“How am I NOT Losing Weight with All this Exercise?”

“How am I NOT losing weight?”

“How am I NOT losing weight?”
It’s a common frustration.

Have you ever wondered that after boosting your activity with extra walking, swimming or other forms of exercise? You’re not alone. Sometimes it is hard to understand a lack of weight loss. Often, though, a little digging can uncover several potential reasons why weight is not dropping as quickly as you expect.

Identifying what’s going on allows you to adjust how you are approaching a healthy lifestyle.

This lack of weight loss is actually a common frustration even among people in cardiac rehab programs, which includes physical activity several times a week as a major focus. Among people in cardiac rehab, 80% are overweight or obese – and 44% are classified as obese, with a higher level of body fat even more strongly linked with health risks. Yet in standard cardiac rehab programs, weight loss is often minimal.

I’ve just returned from speaking at the annual meeting of the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR), where my presentation was “Information Overload! Helping Patients Distinguish Evidence-Based vs. Anecdotal Nutrition Strategies”. I was speaking to health professionals in cardiac and pulmonary rehab, including doctors, nurses, exercise physiologists, registered dietitians and specialists in mental health and behavior change. I discussed commonly heard nutrition headlines that people find confusing, framing them within context of overall research — which is not always the same as the message that gets communicated.

The points I shared with them about addressing patients’ lack of weight loss are relevant to many people facing the same frustration.

Why no weight loss?

People may wonder, “How am I NOT losing weight when I’m exercising more?”

♥  “All that exercise” is relative. For people not used to exercise, cardiac rehab may seem like a big change, but most participants burn only about 700-800 calories per week in activity. Even that will eventually lead to some weight loss for most people, but it won’t be quick, and it’s easily overcome by other daily lifestyle choices. Making exercise part of everyday life, and longer or more intense exercise sessions, can amp up both the health benefits and calorie burn, as appropriate for each individual.

♥  What you do the other 23 hours matters. Moderate and vigorous physical activity offer health-protective benefits that extend well beyond weight management and heart health, including lower risk of cancer and type 2 diabetes. However, though in the same amount of time you burn at least four times as many calories in moderate “exercise” as when you sit and read or watch TV, that’s a small fraction of your day. A day with less sitting and more movement of any kind may actually have a bigger impact on weight. And as I shared in a recent Smart Bytes® post with what I learned by wearing a pedometer, a lifestyle with step-counts low enough to be linked with negative health effects is easier to fall into than most of us realize.

♥  Rewards can backfire. People who mistakenly think they’ve burned lots of calories in exercise may “reward” themselves with treats. Exercise equipment often lists inaccurate estimates of calorie expenditure. I’ve worked with people in my nutrition counseling private practice who were shocked to discover that the treat they picked up after exercise contained more calories than they just burned up.

♥  Healthy foods do count. Giving health-promoting foods a bigger part of your plate is a great idea. Unless someone is trying to gain weight, however, these need to be replacements for less healthy foods, not additions to usual eating.

♥  Unrealistic restrictions are a slippery slope. Any sort of change can be hard enough. When it’s too difficult, people may rebound in frustration over their sense of deprivation. It’s key to learn how to make healthy eating an enjoyable, long-term habit.

♥  Ungrounded expectations set you up for failure. Although research has now clearly shown that the old “3500 calories equals a pound of fat” rule is untrue, it’s an expectation that is still unfortunately circulating (even by some health professionals). If weight loss is slower than you hoped after you’ve made reasonable changes, keep at it and be patient, or see a registered dietitian nutritionist (RD or RDN) for help identifying further adjustments that might work for you.

Does weight loss matter?

The issue of fitness and health at a variety of body sizes is a hot topic. Research shows that some people are “metabolically healthy” even with body fat that exceeds generally recommended levels. Health outcomes are often better for people who are fit with excess body fat than for those who are lean but unfit.

However, excess body fat – especially the most metabolically active fat that’s located deep in the abdomen – is strongly linked to chronic low-grade inflammation and insulin resistance (leading to a whole chain of unhealthy effects following elevated insulin levels).

