1. Fitting into Skinny Genes? The Real Reasons We Struggle with Weight Loss Graeme Thomas, MSc.

2. Weight Loss 101 “Energy can neither be created nor destroyed. It can only change forms.” Calories In = Calories Out

3. We “Know” More About Dieting Than Ever

4. Obesity Trends* Among U.S. Adults BRFSS, 1985 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% BMI: Body Mass Index, 20-25 is ideal

5. Obesity Trends* Among U.S. Adults BRFSS, 1986 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%

6. Obesity Trends* Among U.S. Adults BRFSS, 1987 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%

7. Obesity Trends* Among U.S. Adults BRFSS, 1988 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%

8. Obesity Trends* Among U.S. Adults BRFSS, 1989 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%

9. Obesity Trends* Among U.S. Adults BRFSS, 1990 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%

10. Obesity Trends* Among U.S. Adults BRFSS, 1991 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

11. Obesity Trends* Among U.S. Adults BRFSS, 1992 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

12. Obesity Trends* Among U.S. Adults BRFSS, 1993 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

13. Obesity Trends* Among U.S. Adults BRFSS, 1994 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

14. Obesity Trends* Among U.S. Adults BRFSS, 1995 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

15. Obesity Trends* Among U.S. Adults BRFSS, 1996 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

16. Obesity Trends* Among U.S. Adults BRFSS, 1997 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24%

17. Obesity Trends* Among U.S. Adults BRFSS, 1998 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24%

18. Obesity Trends* Among U.S. Adults BRFSS, 1999 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24%

19. Obesity Trends* Among U.S. Adults BRFSS, 2000 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24%

20. Obesity Trends* Among U.S. Adults BRFSS, 2001 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29%

21. (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) Obesity Trends* Among U.S. Adults BRFSS, 2002 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29%

22. Obesity Trends* Among U.S. Adults BRFSS, 2003 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29%

23. (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) Obesity Trends* Among U.S. Adults BRFSS, 2004 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29%

24. (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% Obesity Trends* Among U.S. Adults BRFSS, 2005

25. (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) Obesity Trends* Among U.S. Adults BRFSS, 2006 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

26. 1998 (*BMI 30, or about 30 lbs. overweight for 5’4” person) 2006 1990 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% Obesity Trends* Among U.S. Adults BRFSS, 1990, 1998, 2006

27. Oh Canada?

28. In under 30 years, obesity rates have doubled! The Shocking Reality

29. Is Weight Loss Rocket Science?

30. Things Weight Loss Experts Historically Have Told Their Clients… Calories In = Calories Out Burn More Calories Through Exercise To Lose More Weight “Everything in Moderation...” and you need to eat “a balanced diet...”

31. Weight Loss 101 “Energy can neither be created nor destroyed. It can only change forms.” Calories In = Calories Out

32. Energy Balance 1 lbs of fat = 3500 kcal Expenditure  Basal metabolism  Activity  Digestion Input  FAT 9 kcal/g  CHO 4 kcal/g  PRO 4 kcal/g  Alcohol 7 kcal/g

33. Clearly We Have a Balance Problem!

34. Weight Loss Prescription 1.1 lbs of fat = 3500 kcal 2.A deficit of 500 kcal/day  1 lbs fat loss per week Yet our failure rates with diets are well over 90%!

35. Health Experts Suck at Math! If we accept an excess of: 3,500 kcal  1 lbs of fat Then to gain 5 lbs in a year: 5 x 3500 kcal  17,500 kcal Which means our balance is “off”: 17,500 kcal / 365 day  47.8 kcal/day!

36. Dietary Intake Patterns From 1991-2001: Increased our consumption by over 400 kcal/day! +400 kcal/day predicts a weight gain of ~42 lbs a year!!

37. How to Become a Millionaire…

38. Making Weight Loss a Math Equation Currently, > 90% who lose weight on a diet will regain it all back!

39. So Where Have We Gone wrong? aka What Do We Think We Know…

40. The Question We Are Going To Answer Is Exercise or Diet More Important For Getting Lean? The Obvious Answer… Yes

41. Exercise: Confusion, Lies and just plain bad science

42. The Exercise Challenge Regular Exercise for 16 months Young men and women (avg age: ~22 and ~24) 20 – 45 minutes a session, 5x/week Goal: 400 kcal per session or 2000 kcal per week Exercise Intensity Males: 154 ± 11 bpm; 77% max HR Women: 156 ± 9 bpm, 80% max HR Donnelly et al. (2003) Arch Intern Med. 163:1343-1350

43. Exercise and Body Weight * *

44. Exercise and Body Fat *

45. The Very Important Conclusion Men are Losers!

46. But Seriously, Guys are Losers Men: lost 5.2 kg Women: remained weight stable Size differences? During exercise Men average 6.7 ± 0.8 kcal/kg Women average 5.4 ± 1.1 kcal/kg Men burn ~20% more energy doing exercise of the same intensity! Key Concept Females should not base their fat loss efforts around steady state exercise!

