Personal trainers and you have the solution to the biggest health care predicament we have ever been faced with—obesity. Obesity is an epidemic. Globally, more than 1 billion adults are overweight—at least 300 million of them clinically obese.
The obesity and overweight epidemic pose a major risk for serious diet-related chronic diseases, including Type II diabetes, cardiovascular disease, hypertension and stroke, and certain forms of cancer. The health consequences range from increased risk of premature death, to serious chronic conditions that reduce the overall quality of life and cost each and every one of us some serious cash.
Whether or not you are fat, you are paying for it; and not just your insurance premiums either. Let me give you an example: I just recently flew back from a conference in New Orleans.
My luggage was twelve pounds too "heavy", so I was charged another $80.00 for the flight. The kicker was the lady that checked in front of me, for the same flight, easily took up three of the seats on the plane. Did she have to pay $80.00 for every twelve pounds she was over "heavy"? Of course not. The examples go on and on.
Stop Worrying About Fat
Now, I am not writing this to cut on people who are overweight (I just had to complain to someone about that incident...). I am writing this to encourage each and every one of you reading it to become actively involved in helping with the obesity epidemic. How?
You have the solution to obesity. You practice it every day. You preach it every day. A number of you write about it every day.
The solution to obesity is to stop worrying about fat. The solution to obesity is to stop worrying about scale weight. The solution to obesity is to increase muscle, and no one knows how to do that better than many fitness related online communities.
Recently, at the same conference I referred to earlier, the key note speaker was a gentleman named Joe Flower of "Imagine What If, Inc." Mr. Flower is a medical futurist. He analyzes trends in medicine and medical care and predicts upcoming events based on current problems and past elucidation.
He was asked, in no less term, how do we fix the current crisis in health care? His response was not universal health insurance, nor was it lessen health care costs. It was: "Fix obesity!"
Why are fitness websites and all of its members, personal trainers and surfers the solution to obesity? Because all we care about is muscle! Muscle is the secret to not only what we all strive for, but the solution to the obesity problem.
Focus On Building Muscle
I am convinced that the problem is not that we are overfat, but that we are undermuscled. An outsized share of our medical dollar is being spent on lifestyle related conditions such as high cholesterol, heart disease, elevated blood pressure, reflux disease, strokes, falls in the elderly, osteoporosis, etc. (Another way of saying this is chronic disease related to poor lifestyle behaviors accounts for more than two thirds of deaths in the United States (1)).
In light of this, we have been "attacking" the fat everywhere you turn without even a dent in the problem. Why? Maybe our focus is wrong. Maybe we should be focusing on a better, longer term solution. Maybe we should be concentrating on building muscle in everyone rather than just loosing fat.
In my clinic in southeast Idaho, I run the busiest weight loss practice in the region. One of the primary reasons we are so busy is all I focus on is muscle. I do not care what someone weighs, or what their percentage body fat is. My only concern is their lean mass.
How much muscle does this person have, and how much can we build on them using proper diet and exercise techniques? Lean mass is the end point for my dietary, nutritional, and exercise recommendations, and our success, both long and short term, speak for themselves.
The first thing I tell each and every one of my patients is: "My goal working with you is to put as much muscle on you as the good Lord will allow."
Let me provide you with a little more detail: The first reaction I get when I mention this approach from just about everyone except bodybuilders is: "I do not want to look like Arnold Schwarzenegger!"
Mind you, the people fearing this are usually consulting me for weight loss, and the last thing they want is to discuss any form of weight gain. But if there was ever a more important group to focus on with increasing lean mass, I cannot think of them.
As you are well aware, ONE (indicating there are others not discussed here) of the causes in the development of obesity is energy imbalance over a prolonged period of time. Energy in (eating) exceeds energy out (exercise). The alteration of this imbalance can be obtained by varying one or the other.
As outlined in many excellent fitness articles on the internet, total energy outflow is the sum of resting energy expenditure (REE), the thermic effect of food (TEF) and the energy used related to exercise (TEE). Under most circumstances, REE is the largest component of total energy expenditure (2).
A number of factors direct REE such as your age, height, genetics, environmental temperature and muscle mass, the only controllable one of the list is your muscle mass. Muscles control REE by the synthesis and break down of muscle protein, so the more muscle you have, the more turnover, the greater number of calories expended.
To give you real numbers: muscle protein synthesis ranges from 0.23 to 0.90 kg/d, once again, dependant on the amount of muscle present. Four mol of ATP are utilized per mole of amino acids incorporated into protein (3) and the hydrolysis of 1 mol ATP releases 20 kcals of energy (4). This means that the energy released per day as a result of muscle protein synthesis may be as high as 500 kcal/d in a young man with 55 kg of lean mass.
Continuing with our real number example, a difference in REE of 500 kcals, based on muscle protein turnover and therefore muscle mass would lead to a gain or loss of 65 g of fat per day (1 Kg of fat is 7700 kcal).
If all things remained constant (no changes in diet or exercise) this would mean that an REE variation of 500 kcal would equate to a gain or loss of 1.95 Kg of fat a month (4.29 lbs). This estimate is actually low, as I have not accounted for the energy expended with the hydrolysis of ATP by way of protein breakdown.
