucks mini bites every other day?! Just a thought that nightmares can be turned to sweet dreams...

  3. For people tracking their calories, sure - that 750 might be something to play with.

    For those who aren't, well then there's the slippery slope of not necessarily earned over indulgence, which in turn is another reason why I do champion caloric awareness.

  4. Anonymous9:17 am

    I always find that there is a synergy between my eating and my exercsing. If I exercise I eat better. Maybe it is becaue my body needs better fuel so that I can keep up the effort, maybe it is because I mentaly feel that if I am going to go to the trouble of exercising then I might as well eat better. What the connection is matters less than the fact that I know it is there. I personally eat better when I exercise and exercise more when I eat better.

    Hmmm - you would think knowing the pattern I would be able to stick to it . . . there's the rub isn't it!

  5. Anonymous9:25 am

    You know, I really think you should relegate "unexplored" to doctors who make their livings with drugs and surgeries.

    Because it's NOT unexplored among the exercise physiologists, who are scientists.

    And it's not unexplored among people who have used it to rehab physical injury, or those who are permanently physically disabled.

    Nor is it unexplored among those who struggle to maintain emotional health, without the determined enslaught of drug pushers (that'd be almost the whole of the medical profession) who prefer to write prescriptions for mood altering drugs which have no benefit in non-industry funded medical literature, but plenty of harm including weight gain.

    Nor is exercise unexplored among the few but growing numbers of your colleagues in Europe who do not rush to prescribe and cut, but instead counsel their clients, not first, but only, to health conditions.

    Sadly I think it will be patients who will turn this sick pharma juggarnaut around and get the medical profession back to healthcare.

  6. Anonymous9:38 am

    This para should read:

    "Nor is exercise unexplored among your colleagues in Europe who do not rush to prescribe and cut, but instead counsel their clients, not first, but only, to health conditions."

    I have (somewhere) an electronic PDR for Swedish physicians which, unlike the PDRs here, is not written by pharma, for drugs. But why a committee of Swedish physicians acting under the Swedish "FDA". The 600-something page tome has chapters on all the major health conditions, how to prescribe and what, to the suffers to ease them to best health. The doctors actually write out exercise "prescriptions" from a prescription pad (letter size), monitor the exericse, increase, decrease, tweak, as needed. How do they find the time? I imagine when you are not seeing detailers, treating the side effects of drugs with more drugs, and patients are educated NOT to turn to chemicals for health, there is time; when direct to consumer advertising is not allowed, and pharma does not control medical schools, medical education and CME.

  7. I just listened to Larry McCleary (author of 'Feed Your Brain, Lose Your Belly') talking about this on a Jimmy Moore podcast (starting 41:30). He described it as exercise helping people "get in touch with their bodies" more.

    I just had my fourth high-intensity strength training session yesterday. I am loving this (am getting such an endorphin rush, I really wish it was more than once a week!), too bad it's hurting me on the scales ;).

    Anyways, I am with you on exercise being crucial -- though I think there's way too much emphasis on aerobic exercise and calorie-burning (I subscribe to the ancestral health approach). Then again, I guess the best exercise is the exercise you'll do regularly!

  8. You are absolutely right. The science of exercise is not yet paved in GOLD and isn't quite there yet. But I wouldn't dream of trying to help someone lose BF or reverse disease without exercise.

  9. Anonymous12:28 pm

    Here's the site for the Swedish Exercise as Prescription PDR Yoni. Would make a nice edition for your desk. You could then relegate the pharma PDR to doorstop, or a step-up for calf raises.

    It's called FYSS, which is a play on the Swedish acronym used by pharmas for their PDRs.

  10. Thanks for all the Swedish sleuthing!

  11. Anonymous2:11 pm

    Apparently they've brought out a partial translation. At the link.

    (Like we don't have half of Sweden here anyway.)

    I do recall sending an electronic copy of the Swedish edition to Brian Goldman.

    Me: How's your Swedish Dr. Goldman?"

    bg: Based on what you've posted, my Swedish ought to get a lot better. We will definitely do a follow up story on this, so thanks a lot for sending it in!

    Brian Goldman, April 11, 2008 9:17 AM

  12. Anonymous4:03 pm

    Having committed in a fun but serious way to one particular form of exercise (the fun but serious part is doing it competitively, with other amateurs), I've found lots of motivation for keeping up healthy eating and have even lost some weight with what seems like no effort at all. The big difference is that I think of myself as an 'althete' now. I want to eat well so I can perform the best I can!

  13. Well written! Personally, 750 cal in a week is not bad at all for busy people that doesn't really go to gyms or performs regular exercise.

  14. Rhodia11:41 am

    I wonder if part of it is due to a cognitive distortion: black and white thinking. It's all or nothing. I am ON the wagon or I am OFF the wagon. If I am not exercising I must be off the wagon, therefore I will not think about eating well.

    It's the same kind of thinking that says "oh no I ate two cookies, I've blown my diet, may as well eat the whole box".

    Like a previous poster, I find that thinking of myself as an athlete helps enormously. I used to be of the "exercise as nasty medicine" mindset. It's good for you, so suck it up. Force yourself to do some boring aerobics or spend some time on the boring exercise bike, then you can cross exercise off today's to-do list. If you overeat that boring hard work was all for nothing, you are undoing it.
    Now that I am a runner who participates in races regularly, I do not just exercise to work out, I exercise to train and improve and beat my personal record at a given distance. And I need food as fuel.

  15. Performing exercise supports her self-image as a healthy, weight-losing person, yet it's a new activity for her. So when she is forced to stop exercising, her self-image reverts back to the old, not healthy overeating person.

    The cure, as for many self-improvement issues, is to think long term and get more information. Almost every serious athlete in the world has suffered injuries and been forced to take time off from training.

    So unless she's suffered a truly traumatic, disabling permanent injury, she'll soon be back on the road, and this brief speed bump will be just a memory. However, it can be hard to think like that while you're laid up, especially without the experience to have perspective.