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Just How Much (And For How Long) Does Metabolism Slow Down After Weight Loss?

>> Monday, March 21, 2016







Many people who struggle with excess weight find that they are able to get weight off, but keeping it off seems next to impossible.

So what exactly happens to our metabolism when we lose weight?  And are any changes in our metabolism temporary, or there for the long term?

A very elegant study was conducted that answers this question – and you may be surprised by the results.

The study enrolled people in groups of three, all three of which were of the same gender and weight: one who was weight stable at their maximum lifetime weight (ie had not had any weight loss); one who had lost at least 10% of body weight and kept it off for at least a year; and one who lost at least 10% of body weight over the most recent 5-8 weeks (using a liquid diet for 1-2 months before the study testing was performed).  The average body weight of people in the study was 98 kg (216 lb), and the age range was 19-41 years. All participants lived at the research centre for the duration of the study, and were fed only a liquid formula diet, to ensure their weights were stable for at least 2 weeks before measurements of metabolism were taken.  (a very impressive and dedicated protocol for both participants and investigators, wow!)

They found that in these study participants, the 24h calorie burn was about 450 calories lower for the people who had previously lost weight, regardless of whether that weight loss was just weeks ago, or whether it was years ago (and similar for males and females in the study).  Many full meals come in under 450 calories - I googled this recipe website to give you an idea (though I have not reviewed the recipes per se).  So this means that the person who has lost weight has to eat this much less, EVERY DAY, for years (and possibly forever) in order to maintain that body weight, compared to someone who weighs the same but has never weighed more than that.

Here's an example from that website: it's a lot of food!


While this 450 calorie drop in 24h calorie burn was partly due to a drop in energy burn at rest, the biggest drop was seen in the energy burned by activity (called non-resting energy expenditure). (Read more about all components of daily energy expenditure here). 

So does this mean that people who have lost weight simply exercise less?  No.  Actually, the literature overall suggests that it is energy burn during low-grade activity that declines (ie activities of daily living), because our muscles become more efficient at low levels of physical activity with weight loss. 

So what can you do to combat this reduction in energy burn that happens with weight loss?  Two things.

1.  Be NEAT! NEAT, or non exercise activity thermogenesis, is low grade activity of daily life.  Give up your parking pass and take public transit (which involves more physical activity than driving). If you do drive, park at the far end of the parking lot.  Stand while you talk on the phone.  Take the stairs instead of the elevator.   Read more on NEAT here!

2.  Exercise more.  Easier said than done, and not all may be able to do this because of physical limitations - but it is because of this drop in metabolism that the US Obesity Guidelines recommend more moderate physical activity to prevent weight gain (200-300 mins per week) than they do for weight loss (150 mins per week).  We have only to look at the National Control Weight Registry to see the proof – 90% of Americans who have lost 30 lbs or more, and kept it off for more than a year, exercise for at least an hour each day.


***Be sure to talk to your doctor before starting or ramping up your exercise program, and also to help you find assistance to learn about modified exercises that may work for you if you have physical limitations.***


Follow me on twitter! @drsuepedersen

www.drsue.ca © 2016

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Caution FitBit HR Wearers - Don't Trust That Your Heart Rate is Accurate!

>> Wednesday, January 27, 2016




In the effort to track calorie burn and activity, I have seen many patients coming in wearing a FitBit HR.  So, I decided to get one myself to check it out.

I use a Garmin to track my heart rate during exercise, which requires a sometimes uncomfortable chest strap, so the idea of tracking my heart rate with my neat little FitBit HR wrist band was very appealing indeed.

Unfortunately, what I have found is very disappointing - for me, the FitBit is completely useless to track higher heart rates (and based on online reviews and even lawsuits in the US, I am not the only one).

When I am at rest, my FitBit HR measures my heart rate very well.   Now, watch what happens when I put the pedal to the metal on my spin bike.  Pictured below is my Garmin (white watch, left), measuring my heart rate via the chest strap; on the right is my FitBit HR.





While my actual heart rate was 167, my FitBit HR registered only 108.  

This is beyond shockingly inaccurate and actually quite dangerous - for example, if a person with a heart condition has been advised to keep their heart rate under a certain target, the FitBit HR could dramatically underestimate their actual heart rate and mislead the person to think they are under their maximum target when they are not.

