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Weight Management & Obesity

  • Water drinking may assist weight loss

    Water is one of the most mundane yet important substances on earth. Over 50% of our body is made up of water, with the average water content slightly higher in men than in women. Most of us probably have heard the slogan that tells us to drink 8 glasses (or 2 litres) of water a day and yet, it was reported that around 75% of the population in America (Australian data not available) may be suffering from chronic dehydration due to a lack of water intake or/and an excessive amount of dehydrating beverage intake. We don't drink enough water. While drinking water has obvious benefits such as thirst quenching and life sustaining, it is the weight loss effect of water drinking that motivated me to write this article and to share this unusual information with you.

    Drinking room temperature water (22°C) can induce a thermogenic response, partly due to the fact that the body has to warm up the water to 37°C after ingestion. How much energy does it take for the body process water? Boschmann et al found in 2 independent studies using healthy male and female subjects that drinking 500mL of room temperature water can increase metabolic rate by up to 30% over the course of 60 minutes after ingestion. This energy-burn generally begins from 10 minutes after water ingestion and reaches maximum at around 30-40 minutes after ingestion. It's estimated that 100kj of extra energy is spent by the body to process 500mL of water. That is 400kj of extra energy expenditure per day if you drink the recommended 2 litres of water, which is equivalent to roughly 20 minutes of moderate-intensity exercise. This may not seem much to some, but for those who want to lose weight, every calorie counts, especially when you can burn them by just drinking the recommended amount of water. The catch however, is that researchers found drinking a small amount of water (50mL) does not induce a thermogenic response, you have to do it in relatively large quantities, i.e. 500mL portions (Boschmann et al 2003 and 2007, Journal of Clinical Endocrinology and Metabolism). So the recommendation of 8 glasses of water 8 times a day should be modified into 8 glasses of water, 4 times a day, 2 glasses each time, if you want to take advantage of the thermogenic effect of water for weight loss.

    The timing of water consumption may also help with weight loss. It was found that premeal water consumption (again in 500mL portion) could significantly reduce energy intake during a meal. A 44% greater reduction in weight was also observed in middle-aged and older adults with BMI of 24 - 40 after 12 weeks of premeal water treatment while on a low calorie diet compared to those on a low calorie diet alone without the water (Dennis et al 2010, Obesity). Other studies have also confirmed the energy intake reduction property of consuming 375 - 500mL of water before a meal in healthy and obese adults aged 55 and above (Van Walleghen et al 2007, Obesity; Davy et al 2008, Journal of American Dietetic Association). However, this energy intake reducing effect was not observed in young health adults aged between 21 - 35 (Van Walleghen et al 2007). No studies that examined the effect of premeal water consumption on energy intake reduction in obese young adults were found during my literature research while writing this article. Therefore, while drinking 500mL of water before a meal may help you to lose weight by reducing energy intake if you are over 55, I cannot comment on the effectiveness of this strategy if you are under the age of 35.

    Drinking enough water can ensure good health and increase energy expenditure, which could help with weight loss. I hope this article gives you enough incentive to follow the doctor's recommendations on water drinking. Go fill up your glasses and drink up.

  • Protein consumption, calorie intake and weight loss

    We have discussed in the past the effect of high carbohydrate intake on weight gain. Although high carbohydrate intake is considered as one of the main culprits for promoting weight gain and having a low-carb diet is one of the most effective ways for weight loss, it is unhealthy and unsustainable to live on a low-carb diet for a prolonged period of time. Rather than deliberately trying to avoid eating carbohydrates, incorporating extra protein into your diet can really help to reduce appetite and calorie intake, hence to achieve a similar outcome as having a low carbohydrate diet. Losing weight from eating more rather than eating less certainly makes dieting a lot simpler and much more entertaining. So what can incorporating extra protein into your diet actually do?

    Increasing protein intake can increase diet-induced thermogenesis by up to 2 fold compared to having a high carbohydrate diet, which can in turn increase energy expenditure and satiety (feeling full and satisfied). A high protein diet can create a negative fat-balance and a positive protein balance, and can increase fat oxidation, at least in the short term (Westerterp-Plantenga 2008, Regulatory Peptides). A high protein diet that makes up 30% of daily energy intake can significantly reduce appetite and hence reduces daily calorie intake by around 441kcal per day and decreases fat mass by 3.7kg over a 12-week period compared to that of people on a weight maintaining diet with 15% of the daily energy intake from protein (Weigle et al 2005, The American Journal of Clinical Nutrition).

