Weight Loss

Obesity: Age-Old Problem

The greatest enemy of knowledge is not ignorance, it is the illusion of knowledge.

—Daniel Boorstin, Historian

Excessive weight is a chronic health condition associated with complex physical, physiological, psychological and emotional issues (Wadden et al., 2002). As early as the 17th century, Tobias Venner (1577-1620), a British physician and medical writer, referred to obesity as a societal disease (Gilman, 2004). In recent decades, obesity has become one of the fastest-growing problems in the United States and worldwide, reaching pandemic proportions to represent a menacing threat to human health, productivity, and healthcare costs.

The World Health Organization (WHO) defines obesity as weight gain beyond the normal body mass index (BMI) limit. This measure is derived by dividing a person’s weight in kilograms by the square of his height in meters (kg/m2).  According to the Centers for Disease Control (CDC), BMI measurements for males and females are as follows: normal = 18.5–24.9; overweight = 25–29.9; and obese ³ 30. 

And the problem is still growing—which can only mean that comprehensive and effective solutions have not yet been found.

Why Conventional Weight Loss Programs Don’t Work

It is understood that basal metabolic rate (BMR) represents the minimum of calories required to sustain body functioning per unit of time at rest. Diets focused on overall caloric reduction were shown to fail as weight loss solutions by Dr. Ancel Keys in the 1950s. His research proved that as you eat less, the body starts to conserve energy, causing the calories burned at rest to decrease, with a 40% reduction in calorie intake leading to a 40% slowdown in BMR (Keys et al., 1950).

Lower calorie intake increases ghrelin, the hormone most closely associated with sensations of hunger, and reduces the satiety hormone to contributes to hunger. Accordingly, reducing nutrient intake from 2,000 calories (kilocalories or kcals) to 1,200 calories a day leads to a decline in basal metabolic rate, with only 1,200 calories metabolized. Additionally, as calories are restricted, hunger mounts, and motivation levels and sense of well-being fall. Low-calorie intake takes its toll, and the feelings of discomfort and depression accumulate progressively.

Very low-calorie diets (VLCDs) are hypocaloric diets that provide between 450 to 800 calories per day and are relatively enriched in protein of high biological value. They must contain the full complement of vitamins, minerals, electrolytes, and fatty acids. They are usually ingested in a liquid formulation and are intended to completely replace other food intakes as part of a weight loss program over a specific period. Widely used in the 1970s and 1980s, VLCDs have brought limited success in sustained weight loss (Tsai & Wadden, 2006).

Energy metabolism is a set of biochemical reactions occurring in a specific, biologically organized sequence within each cell to provide energy for movement, growth, development and reproduction (Judge & Dodd) (Britannica). Any modifications to the intake of macronutrients (like those artificially imposed through various diets) should consider the extent to which they may influence the efficiency of optimal metabolic and oxidative processes.

Bioavailability (BA) is a term used to refer to the percentage of an administered dose of a substance that reaches systemic circulation. The BA for dietary supplements can be described as the nutrient utilization of the distributed substance capable of being digested and available for use or storage. Approximately 5,000 publications are listed in the PubMed database for micronutrient bioavailability, and minimal conclusive evidence exists with respect to the definition and understanding of bioavailability in all contexts. Bioavailability is a challenging factor and presents significant uncertainties related to food component interactions which may be attributed to poor outcomes of most dietary plans. 

“Eat Less, Move More”—but Why?

The concept of “Eat Less, Move More” (ELMM) dominates most conventional weight loss programs. ELMM is a loosely-defined strategy with broad interpretations, often presented without scientific merit, and incorporating diet and exercise into weight management interventions. Despite ELMM having a long history of poor long-term results, with a high rate of regaining unwanted pounds, numerous exercise and nutrition plans for weight loss continue to follow this type of framework (Howard et al., 2006) (Tinker et al., 2008).

For centuries, weight management has been thought to be the most effective way to lose weight. In the meantime, obesity has turned into a health disease of global proportions in the US and worldwide. These outdated notions are still dominating current mainstream understanding. Amazon.com features approximately 18,000 books that offer mostly information confined to food, nutrition, diets and fitness workouts, which do not provide scientifically-vetted knowledge and accurate facts related to energy metabolism and do not discuss the principles of human movement supported by the science of biomechanics. The time has come to readjust the traditional frame of thinking and revise existing weight loss interventions to reverse the direction of this pandemic. 

