o venvhelmingly. research studies are delivering staggering statistics: approximately two-thirds of the American population is overweight, and nearly-half of those folks are obese. The causes of obesity are assumed to be well know n: too much food and too little exercise. As healthcare professionals, we have an obligation to help our patients by educating them on the right course of action to reverse the trend. We also have an opportunity to move past the generic recommendation of "exercise and cat right." We must challenge ourselves to explain what constitutes good nutrition and effective exercise for this population. We recommend a three-pronged approach for our obese patients. It tackles the key areas that often combine to produce failure. Our goal as healthcare professionals is to enable our patients to be successful in their weight loss goals. The three components include: Identify what constitutes good/proper nutrition. Incorporate a realistic strength training program that doesn't overwhelm or over-complicate. Educate patients on up-to-date research that sheds the truth on salt, sugar (especially fructose), and saturated fats. While lack of exercise is constantly cited as a major cause of obesity, the facts do not support this sweeping generalization. We have come to realize that the majority of people who rely on exercise to lose weight are extremely fnistratcd with the results. Numerous studies over the last three decades show that exercise, in general, is not particularly effective at reducing fat stores. We know people who spend a lot of time in the gym. on the treadmill or stair stepper, who never see any lasting benefits. We also all know people who have lost weight on an effective eating plan without exercise. The healthcare system's bland and undocumented recommendation to be "active" is a simplistic and ineffective approach to obesity. So. what can we offer our patients as a realistic "single-pronged" approach to better health and fitness? We need to tell our patients that the most essential part of a weight loss program is maintaining glycemic control or maintaining normal blood sugar and brain sugar levels. We need to explain that clearly by impressing the fact that reducing the consumption of refined starches and sugars—especially fnictose—w ill result in weight loss and lower blood pressure, both of which will reduce the likelihood of diabetes. The fructose phenomenon There is compelling new evidence linking fructose consumption to increased uric acid levels, which is intricately linked to obesity and associated health problems such as diabetes and hypertension. Fructose is the most pernicious type of sugar. It contributes to glycatioa a pathological aging process, more than any other sugar. The oxidativc damage caused by gh cation, and its cascading effect on the tissues of the vascular system, renal capillaries (kidneys), joints, retinal capillaries, and the skin (wrinkles), will surely grab our patients" attention. Dr. Mchmct Oz and others proclaim that Americans should add more fniit to their diets. The blanket statement that fniit is always an acceptable part of the diet does not hold tnic for those with a problem regulating blood sugars. Fnictosc content is particularly high in some fniits. such as raisins, grapes, prunes, plums, figs, dates, cherries, pears, bananas, berries, apples, and watermelon, as well as honey, ordinary sugar, and com syrup. Is that to say no one should cat fniit? Of course not. Everyone has an individual tolerance for fniit. For those who proudly claim they are juicers, the concentration of fnictose is even higher than in whole fruit. There is nothing natural about consuming large quantities of juice. You may have heard or know someone who has lost weight juicing. More than likely, the weight loss was a result of a dramatic reduction in the total amount of sugars and carbohydrates they were consuming before juicing. The skinny on fat At the other end of the nutritional spcctnim. educating patients on the importance of fats, especially saturated fats, is often more challenging. Fats arc one of the body"s most important nutrients. Scientific research clearly shows that saturated fat does not cause degenerative diseases: it actually protects against them. Fats arc essential for hormone production and for slowing down the aging process. For more than forty years. Americans have been duped into believing that fats are the culprits in their weight loss failures. However, groundbreaking studies show that a high fat intake uprcgulatcs key enzymes (lipasc). which break down dietary fat and body fat. It seems counterintuitive to most Americans, but a high fat intake can actually lower body fat! The body is an amazing organism: highly regulated and fine-tuned. Making changes across the board is important because switching to a high fat diet without limiting or removing carbohydrates will result in body fat accumulation. If we emphasize how foods affect hormones and fat storage, we dc-emphasize the requirement to compensate for bad dietary choices with excessive exercise. Working out the time to work out Time is a very relative factor for most people when trying to work exercise into a hectic lifestyle. The recommendation to exercise for at least 30 minutes a day for five. six. or seven days usually has a negative effect on compliance for obese and overweight patients. The goal is to set your client up for success. Don't overwhelm and stress out the non-athletic, overweight, and obese population with formulas for failure. A successful exercise program must show immediate, incremental accomplishment and be as stress-free as possible. Our expertise with the obese/overweight population clearly demonstrates that a new approach to fitness