    Eating less carbohydrate will help to maintain body weight and assists weight loss. However, it is unhealthy to have no carb and on top of that, it's difficult to know the exact carbohydrate content of the food we eat, which makes carbohydrate reduction from our diet a real challenge. Eating more protein can reduce one's appetite for other food, increases energy expenditure and subsequently promotes weight loss. It's much easier to eat more than to eat less. Make protein at least 25 - 30% of your daily energy intake and the extra weight around your belly will go.

  • Calories are not created equal

    The balance of our body weight can be seen as an act of balancing energy input and energy expenditure. There are four subcomponents that contribute to energy expenditure: resting energy expenditure (the energy used to just stay alive), thermic effect of food (the energy needed to digest food), activity energy expenditure (energy used from doing activities) and total energy expenditure (the combination of the 3 above). Calories-in-calories out is the traditional model for weight gain and weight loss. Many professionals hold the belief that a calorie is a calorie, no matter what you eat. However, it has became more apparent that not all calories are created equal, some calories will make you burn more energy, through altering one or more of the 4 subcomponents of energy expenditure.

     

    A study conducted by Ebbling et al and published in the prestigious The Journal of the American Medical Association in 2012 compared the effects of three common diets, low-fat diet, low-GI diet and low-carb diet on energy expenditure. In contrast to the conventional recommendations, the study showed that the low-fat diet tested was probably the worst diet for weight loss and maintenance compared to the low GI and low carb diets. The authors concluded that low fat diet "produces changes in energy expenditure and serum leptin that would predict weight regain".

     

    In agreement with some available diet programs, the study showed that low-carb diet resulted in the highest resting energy expenditure and total energy expenditure in most test subjects compared to the low-fat and low-GI diets. Test subjects on a low-carb diet used on average 67kcal per day more resting energy than subjects on a low-fat diet and 29kcal per day more compared to those on a low-GI diet. The figures shown represented average data from all test subjects, there were of course exceptions, some people tested seemed to respond better and burn more energy on low-GI and low-fat diets. One has to choose what is more suitable for them based on their own experiences.

     

    Although low-carb diet is the most beneficial in terms of energy expenditure and a number of metabolic syndrome components, prolonged enforcement of this diet can increase the secretion of the stress hormone cortisol in the body. High cortisol levels may in turn promote fat gain, insulin resistance and cardiovascular diseases. Therefor, low-carb diet may not be a long-term solution to weight loss and maintenance.

     

    Low-GI diet on the other hand, appeared to be the most healthy and sustainable in the long run compared to the low-carb diet, even though the effect on energy expenditure was not as pronounced, it was comparable nevertheless and more effective than the low-fat diet.

     

    Altering the components of your diet based on how your respond to different foods can make a significant impact on the body's energy expenditure and consequently affects weight loss/maintenance. Reducing fat from your diet doesn't necessarily translate into fat loss. A low-carb diet may be an effective and safe short-term boot camp solution for some but may also be harmful in the long run for others. A low-GI diet might not have the impact of the low-carb diet but it may be good for weight maintenance. Different people will respond to different types of food differently and you will have to find what's best for you. Remember, not all calories are created equal.

  • Sedentary life style can be detrimental

    Having a sedentary life style doesn't just make you unfit or gain weight. A recent study by Schmid and Meitzmann and published in the Journal of National Cancer Institute meta-analysed data collected from 4 million individuals including 68,936 cancer cases concluded that there is an increased risks of chronic disease and mortality rate associated with sedentary behaviors such as watching TV.

     

    The study found that each 2-hour per day increase in sitting time outside your normal occupation is associated with an 8% increased risk in colon cancer, a 10% increased risk in endometrial cancer and 6% increased risk in lung cancer. The increased risks in these cancers appear to be independent of physical activity. This means spending a large amount of time sitting down could be detrimental to health even to those who do regular exercise. Sitting at work seems to be a lot healthier than watching TV, given that you don't over do it. A 2-hour per day increment in sitting at work has been found to increase the risk of obesity by 5%, whereas each 2-hour per day increase in TV time is associated with 23% increase in obesity risks.