Unfavorable outcomes of the “Eat Less, Move More” strategy were displayed during and after the NBC TV show The Biggest Loser (TBL) airing. The Biggest Loser is a reality television show that started in 2004 and ran for 17 seasons. It centered on extremely high BMI individuals attempting to lose the highest percentage of weight relative to their initial weight by employing long training hours and revamping their nutritional strategies, with the added goal of winning a cash prize.

A 2016 study published in Obesity Journal found that six years after participating in the wildly popular TBL competition, only one of the 14 contest winners weighed less than when they completed the contest. The remaining participants either weighed what they did when they joined the show or, in four cases, added weight—a discouraging overall failure rate of 93 percent (Fothergill, 2016).

These results underscore that the TBL weight management framework has not reflected the entire array of scientifically-sound considerations of energy metabolism to bring positive outcomes while taking a shortcut to success in meeting television network revenue goals.

Steady-State Movement and Physical Endurance

Steady-state movement (SSM) pace, duration, and intensity are paramount to building physical endurance obtained from this type of training and reducing overall mortality risk. Literature suggests that continuous or steady-state movement is an essential factor in cardiorespiratory health and building physical enduranceto support the lengthening duration of the activity, which in turn impacts physical fitness and athletic performance across most sports and human movement activities (Yoke, 2010).

Inadequate aerobic energy production is specifically linked to insufficient levels of physical endurance, limiting oxygenated energy supply for supporting prolonged physical efforts and compromising the development of physical endurance capacity.

The challenge in sustaining steady-state movement leads to physical endurance shortfalls, which can be directly associated with numerous potential problems such as immune system disorders, a higher risk of chronic diseases, and a loss of vitality needed to support an active lifestyle and engage in physical activities.

In addition, efficient functioning of energy metabolism ensures the proper response of the immune system, as immune cells require that their energy demands be met to support cellular viability and to perform specific immune functions.

Fat Oxidation, Weight Loss and Diabetes

 The fat oxidation process is not well-understood or widely discussed in clinical and fitness settings, despite research establishing a direct link between fatty acids oxidation (FA-ox) and the production of oxygenated biochemical energy through the aerobic metabolic pathway. The aerobic metabolic pathway has a significant impact on burning calories. Importantly, optimal FA-ox is subject to meeting steady-state movement determinants performed for a prolonged period at a moderate or vigorous intensity and consistent pace (Chávez-Guevara et al., 2021).

Oxygenated energy production is accomplished by metabolizing glucose, amino and fatty substrate compounds and oxidating fatty acids, which is meant to support steady-state physical activities such as walking, running, cross-country skiing, or cycling, for example. In contrast, unoxygenated (anaerobic) energy is supposed to sustain intense bouts of interval movement such as jumping, weightlifting, or sprints.

Most current weight loss programs recommend high-intensity interval training (HIIT) programs that are predominantly anaerobic. Systematic review and meta-analysis of the WL impact of HIIT have not shown clinically significant or reproducible reductions in body fat (Keating et al., 2017). Research has shown that steady-state exercise for obese individuals with high blood lipids is recommended as a primary training tool to minimize the risk of diabetes (Li D & Chen 2021).

The breakdown of triglycerides provides energy for submaximal exercise and contributes to FA-ox, with maximal FA-ox capacity occurring at exercise intensities between 45 and 65% VO2 max combined with carbohydrate oxidation.

Studies have found that a reduced fat oxidation capacity is commonly observed in obese individuals, and regular endurance training positively affects resting FA-ox (23%) and generates a wide range of adaptations that bring elevated fat oxidation outcomes (Berggren et al., 2008), (Shargel & Horowitz, 1999). The training modality may impact fat oxidation and the rate of the oxidative process (Shenk & Horowitz, 2006).

Research has shown that endurance training leads to peak fat oxidation (PFO), which may contribute to successful weight loss management (Nordby et al., 2015). These findings highlight the importance of weight loss Interventions targeted at improving FA-ox to have potentially widespread clinical significance for addressing obesity and type 2 diabetes—also known as adult-onset or non-insulin dependent diabetes—and its related health conditions.

Research has shown that endurance training leads to peak fat oxidation (PFO), which may contribute to successful weight loss management (Nordby et al., 2015). These findings highlight the importance of weight loss Interventions targeted at improving FA-ox to have potentially widespread clinical significance for addressing obesity and type 2 diabetes—also known as adult-onset or non-insulin dependent diabetes—and its related health conditions.