Roughly five pounds of fat a month for an over fat person is colossal! Notice I said FAT loss, not weight loss. I spend half my life arguing with people about the importance of differentiating fat from muscle when it comes to the scale (Measuring Fat: The 'Skinny' On Techniques ). This is where you come in yet again. What group of people distinguishes, follows, tracks, and ponders muscle vs. fat with more vigor, intensity, and research?
Focusing on muscle instead of scale weight does three primary things:
1. You Focus On Metabolism
Every "diet" out there that utilizes scale weight is a setup for long-term failure. It only takes 363 kcal to burn a pound of muscle off your body, but it takes 3500 kcal to burn a pound of fat from your body. Starving someone by putting them on a major caloric deficit eating plan will most likely see muscle loss.
The body is very good at protecting fat in the face of "famine". When you focus on muscle, your shift goes from losing pounds to increase muscle, and as we discussed above, you increase your REE (i.e. your metabolism)!
2. Disease Prevention
As I stated above, fat is not the only culprit in our disease ridden society, the lack of muscle is as well. It has been proposed that the metabolic changes of a majority of lifestyle related diseases such as insulin resistance and diabetes occur before you get fat, and therefore fat is yet another indicator of inadequate hormonal, cellular, and biological function.
Focusing on building muscle prevents that. Another prime example is that with osteoporosis: maintenance of adequate bone density and strength is decidedly dependent on adequate muscle mass and function.
3. Long-Term Success
When you fix someone's metabolism with proper nutrition and exercise (i.e. you build muscle), you enable them to maintain the fat loss by, once again, increasing their metabolism and teaching them the ways to maintain it.
One of the arguments for dietary "fads" such as low-carb dieting has been lack of long term maintenance. This factor is twofold in my opinion because low-carb dieting burns fat, end of story, no argument there—however—as any bodybuilder will tell you, you have a heck of a time building muscle without carbs.
Burn fats without building muscle and you have long term failure. Use low-carb dieting for short runs(5) and build muscle with proper nutritional and exercise techniques and you have long term success. Any bodybuilder can tell you that.
How Can We Fight Obesity?
So how can we as a group of dedicated, muscle minded meat-heads change the world and put a dent in our obesity problem? The first step is to appreciate the fact that we have the solution.
As I said above, the resolution of our obesity problem in this country can be found in many different places. Second, I think personal trainers need to be reimbursed by insurance companies, just like medical providers. This is a daunting task, but we are in the process of trying to put it to value. Until this appropriate recognition is realized, health clubs, personal trainers, and fitness related websites need to petition doctors, physician's assistants, and nurse practitioners.
We need to be in the face of the medical community and show them we know how to help these people. One simple way to do this is to take the pharmaceutical representative approach. Call a doctor's office, offer to bring in a healthy snack or lunch for 20 min of the doctors time. Then, once in front of the doctor (or PA, NP), tell them of your services, give them some cards or even a mock prescription pad with your information on it and a simple check list of the type of exercises or plans you offer.
Before you know it, you will be getting referrals from that health care provider based on that simple presentation. Health clubs need to do the same; let the medical community know you are available, willing and capable of helping fight the obesity epidemic and improve their patient care.
Web sites and nutritional stores need to let the medical community know that a lot of their supplements are not just for the gym rats. The multiple arrays of protein choices and amino acids, as one example, are of and can be greatly beneficial to any person, no matter what the physical condition.
Studies have shown that both muscle mass and strength are improved by increasing the availability of amino acids, even in the complete absence of activity!(6)
In summary, I encourage each and every one of you reading this to get actively involved with teaching others about the benefits of building muscle. The building and maintenance of a large muscle mass and consequent muscle protein turnover can contribute to not only the prevention of obesity, but all of the lifestyle related medical conditions.
I will continue to do my part; talking to the medical community about proper nutrition and exercise and providing tools for them to utilize the power of food in their offices and with their patients. I would ask that you too become involved with helping others see what we all have known for a long time! Until next time: Train with your Brain!
- Anderson RN, Smith BL. Deaths: leading causes for 2002. National Vital Statistics reports. Vol 53. Hyattsville, MD: National Center for Health Statistics, 2005. (No. 17.)
- Schoeller DA, Ravussin E, Schutz Y, Acheson KJ, Baertschi P, Jequier E. Energy expenditure by doubly-labeled water: validation in humans and proposed calculations. Am J Physiol Endocrinol Metab 1986;250: R823-30.
- Waterlow JC, Garlick PJ, Millward DJ. Protein turnover in mammalian tissues and in the whole body. Amsterdam, Netherlands: North Holland Publishing Co, 1978:753.
- Newsholme EA. Substrate cycles: their metabolic, energetic and thermic consequences in man. Biochem Soc Symp 1978;43:183-205.
- Willey, JW. Better Than Steroids. 2006. Pocatello, Idaho. Trafford Publishing.
- Paddon-Jones D, Sheffield-Moore M, Urban RJ, et al. Essential amino acid and carbohydrate supplementation ameliorates muscle protein loss during 28 days bedrest. J Clin Endocrinol Metab 2004;89:4351- 8.