When I drove my output near my max with a heart rate of 180, the FitBitHR didn't register at all, which is safer, as at least it is not misleading the wearer with a wildly incorrect heart rate:




***NOTE: Discuss with your doctor to find out what your appropriate target and/or maximum heart rate should be before embarking on an exercise program. ***

It was only after I had stopped my exercise and my heart rate came down into the 120s that the FitBitHR became accurate again:

 

For those who are wondering if the problem could be the Garmin, it's not - I checked each of these heart rates manually against my own pulse, and the Garmin was accurate (though it too can be inaccurate, for example if you are in a cold environment and/or not sweating).  I have also carried out this experiment with different activities, and yes, I have also tried moving the FitBit HR further up my wrist. The results are the same.

The reason for the inaccuracy comes from the technology used to monitor HR.  While the Garmin strap uses electrical activity from the heart measured via the chest strap, the FitBit HR use optical technology to measure heart rate.  This involves using a LED light to illuminate your capillaries (tiny blood vessels) as blood runs past.  Capillary blood flow isn't as distinctly pulsatile as the bigger blood vessels (arteries), and at higher heart rates, it may be very difficult for this technology to distinguish higher heart rates.    I have not tested any of the other wrist devices using optical technology out there, but I suspect they may be at risk of similar inaccuracies.

What I do like about my FitBit HR is the sleep tracker, and the pedometer (step counter) - though both of these features have their limitations as well.

Thus, please exercise caution in your interpretation of your FitBit HR data - your heart rate, particularly during activity, may be highly inaccurate.

***NOTE: Before starting any moderate or vigorous exercise program, be sure to speak with your doctor.***


Thanks so much to Ryan, Jacqueline, and friends for the fabulous discussion that led to this blog post.


Follow me on twitter! @drsuepedersen

www.drsue.ca © 2016

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#Active365 Goes Public!

>> Tuesday, January 12, 2016







Here's a chance to get motivated to stick with those New Year's resolutions you're trying to keep.

Lisa Taylor, a Calgary high school teacher (and, I'm proud to say, my amazing sister), launched a Twitter initiative #active365 to help her phys ed students feel inspired to engage in daily physical activity.  When they get active, they take a picture and post it on Twitter - this gets their classmates hyped about being active, stimulates some friendly competition - and Miss Taylor even gives them bonus marks towards their report card!

We are now taking #active365 outside of gym class and to the general public!  Here's your chance to get friends, family, and work colleagues involved and see who can rack up the most #active365 tweets each week, each month, and for all of 2016.  Being #active365 will mean different things to different people - it can mean walking to work or school instead of taking a bus or car; taking the stairs instead of the elevator; taking your kids for a swim in the local pool; going to the gym; ice skating; starting a new exercise class... use your imagination!  You can choose to tweet with or without a picture, but be sure to describe what you did!

So start racking up those bonus marks to your health - let's tweet up #active365 and motivate each other every day of the year!

I would love to know when my readers are Tweeting at #active365 - my Twitter handle is @drsuepedersen - please add it to your Tweet so I can cheer you on!

Important note: Be sure to discuss with your doctor before starting any new activity or exercise program. 


Follow me on twitter! @drsuepedersen

www.drsue.ca © 2016

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Exercise Prescriptions - How They May Differ In Obesity

>> Friday, November 13, 2015



In follow up from my recent blog on the Home VO2max text, let's now talk about resting VO2, which is the amount of oxygen we consume at rest per kilogram of body weight per minute, and therefore a measure of basal (resting) metabolism.  This blog post is a little heavy in the math details, but trust me, well worth it to understand for anyone who struggles with their weight, and for any health care professional who cares for people with obesity. Read on!

There are many things that affect resting VO2, including:

  • Age (resting VO2 decreases with age)
  • lean body mass (resting VO2 is higher with more muscle) 
  • higher Body Mass Index (BMI) - resting VO2 decreases with higher BMI.  In other words, people with obesity may have a lower resting VO2, and this gets lower with more excess body weight.  This is due to a number of factors, including genetics, sympathetic nervous system tone, and also because fat tissue is less metabolically active per kg.

The amount of oxygen we consume at rest is equal to one MET (metabolic equivalent) of energy. The amount of oxygen used and energy burned (Calories or kcal) at rest is generally assumed as follows:

Resting VO2 = 1 MET = 3.5 mL/kg/min of oxygen

1 MET = 1 kcal/kg/hour of energy burn

We often describe physical activity in METs:
  • Light activity: less than 3 METs
  • Moderate activity: 3-6 METs
  • Vigorous activity: 6 METs or more

For example: 
  • walking at 4 miles per hour is about 3-5 METs (moderate activity)
  • shovelling dirt or light snow is 5-7 METs
  • jogging at 5mph is about 7-9 METs
  • shovelling heavy snow or playing squash is 9 METs or more

A full compendium of METs with particular physical activities can be found here.