The Look AHEAD (Action for Health in Diabetes) trial is a large-scale randomized study conducted to assess aggressive lifestyle interventions in older adults with type 2 diabetes, compared with a diabetes support and education control group. In the study, the intensive lifestyle intervention group targeted weight loss of at least seven percent through a modest dietary energy deficit and approximately three hours per week of aerobic training performed without supervision. The intensive lifestyle intervention group achieved significantly greater sustained improvements in weight loss, cardiorespiratory fitness, blood glucose control, blood pressure, and lipids with less medication (Look Ahead Study, 2006).

High-Intensity Interval Training (HIIT)

While HIIT dominates the training protocols throughout the fitness industry and competitive sports landscape, it may cause adverse consequences to the long-term capacity of aerobic energy metabolism to perform steady-state movements.

It is imperative to understand that HIIT is an exercise regimen that relies heavily on unoxygenated energy and may put a significant strain on the body’s internal systems, lead to excessive deterioration of the human body, and may contribute to premature retirement from a physically active lifestyle and competitive sports when it is performed for an extended period. When the training intensity is increased up to 80% of the maximum heart rate, it may elevate cortisol levels, also known as a stress hormone (Hill et al., 2008).

A study in the Journal of Physiology found that glycogen depletion was elevated drastically when exercise intensity was increased; depletion was 2.7 and 7.4 times greater, respectively, at interval workloads demanding 64 and 84% VO2 max than training at 31% VO2 max. Even greater rates of glycogen utilization occurred at supramaximal musculoskeletal expenditures (Gollnick et al., 1974).

The findings of metabolic health research demonstrate that the highest exercise intensity caused a remarkable reduction in mitochondrial function that coincided with a disturbance in glucose tolerance and insulin secretion. The blood glucose profiles of world-class endurance athletes indicated impaired glucose control compared with a matched control group (Flockhart et al., 2021).

The American Council on Exercise (ACE) recommends that HIIT sessions be performed one or two times a week, at 30 to 40 minutes per workout; training should be limited to five or six weeks at a stretch instead of being a year-round fitness strategy.

Associate Professor Jinger Gottschall presented a study at the 2018 American College of Sports Medicine (ACSM) conference indicating that body movement intensity up to 90% of the maximum heart rate and beyond 30 to 40 minutes per session does not contribute to tangible fitness improvements and may compromise weight loss training effects.

As you recall, building a healthy heart and physical endurance requires maintaining a sustained flow of aerobic energy for an extended period. These findings raise questions about the scientific merit and benefits of high-intensity interval training.

The short bouts of intensity cause an irregular heart rate and a spike in high blood pressure, both of which are associated with the risk of heart disease. Arrhythmic heartbeat disrupts a blood supply to internal organs, and this condition warrants thorough testing to determine if the cardiorespiratory system might be compromised or require medical treatment.

The rapid changes in heart rate and blood pressure during HIIT cause an irregular heartbeat, while rhythmic functioning is a normal cardiorespiratory system operation. In the meantime, researchers, fitness and medical practitioners continue recommending HIIT training for building a healthy heart.

Further rigorous research is warranted to develop a better understanding and align the HIIT concepts with the scientific principles of human anatomy and physiology to resolve contradictions associated with the inconsistent guidelines of the fitness industry and medical fields. Contradictory outcomes must be reconciled when irregular heart rates represent a double edge sword that may simultaneously lead to fitness improvements and the risk of an adverse heart condition. 

Weight Loss Considerations from Bio-Mechanical Prospective

The term “bio-mechanical” refers to biological systems, particularly their structure and function, using methods derived from mechanics, which is concerned with the effects of forces on the motion of bodies (Brittanica).

Metabolism refers to the biochemical processes within the human body by which food is converted into a source of energy (Yadav 2013). Movement mechanics describe integrated mechanical interaction among bones, muscles, tendons, joints and neuron cells within the muscular, skeletal and nervous systems collectively called the human movement system (Lu TW & Chang). It is proposed that the integrated functioning of body movement mechanics and fat oxidative processes is an effective way to burn calories and accomplish weight management in the long term.

The current understanding of human movement mechanics as described by gross anatomy is limited to considering the body movements and parts visible to the naked eye. I am introducing an alternate way of thinking that views the human body entirely—which includes body parts and movements that are not readily visible—to represent a complete skeleton structure.

It is understood that the skeletal joint motions are an integral part of the movement mechanics framework that play a major role in muscular force production, and joint movements are not rendered evident to the unaided eye. The structure and function of motion mechanics related to human movement and implementation in clinical and fitness settings will be elaborated on in an upcoming book dedicated to incorporating the science of biomechanics for improving current fitness, health and wellness protocols.