47. Your Metabolism Is Smarter Than You Are Sullivan EL & Cameron JL. (2010). Am J Physiol Regul Integr Comp Physiol

48. How Do You Compensate? King et al. (2008) International Journal of Obesity, 32, 177–184 12 weeks 5 exercise sessions per week 500 kcal expended per session Average weight loss Exercise a ton, gain more weight !

49. Steady State Exercise Summary Key Fat Loss Concept: For most females, simply exercising more or dramatically cutting calories rarely works. More is not better, better is better.

50. Hold The Phone Guys…

51. Fat Loss is a Hormone Problem

52. Body fat is designed to regulate itself!! Humans are not optimized for weight loss Obesity no longer just a disorder of simple caloric excess Fat incredibly metabolically active Leptin, estrogen Weight Loss Revelation

53. Energy Has to Balance Here…

54. So If Exercise Doesn’t Work, It Must Be All Diet…

55. 12 Week Makeover? Weight Watchers vs. Gold’s Gym Quick Start Ball & Bolhofner (2008). Journal of Exercise Physiology, 11, 1-9. 43 subjects Initial body fat ~40% WW: given diet/exercise advise, weekly weigh-ins GG: 3x weight training + additional cardio Unsupervised

56. Body Weight * (kg)

57. % Body Fat

58. In other words Exercise alone Not much weight or body fat change Often increases hunger Calorie restriction-only plans You might lose weight But remain a smaller version of your previous self

59. So How Does Exercise Actually Help With Weight Loss?

60. But how exactly do we accomplish this? Mission Thin-Possible 12 Week Weight Loss Context Starts Sept 19 th 1 Grand Prize Winner wins $10,000 Expert training guidance + nutrition seminars Massive boost to accountability

61. Resistance Training During a Diet Over this 10 week study, older (mean age of 67 years), overweight individuals were placed into one of two conditions. Diet alone (DASH): a 10% reduction in total calories Diet + exercise (DASH+RT): same reduction in calories + 3 full body resistance training sessions 1. Avila et al. (2010), Effect of moderate intensity resistance training during weight loss on body composition and physical performance in overweight older adults, European Journal of Applied Physiology, February 2010 Key Concept: During a period of calorie restriction, it is imperative to resistance train, in order to preserve lean mass.

62. Training Long vs. Training Hard Endurance training 3x week 2 weeks each 30-45-60 minutes @ 65% VO2max Total exercise time: 13 ½ hours Sprint training 3x week 4-6 30-second max effort sprints 4 minutes of recovery Total exercise time: 6 ¾ hours (6 hours rest, 45 minutes work)

63. Fat Mass (kg) kg = Pre = Post **

64. Intensity is Key Endurance – Decrease 1.1% body fat – Lost 0.7 kg of fat mass Sprint – Decrease 1.8% body fat – Lost 1.7 kg of fat mass Exercise CANNOT undo a bad diet 30 minutes of exercise to burn 300 calories 30 seconds of donut eating to replace those calories...

65. Key Exercise for Fat Loss Take Away The important question is not many calories you burn during a workout… instead ask yourself: What kind of 24-48 hour impact is your training having? Calorie restriction will drive fat loss, exercise is vital to protect lean mass and influence fat loss hormones Lean mass protection is one of the strongest predictors of long-term weight loss maintenance If you aren’t already weight training, start now

66. What The Experts Missed… Intake Expenditure Resting Metabolism 50-70% Resting Metabolism 50-70% Digestion 5-10% Digestion 5-10% Physical Activity 10-30% Physical Activity 10-30% Food Harder to influence, but payoff is worth it! Substantial Control Total control Some control

67. For Next Time… Calories In = Calories Out Burn More Calories Through Exercise To Lose More Weight Mission Thin Seminar Series Program starts Sept 19th “Everything in Moderation...” and you need to eat “a balanced diet...”

68. Secrets to Weight Loss Success 1.I Know 2.I Do 3.I Am

69. Your Bonus 1.If you’d like a copy of these slides The “I know” 2.Diet Overhaul Handouts The “I do” Make sure you add your name and email address to the sign-up form being circulated Please print legibly!

70. What Are You Going to Do? “If I am not for myself, who will be for me? If I am not for others, what am I? And if not now, when?” - Rabbi Hillel