Went to see the Doctor because I wasn't dropping weight

mutabo_

So, I thought I'd share this information on the basis it's worked for me. I make no warranty for you, but I think the approach makes some sense.

I also acknowledge this might take a few paras to cover - so sorry if it ends up a long post.

To help explain - I was always pretty much on the right weight til I was about 38. I never had to try but I liked to eat healthy food. I had an accident and broke my back. After some years of working to gain the ability exercise at the pace I used to once again I decided I needed to lose the extra kilos that I had piled on. For about 4 years I couldn't run, walk very far or do much. So getting back into things was slow but I was determined to shed the fat suit. It's not much fun.

The problem I was having was I was doing the right things (I thought) and nothing was happening. I at first followed the MFP recommended eating numbers and was exercising a lot - I was measuring everything - all food and exercise so I know I was accurate in my measurements. From memory I was eating about 1800 calories a day with a slight lean towards protein. I did this with lite n easy so the extra protein came from one shake after gym.

In concert with this, I was doing sometimes 3 hours a day of exercise. 1.5 hours of cycling and the rest in the gym with 30 mins of warm up and then weight training. The least I did was 2 hours a day. That's 7 days a week. On Saturday I did all of this plus a 60 minute boot camp. I logged that I was exercising at a slow to moderate pace but felt like I was going hard. I just figured I log on the conservative side.

I reckon I could be forgiven for thinking I was doing the right things. Before you say 'starvation mode' or the like, I should point out that I was doing this for about 9 months without result - not just getting sooky after a week or two. I also never notice photos of people getting out of forced labour camps looking chubby so I don't know about this 'starvation mode' thing. Who knows though, I'm no expert.

So I went to see my GP. He's also a sports doctor so understands the deal, and we were both baffled. He suggested dropping to 1500 calories and seeing what happens, so I did. I should also mention I workout with a PT who is well qualified. He was as baffled about all of this like my doctor and I.

A month later - all fairly much the same circumstances except I dropped the boot camp on the Saturday - and I had dropped a small amount of weight - maybe 1.5 kgs which was not enough to establish any 'real' drop - it could have been just fluid!

My GP sent me to see an endocrinologist. He ordered a blood test, a CT scan of my abdomen and did some other functional tests. The results were surprising.

Even though I was (and still am just now) overweight a few things were startling. My bloods and BP were right on the money - perfect. My stress test showed I was very fit for my age. The CT scan was the real surprise.

The CT showed I had only a very small amount of visceral (internal near the organs) fat - the subcutaneous (under the skin) fat was the problem. The visceral fat was that of a person who was athletic and lean.

He said that his and lots of other research showed that visceral fat is what responds to exercise most readily (on the basis the person has a normal to good insulin response to exercise). This type of fat also doesn't multiply but moreover expands and shrinks.

Subcutaneous fat on the other hand is different. It responds to exercise at 1/3 the rate of visceral fat, to exercise - it responds primarily and most readily to underfeeding. His view was that my calories were still too high at 1500. He said I should aim for 1200 a day but to take solace that his advice to women was to aim for 800-1000! Imagine my response. A big guy who does weights at a gym. I could spill 1200 calories!

Now I should hasten to add that his practice also uses dietitians and sports physiologists - so it's comprehensive and I'm jumping over explaining the advice I got from them as to how to implement 1200 calories with heaps of exercise while avoiding catastrophe. That's a different issue. I'm just talking about the calories right now.

I dropped the calories (and the lite and easy by the way) and slowed the exercise down a little - mostly because I had a bike crash but also because the doctor said exercise was important but not to the extent it made me more hungry. At that rate I dialed it back to 30-60 mins a day including the weight training.

I found the adjustment to lesser eating a bit tough but am used to it now. I have also started losing weight - finally! I lose about 1kg a week.

One thing he said was that my experience was quite common. People start doing what I did - drop calories to 1500 - 2000 a day, exercise hard then notice a loss of weight in the face and chest but then a real slow down or full stop on weight loss despite any increase in exercise. That was me indeed.

When he explained the issue of subcutaneous vs visceral fat he also mentioned something interesting. He said that subcutaneous fat doesn't just expand and shrink but it, unlike visceral fat - multiply in number. The fat cells will multiply if you gain weight quickly so the aim of the underfeeding was to shrink them through underfeeding then maintain the weight loss for between 2-5 years (or more of course!) after which the extra fat cells will die. This means that at that point, if you were to have a bad week of eating (binge on fast food for whatever reason) you'd be likely to just expand existing fat cells rather than creating new ones. The important difference is that these expanded (rather than multiplied) fat cells are more likely to respond to a good come back of exercise and a drop in calories for a week or two thereafter.

I found all of this quite interesting and I guess, if you got this far, you did too.

I suppose YMMV, but for me, it answered a lot of questions about the standard lines you get regarding weight loss. It also unified the theories which to me contradicted sometimes. Some which say you have to exercise more, others which say it's all about the diet. Others which say it's about some types of foods than others. In fact - it can be all correct at once.

Hope it's of use - and while I may cop criticism or maybe questions - just remember I'm relaying what I've been told by someone who seems to be an expert in his field and what's working for me so far. I don't know much more than what I put in this post.