     

    The mechanism of which sedentary behaviors cause cancer is unclear. However, the authors of the study speculated that unhealthy eating habits, vitamin D deficiency due to a lack of sun exposure, weight gain from low energy expenditure and an increase in pro-inflammatory markers in blood due to prolonged sedentary life style maybe the main culprits. Colon cancer and endometrial cancer are obesity related cancers. Therefore, the increased risks of cancer caused by sedentary life style may work through similar pathways, even if you are not obese.

     

    People today spend on average 50 - 60% of their time in sedentary pursuits and we are in the middle of an obesity epidemic. On top of that, it's forecasted by the US National Cancer Institute that 1 in 2 men and 1 in 3 women will bear the risk of developing some form of cancer by 2050 in the US, doubling the current rates. Doing regular exercise can reduce the risk of mortality and chronic diseases. The world health organization (WHO) recognizes this and recommends adults to do a minimum of 150 minutes of moderate intensity exercise each week. What the WHO guideline doesn't address is the amount of time spent by people in sedentary pursuits, which will cause an increased risk in cancer independent of physical activity levels. It is therefore recommended that one should consciously limit the time spent watching TV and other screen-based entertainments. It is also recommended that children and adults should breakup their sitting-down periods, let it be at work or watching TV, traveling on a plane or during long distant driving with interspersing intervals of standing or short exercises. We as humans are not built to cope with sedentariness, start moving and life will prosper.

  • Types of exercise and fat loss

    One of the biggest issues of the modern society is the promotion of physical inactivity due to the advancements of technologies and social media, which intend to restrict our movements to as little as possible with the world on your fingertips. The physical inactiveness, along with bad diet and deteriorating daily routines are the main causes of the current obesity epidemic and the increasing prevalence of a number of lifestyle related diseases such as type 2 diabetes, stroke, cirrhosis, cancers and heart diseases. The World Health Organization (WHO) recommends an adult to perform a minimum of 150 minutes of moderate intensity exercise or 75 minutes of vigorous intensity exercise or a combination equivalent of both each week for health benefits. Recent research showed that one needs to perform up to 2-3 times the WHO minimum in order to achieve maximum benefits from exercise. Just doing the number may not be enough though. For many who want to trim, the type of exercise you do can make a difference in how quickly and effectively you can lose fat. One should always tailor their exercise regime based on their goals in order to achieve optimal results.

     

    Resistance training VS Aerobic training

     

    Research has shown that resistance training can improve lean body mass and glucose tolerance. The role of resistance training in fat loss is more debated, some suggested that resistance training could increase resting metabolic rate, hence induce fat loss. However, many of the studies to date found that resistance training doesn't significantly reduce fat mass irrespectively of the resting metabolic rate compared to the placebo. The effect of resistance training on fat mass is therefore inconclusive and resistance training is not effective for fat loss.

     

    On the other hand aerobic training (65% - 80% peak VO2, 150 minutes or 20km equivalent per week) decreases both body weight and fat mass significantly compared to resistance training and is more effective for fat loss.

     

    A combination of resistance training and aerobic training has been found to further promote fat loss in diabetic patients but not in inactive, obese individuals compared to doing aerobic training alone. However, combing resistance training and aerobic training has been found to significantly decrease waist circumference compared to resistance training alone.

     

    High intensity aerobic interval training VS continuous moderate intensity aerobic training

     

    High intensity aerobic interval training (~90% VO2) can increase fat oxidation in a very short period and can significantly reduce blood lipid levels compared to continuous moderate intensity aerobic training (VO2 65% - 75%). It also burns more calories than continuously moderate aerobic training and has a higher post exercise energy expenditure. High intensity aerobic interval training has been shown to require only 50% - 60% of the time to achieve the same gain in fitness compared to moderate intensity aerobic training. However, it is more prone to injury due to the increased intensity and harder for people to adhere to the training program.

     

    Interestingly, one recently study by Keating et al. 2014 published in the Journal of Obesity suggested that although high intensity aerobic interval training is effective at fat loss and improves fitness, continuous moderate intensity aerobic training is better at improving fat distribution independently of weight loss in previously inactive, overweight adults.

     

    Taken all the information together, the best way to lose fat and gain good body shape is to combine high intensity aerobic interval training with moderate intensity aerobic training and resistance training. Balance is key. Talk to your fitness professional to properly plan your exercise regime in order to prevent overtraining and injuries and to achieve maximum benefits.

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