Proper motion mechanics determine an efficient locomotive gait to sustain a steady-state movement. Effective SSM contributes to optimal fat oxidation. Conversely, inadequate movement mechanics influence sufficient fat oxidation, which is subject to meeting steady-state movement determinants (duration, intensity and pace). A deficient rate of FA-ox causes lower supply levels of aerobic (oxygenated) energy and a supply disruption of uninterrupted energy to support steady-state movement and compromise the economy of locomotive gait.

A greater reliance on anaerobic (unoxygenated) energy leads to sustaining bodily movement by high and low bursts of energy in the absence of oxygen. An interval mode of motion affects movement mechanics, which causes a suboptimal, or improper, running and walking stride.

This author views weight loss from the biomechanical standpoint, where muscular forces influence biological processes represented by metabolic pathways for producing aerobic and anaerobic energy. Understanding the significance of the biomechanical relationship between energy metabolism and human motion mechanics has not been given adequate attention by traditional clinicians, practitioners, and researchers. Viewing aerobic energy metabolism, steady-state movement, and efficient locomotion gait from the integrated functioning standpoint has lagged.

As discussed, excess weight reduction is accomplished through the fat oxidative process, directly linked to steady-state movement sustained by proper motion mechanics and locomotion gait. This means that weight loss interventions must consider the integrated functioning of energy metabolism and body movement mechanics to ensure successful weight loss outcomes.

Lifestyle and Physical Training Adaptation

A weight loss program for an overweight person should allow for the necessary physical, psychological, and emotional adaptation to transition to a more active lifestyle. This will require prioritizing and adjusting to nutrition, sleep, body intensity movement, and a new daily schedule from eight to 12 weeks before starting a moderate to vigorous training program for weight loss. 

I have learned from working with some of my clients that among the major challenges overweight people encounter during weight loss center around the new adoption of a physically active way of living. Newly incorporating physical activities into everyday living will likely make these individuals experience a spectrum of uncomfortable issues, including being physically tired, emotionally confused, intimidated by past failures, pessimistic about potential success, or frustrated with a lack of immediate progress.

One of the goals in adapting to physical challenges is to ensure that a client can successfully build the frequency of the number of weekly sessions for consecutive weeks without missing training days rather than focusing more narrowly on the quantity of training completed. During this training phase, it is important to focus on preventing exercise from being boring or unpleasant.

Regular physical activity added to a daily routine as part of a healthy and active lifestyle is optimal for long-term success. Performing light-intensity baseline training during the adaptation period that might include, for example, indoor cycling and speed walking can ensure development and provide needed reinforcement of mental focus.

With each client, I make every attempt to provide emotional support and make them comfortable, telling them that it is all right not to be all right as long as they make an effort to change their behaviors and perceptions, aim to counter past negative experiences, and prevent a loss of confidence.

Optimal values of fat oxidation have been established to be achieved at intensities between 59% and 64% of maximum oxygen consumption in trained individuals and between 47% and 52% of maximum oxygen consumption across the general populations (Achten & Jeukendrup 2003). The understanding from the bio-mechanical perspective of optimal values of duration and intensity of SSM training required to cause the rate of sufficient fat oxidation needs further research.

It is commonly recognized that steady-state movement outcomes are illustrated by individuals who regularly run medium and long distances and are affected to a minimal extent or not at all by excessive weight problems.

The integrated weight loss program samples below represent training modalities to accomplish effective fat oxidation to burn calories. A custom-tailored program should address the selection of appropriate duration and intensity variables to reflect specific challenges and needs for reaching desired goals.

Moderate to Vigorous Duration and Intensity Training

When the adaptation period is completed successfully, a client is ready to start the intensive training, which includes rounds of stationary bike cycling followed by speed walking or jogging (five to ten minutes for each component) for 30 to 45 minutes for each session, three to four times a week. Aerobics and Fitness Association of America (AFAA) testing and prescription guidelines suggest the following recommendations to determine movement intensity linked with the heart rate (HR) as a percentage of maximal HR: light – 35-54%, moderate – 55-69% and vigorous – 70-89%.

Light movement intensity is also known as a long slow distance (LSD) performed continuously at a constant pace and for an extended period and is considered appropriate for inactive and deconditioned individuals to perform the baseline training and adjust to a physically active lifestyle.

Published literature indicates that misconception exists regarding training protocols performed at a slow-moving pace and low- intensity, and they allow for reaching a fat-burning zone. In contrast, a moderate increase in intensity leads to a greater contribution from fat as opposed to elevated demand for glucose as a source of energy (Clark et al., 2012).

Research has revealed that training at a vigorous intensity produces greater cardiovascular benefits than physical efforts at a moderate intensity when total energy expenditure is consistent (Swain & Franklin 2005).