Key Point: For some people with obesity, because they may have a lower resting VO2 and therefore a lower resting MET, 'moderate activity' of walking at 4 mph may actually be well into the vigorous METs category for them.

To assign a person with obesity who has a much lower resting VO2 a 'standard' moderate exercise prescription may result in this person feeling heavy exertion at that level of intensity - a potentially unsafe leap in exertional intensity, and also leaving one feeling discouraged that the activity feels too intense to continue.

Therefore, attention health care professionals:  When helping a patient with creation of an exercise prescription, it is important to listen to your patient (as always!), and understand what kind of activity gives them what level of perceived exertion - you may need to start the exercise prescription for your patient with weight struggles at a lower level of activity.   Most exercise prescriptions start with a moderate level of exertion, so for example, if walking at 2mph gives your patient a sense of moderate exertion, this would be where the exercise prescription would start, and you and your patient can build upwards from there.

If you are personally thinking about embarking on an exercise program, be sure to speak with your health care professional to see if any health checks need to be done before you begin.  When you and your health care professional are ready for you to begin, use this awesome METs compendium to find something fun - the choices are endless!


Follow me on twitter! @drsuepedersen

www.drsue.ca © 2015 

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How Fit Am I? The Home VO2 Max Test

>> Friday, November 6, 2015



Ever wonder how fit you are, or if this could be measured?  The best measure of aerobic fitness is called the 'VO2max', and is literally equal to the volume of oxygen consumed per minute during maximum exercise effort.

How does VO2max reflect fitness?  Well, we use oxygen to generate energy (called ATP) at rest and during aerobic activity.  Energy can be generated without oxygen for very short periods of time, which is called anaerobic respiration, but the best marker of endurance/cardiorespiratory fitness (which requires oxygen) is the maximum possible oxygen consumption that a particular person can achieve - that is, the VO2max.

The VO2max is most accurately measured in a lab, where oxygen consumption is measured while a person exercises to maximum capacity on a treadmill or stationary bike.

There are a couple of neat ways that VO2max can be predicted: (IMPORTANT: check with your doctor to make sure it's safe for you to do these tests before you proceed)
VO2max ranges and what they mean for fitness level can be found here.

To learn about VO2 at rest, how this translates into METs, how this is important for exercise prescriptions, and how this can be different in people with obesity... stay tuned to www.drsue.ca for more!


Follow me on twitter! @drsuepedersen

www.drsue.ca © 2015 

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Secrets To Success - Keeping Weight Off

>> Wednesday, October 21, 2015



Have you ever wondered what the secret to success might be, for people who have lost weight and have been able to keep it off?

While the answer to this question will be different for each individual, the American National Weight Control Registry was established in 1994 to try to identify behaviors associated with long term weight loss success.   It is the largest prospective observational study of weight maintenance out there, and includes individuals who have maintained a weight loss of at least 30 lbs for at least 1 year.

Some interesting facts about NWCR members:
  • 80% are women, 20% men
  • average age is 45-50 years
  • 45% lost weight on their own, and 55% with a program

Here are the winning patterns of NWCR members:
  • 98% modify their food intake in some permanent way: portion control, low fat diet
  • 90% exercise at least 1 hour per day, burning at least 400 calories per session
  • 78% eat breakfast every day
  • 75% weigh themselves once a week
  • 62% watch less than 10 hours of TV per week
  • average daily calorie intake for women = 1306 cal
  • average daily calorie intake for men = 1685 cal

While the causes and contributors to excess weight, and the challenges in maintaining weight loss are different from person to person, it would be worthwhile to consider these permanent habits to improve the likelihood of long term weight management success!


Follow me on twitter! @drsuepedersen

www.drsue.ca © 2015 

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Keeping Kids Active This Father's Day - And All Year!

>> Saturday, June 20, 2015




In the fight against childhood obesity, it's important to promote an active lifestyle for kids.  Studies show that family based interventions work best to prevent and treat childhood obesity.  Recently, I participated in a fantastic family-oriented triathlon weekend, where kids raced one day and adults the next.  What a great way to get kids interested and enthusiastic in not one but three sports - and adults got to be great role models at the same time!

So this Father's Day weekend, grab your kids and embrace a fun, family-oriented activity - and keep the theme going all year long!



Follow me on twitter! @drsuepedersen

www.drsue.ca © 2015

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