Part 3: training the obese beginner

One More (Irrelevant) Tangent: Fat Loss vs. Health

Mainly throughout this series, I’ve focused on fat loss as the primary end-goal for the obese trainee but it’s worth noting that this is absolutely NOT the only (or even necessarily the primary/best) end goal when we talk about training and dietary modification. Certainly it’s the one that most people are concerned about but that doesn’t mean that their approach is the correct one. What I’m getting at is that there is the whole health thing to consider.

And in that vein studies clearly show that even small weight losses (as little as 10% of current weight) can drastically improve health parameters. So even if someone never achieves a ‘normal’ or ‘ideal’ (two very loaded words) weight or body fat percentage, that doesn’t make that act of losing weight/fat useless; it may still improve health significantly.

And in that vein, some studies have even suggested that people who remain overweight but are regularly active may be healthier than folks who are skinnier but inactive. Please please note my use of the word ‘may’ in that sentence. This is an issue with very mixed data that is contentious as hell. More research is needed so don’t bitch me out in the comments for saying something I didn’t say.

In any case, some are now talking about metabolic fitness (in terms of physiological parameters such as insulin resistance of blood lipids or blood pressure) versus things like physical fitness (VO2 max or body fat percentage). Again, it may very well be possible to improve health and reduce disease risk even if fitness per se isn’t improved and fat loss per se doesn’t occur.

Back to the Series

But I started this series with a focus on fat loss as an end-goal and I’m going to continue with that primary focus. So here’s a quick summary of the issues I’ve discussed.

In Training the Obese Beginner: Part 1 I looked at the following:

Insulin Resistance/Metabolic Syndrome
A high resting/exercise RER (indicating decreased fat use for fuel)
Impaired Mitochondrial Function
A low tolerance for activity (as a function of low fitness and the realities of physics)

In and Training the Obese Beginner Part 2, I continued by pointing out:

That the obese typically have increased muscle mass
That the obese typically have an increased resting metabolic rate
Some of the realities or exercise including realities about caloric expenditure and an often lack of enjoyment of exercise (on top of the generally low tolerance for it)
So let’s put it together, given these situations, how to practically approach training the obese beginner to overcome this. First let me focus on the physiology a bit.

Becoming a Fat Burning Machine

I want you to know that typing that heading made me die a little bit but that’s how it goes; it’s just such a trite, cliched and worn out phrase. As I mentioned, a common finding is that the obese individual often has a lot of fatty acids floating around in the bloodstream (secondary to insulin resistance at the fat cell) but tend to rely more heavily on glucose and carbohydrate both at rest and during exercise for various reasons.

Some of this is certainly genetic, some of it is due to low activity/impaired mitochondrial function and a lot of it is related to diet with a chronically high carbohydrate intake promoting high carbohydrate oxidation across the board, secondary to increased muscle and liver glycogen stores (along with increased insulin levels due to the combination of high carbohydrate intake, high fat intake and insulin resistance).

The solution to this is multi-fold. Obviously diet is a clear place to make changes. Reducing carbohydrate intake with an increase in protein and dietary fat (protein can raise insulin but fat is relatively neutral) is a good first step. I’m not even saying that a full blown removal of carbohydrates is required, simply a reduction.

Often times this can be made by making merely qualitative changes in the diet, simply replacing certain foods with others, without having to make actual quantitative changes. This is mainly accomplished by getting a food diary (or just having a client walk you through a day’s eating) and looking for major red flags. Places where simple changes can be made that will have big impacts overall. This approach often has the end result of lowering total calorie/carbohydrate control without the person feeling like they are ‘on a diet’. Which can help to avoid the psychological stress of ‘being on a diet’.

But doing this, lowering carbohydrates and raising protein/fat/fiber (every meal should contain all four nutrients) tends to give better blood glucose and appetite control, lowers insulin levels (improving glycemic control), generally improves a number of metabolic parameters etc. Something approximating the Zone as a first step perhaps, 25-30% protein, 30-40% carbs and 25-30% fat; years ago something to that effect was proposed as the optimal diet for treatment of the metabolic syndrome and it’s just as relevant today.

Somewhere in that range in any case. Ignoring the fact that I don’t like percentage based diets, of those numbers, protein should come from mixed sources with most of the fat coming from monounsaturated sources (e.g. olive oil, oleic acid, etc.) and the carbs probably needing to come from lower down on the glycemic index scale (this tends to be less important as the quantity of carbs goes down but many find better satiety from lower GI carbs).

In some extreme situations, a full blown ketogenic diet (100 g carbs/day) may be necessary to overcome massive insulin resistance. It can also help by eliminating a lot of the ‘trigger’ foods that cause problems with food control for folks. That is, as I talked about in the Comparing the Diets series, many people just can’t do moderation.

If they eat some carbs, they want more carbs (this is highly individual but not uncommon with the obese individual). Cutting out everything but vegetables and fruits can go a long ways towards long-term food control and reprogramming food preferences (just expect them to bitch for about 3 weeks as their taste buds and such adapt). Especially initially (often times other foods can be added back in after taste buds adapt and the person is on a good rhythm of eating habits).

Of relevance to fat oxidation, a lowering of carbohydrate will not only reduce carbohydrate oxidation but also help the process of lowering glycogen stores within muscle and liver. As that occurs (and I’ll talk about training next), the body will start to increase whole body fat utilization.

Studies years ago (I cited them in The Ketogenic Diet) found that full body glycogen depletion (via training) enhanced whole body fat use in both the lean and the obese. I used this strategy for very lean folks in The Ultimate Diet 2.0 but it has relevance here as well to start correcting a ‘defect’ that has occurred.

And this is one of several ways that weight training can play a role (there are others that I’ll come back to below), it’s one of the best and fastest ways to deplete muscle glycogen and start getting fat burning pathways running again. Generally a focus on higher repetitions (more accurately sets lasting about 45-60 seconds) is the goal here. So you’re looking at 12-15 reps on a slow tempo or 15-20 with a faster tempo. In that range.

Multiple sets would be ideal (to fully deplete the body quickly takes about 12+ sets per muscle group) although it would be a massive mistake to try and do this out of the gate with a beginner. But over the first week or two, with a gradual increase in volume over that time period will get the job done, it will just take a bit longer.

You don’t even need a ton of exercises, pick compound movements like leg press, chest press and rowing or pulldowns and you’ve got most of the body. A routine centered around 3-4 sets of 12-15/15-20 repetitions might take as little as 30 minutes. I’ll talk about exercise selection in part 4 when I will finish up (promise).

Of course, cardio, even with the limited amount that can be done also starts helping with this process. As I’ll talk about on Tuesday, while the typical obese beginner trainee has a very low tolerance for exercise (and usually not much enjoyment for it), both can be improved over time with the right approach.

And this will have two effects: one of which is to help to burn fatty acids directly (and this effect will increase over time as fitness improves and glycogen is depleted), the second is to start readapting mithochondria to overcome that physiological ‘defect’ of decreased mitochondrial function. This is a slow process mind you but it will happen with consistent work.

Is that All?

In a sense, yes. All of this blabbering to tell you to lower carbohydrates and calories, deplete glycogen with progressively increasing volumes of high-rep weight training and ramp up cardio over time. From a purely physiological standpoint, that’s really the approach that I’m talking about. But it would be silly to think that that’s all there is to this topic.