A study aimed at determining levels of body fat and BMI index related to training at vigorous (running) and moderate (walking) pace established that greater weight changes may be achieved by vigorous than moderate intensity in men and heavier women (Williams 2013).

The talk test method may be used to determine the proper intensity. The movement intensity is likely too high if a person cannot maintain a conversation during a training session (Clark et al., 2012). Most research studies found that light-intensity cycling, jogging and running may compromise optimal fat oxidation and weight loss outcomes.

A running or jogging training modality may be used if a client can perform sustained movement of a longer duration at a moderate speed without significant negative physical and mental impact.

Improving the efficiency of the walking and running gait is critical as the intensity and duration of training are gradually increased. As a client can maintain the intensity and regularity of steady-state movement training, the number of sessions can be increased to four or five times a week. The training session duration can be gradually extended from 45 to 60 minutes. At this juncture, it might be feasible to introduce resistance training. Many overweight individuals do not have extensive experience with weight lifting, and resistance bands produce better results for an effective body adaptation to weight resistance training.

If possible, I also suggest to my clients to train in the morning before going to work. This schedule allows one to avoid a fatigue factor at the end of the day and interferes minimally with work and other responsibilities. 

Psychological and Emotional Issues

According to the National Council on Aging (NCOA), obesity negatively affects mental and emotional health, impacting the ability to take action and achieve weight loss. Chronic health problems associated with obesity disrupt nervous system functioning, and obesity-related problems may lead to various psychological disorders, including clinical depression. As changes in activity are attempted as part of weight loss initiatives, overweight individuals who previously led a sedentary style of life may experience feelings of intimidation and discomfort from recurring physical activity, which can affect their mindset and positive attitude.

The takeaway is that underlying psychological issues must be addressed in a weight management program, along with requisite attention to physical activities. If these issues don’t receive sufficient attention, the desired results will most likely be obstructed, and the efforts will fail.

An integrated weight loss program should include an assessment of individual psychological problems and determine a comprehensive plan to address them, along with physical activities and nutrition plans. Program management by a single practitioner is highly desirable to support a comprehensive approach to weight loss implementation instead of having different practitioners handle the program’s different fitness, nutrition, and psychotherapy aspects.

Typically, obesity is a long-standing issue, and individuals with excessive weight are often adapted to living with the problem for an extended period. As a result, an overweight individual is impacted by various psychological and emotional problems that may manifest in various forms, such as low motivation, anxiety, lack of confidence, and stigma of negative stereotypes.

Setting attainable expectations and measurable goals and avoiding attempting to accomplish “too much, too soon” is of utmost importance. Addressing these issues will increase the chances of achieving the intended results. In this regard, I assist clients by being patient and supportive, giving positive feedback, preparing for potential risks, and helping them practice healthy behaviors.

When I worked at the Boston Sports Clubs in Newton, Massachusetts, I offered a group weight loss program to the club members. Fifteen members expressed interest in attending an initial meeting to review the weight management program. No one showed up for a meeting on the scheduled date. For many individuals, I believe their chronic excessive weight condition could have caused a state of cognitive stagnation and compromised the chances of taking a proactive approach to solving the problem.

Weight Maintenance and Management

Initial weight loss can be accomplished through regular physical activity, a healthy diet, and stress reduction. However, many research studies conclude that the most challenging problem for overweight individuals who have succeeded in losing weight is long-term weight maintenance and management, as most people gradually return to their original body composition. The percentage of individuals who initially lose excessive fat and maintain optimal weight has been estimated to be as small as one to three percent (Ge et al., 2020). The following are ways I suggest to improve weight loss outcomes:

  • Sustained movement activity performed regularly can improve outcomes of weight maintenance to prevent regaining original weight and contribute to maintaining optimal body composition in the long term.
  • It is important to focus on lifestyle adaptation instead of exclusively targeting specific nutritional and physical goals. Make positive changes to detrimental lifestyle behaviors that might have contributed to gaining excessive weight.
  • An exclusive focus on calorie reduction may slow down basal metabolism and contribute to the accumulation of excessive body fat.
  • Aim for sustainable habits and lifestyle changes as opposed to nutrition discipline to minimize the effect of diet restrictions.
  • A narrow-minded focus on dieting and excessive concern with nutrition may interfere with weight loss programs and compromise overall outcomes.
  • Determination is required to turn weight loss endeavors into success. Steady-state training is shown to develop vitality and contribute to improving physical strength and mental resilience to face challenges and avoid failures.