Considering preventive health:

♦  The association of increases in blood pressure with gain in that visceral (deep abdominal) fat, as reported at the current American Heart Association research conference, could be related to changes in blood vessel constriction that have been tied to insulin resistance.

♦  Analysis on which the American Heart Association, American College of Cardiology and The Obesity Society guidelines are based notes that   3 to 5% weight loss can bring clinically meaningful benefits. This includes decrease in LDL cholesterol and triglycerides and lower blood pressure.

♦  The ENCORE trial showed that among people who were overweight or obese, even compared to a healthy diet like the DASH diet (loaded with vegetables and fruits), insulin levels and markers of heart health improved even more when physical activity and a cut in calories consumed were added, producing weight loss.

♦ In the Diabetes Prevention Program, even modest weight loss was tied to reductions in a major marker of inflammation.

♦  Excess body fat is linked with increased risk of at least eight forms of cancer. The American Institute for Cancer Research includes reaching and maintaining a healthy weight as one of its major recommendations to reduce cancer risk.

Among people in cardiac rehab:

♥  In a study that included enhanced exercise plus changes in eating behavior to promote modest weight loss during cardiac rehab, an average loss of less than 14 pounds in five months was enough to decrease blood pressure, triglycerides, hsCRP (a marker of inflammation); increase HDL (“good”) cholesterol; and improve blood vessel function.

♥  Modest weight loss during cardiac rehab has been linked with better outcomes, including fewer deaths, heart attacks and other cardiac “events”.

The challenge:

Patients in cardiac rehab (and certain other people, too, such as older adults and cancer survivors) need to be especially careful to avoid loss of lean body mass, because that could place them at risk. That means that how you lose weight is important. Avoiding rapid loss, and including resistance (muscle-strengthening) exercise, plus a healthy eating pattern with adequate protein at several meals of the day all help.

The Bottom Line

Adding physical activity is a huge plus for many aspects of health. Celebrate and be proud of what you are doing for yourself as you create a more active lifestyle. Don’t stop there, however. Use the energy and sense of accomplishment that step brings to move on to create an overall healthy lifestyle. This includes a focus on healthful food choices, amounts appropriate for your calorie needs, and a mindful approach to eating that allows you to enjoy food and does not use food to deal with non-hunger issues.

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Resources

If you want help creating a lifestyle of healthful physical activity and eating habits, a great opportunity is about to start  — The American Institute for Cancer Research’s New American Plate Challenge. It’s a free online program worth checking out. You could use the information and support here on your own, paired up with a family member or friend, or in conjunction with help from a registered dietitian.

To learn more about this concept of mindful eating – which helps you tune in to how much you eat, how  you are using food, and how you are nurturing yourself – I recommend these three resources. Each provides a unique slant on this important issue.

Intuitive Eating – website and book by Evelyn Tribole, MS, RD and Elyse Resch, MS, RDN, CEDRD, Fiaedp, FADA.

Am I Hungry?® –website and program by Michele May, MD

Eat, drink and be mindful™ – the website of psychologist Susan Albers, PsyD.

References

Jensen MD, Ryan DH, Apovian CM,et al. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. Circulation. 2014 Jun 24;129(25 Suppl 2):S102-38.

Blumenthal JA, Babyak MA, Sherwood A, et al. Effects of the dietary approaches to stop hypertension diet alone and in combination with exercise and caloric restriction on insulin sensitivity and lipids. Hypertension. 2010 May;55(5):1199-205.

Ades PA, Savage PD. Potential benefits of weight loss in coronary heart disease. Prog Cardiovasc Dis. 2014 Jan-Feb;56(4):448-56.

Sierra-Johnson J^, Romero-Corral A, Somers VK,et al. Prognostic importance of weight loss in patients with coronary heart disease regardless of initial body mass index. Eur J Cardiovasc Prev Rehabil. 2008 Jun;15(3):336-40.

 
Article by speaker and author @KarenCollinsRD