is necessary. First, it's important to make a realistic assessment of immediate needs. It is critical to understand the extremely different exercise protocols available to this group, and the relative effectiveness each lias on influencing weight loss. Making an exercise protocol accessible and doable is an important part of the equation. Based on the tremendous clinical improvement we have witnessed with the obese market, we firmly arc convinced that the healthcare system has overcomplicated exercise for the population interested in only health and fitness. Trainers arc overemphasizing endurance training, such as running and aerobics, for the obese and overweight population, which is not pnident or appropriate. This kind of training does little to promote muscle, and provides little metabolic stimulus post-workout. With years of experience under his belt. Rick Bramos believes the average overweight person docs not need the endurance of an athlete, but instead needs to engage in strength training to wake up dormant muscle fiber and even add a few pounds of this mctabolically active tissue. Because muscle is where fats and sugars arc metabolized, it should be a priority for this group to maintain and build muscle as it helps normalize blood sugars seven days a week. Resistance training is inherently safe for all fitness levels regardless of age or gender. It packs a potent post-workout punch when executed properly. Putting it all together We believe that once your patients understand that losing weight (fat) is primarily impacted by what you cat. not necessarily how much, then all you need is two strategically planned workouts a week to stay fit and healthy for the rest of your life. Research has shown that someone can achieve and maintain sufficient gains in muscle and strength with only two workouts a week. Two workouts a week arc doable and that dramatically improves compliance, which leads to more positive clinical outcomes. The following is a simple guide to present to patients who have issues with their weight: Keeping insulin levels low is the key to losing weight. With low insulin levels, exercise will accelerate weight (fat) loss because the body has access to the fatty acids that arc stored in the fat cell. This is accomplished by limiting sugars and refined carbohydrates. Managing stress has a profound effect on weight gain because cortisol has an upregulating effect on the LPL receptors of the fat cells. Sleeping soundly is necessary for adequate growth hor mone production. Matching the training approach with the patient's goals and available time will improve long-term compliance, which supports normalized blood sugar levels. Addressing the biochemical glitches such as thyroid, environmental toxins that disnipt fat metabolism, and nutrient deficiencies. Addressing obesity requires a multifacctcd approach that meets the patients needs. A simple solution to our country's chronic obesity problem is to pay greater attention to the root of the problem: the food that we cat. As healthcare professionals, we can educate our patients by-presenting them with the facts and solutions that truly work. References: Brooks G. Fancy T. Baldwin T. Exercise Physiology: Human Biocnergctics and Its Applications. McGraw-Hill Humani ties. 4 edition (September 17. 2004) Brooks D. Effective Strength Training: Analysis and Tech nique for Upper-Body. Lower-Body, and Trunk Exercises. Human Kinetics: 1 edition (June 29. 2001) Faigcnbaum AD. MillikcnLA. Loud RL. Burak BT. Dohcrty CL. Westcott WL.Comparison of 1 and 2 days per week of strength training in children.. Res Q Excrc Sport. 2002 Dcc:73(4):416-24. Buchhcit M. Laurscn PB.High-Intensity Interval Training. Solutions to the Programming Puzzle. Sports Mcd. 2013 Mar 29. Weslcotl WL. Anncsi JJ. Skaggs JM. Gibson JR. Reynolds RD. O'Dell JP.. Comparison of two exercise protocols on fitness score improvement in poorly conditioned Air Force personnel.. Percept Mot Skills. 2007 Apr:104(2):629-36. Reiser & Hallfrisch. "Metabolic Effects Of Dietary Fruc tose." CRC Press. 1987 Ravinskov. Journal of American Physicians and Surgeons 8. No 3 (2003). 94-95. The retreat of the diet heart hypoth esis. Journal of American Physicians and Surgeons 8. No 3 (2003). 94-95. Ling. P.. ctal. "Evaluation Of Protein Quality Of Diets Con taining Medium and Long Chain Trygliccridcs In Healthy Rats." Journal Of Nutrition 116. 343-9. 1986. Laitincn. M.. ct al.. "Effects of Dietary Cholesterol Feeding On The Membranes Of Liver Cells And On The Cholesterol Metabolism In The Rat." International Journal Of Biochem istry 14(3)239-41. 1982 10. Gary Taubcs. Good Calories Bad Calories. Anchor Books. 2007 Gars Taubes. Why We Gel Fal. Alfred A. Knopf. 2011 Michael Aziz. The Perfect 10 Diet. Cumberland House 2010 Ronald Grisanti D.C., D.A.B.C.O., M.S., is medical director of Functional Medicine University. If interested in improving your diagnostic skills and increasing your community reputation and recognition, we strongly recommend subscribing to our Free Clinical Rounds Series. These challenging case studies will give you the unique opportunity to test your clinical skills and, at the same time, improve your ability to handle many oj the most difficult cases. Go to the following link to get your free access: www.ClinicalRounds.com. Rick Bramos is a 35 year fitness veteran. He has successfully trained thousands of obese individuals using the lalesi scientific research on losing fal and getting fit. He is the author of the breakthrough book, 2 Days to Fitness (www.2DaystoFitness.com). He has had the privilege of sharing his experience and knowledge with a growing number of chiropractors. In turn, his fitness and training philosophy is making a significant impact on thousands of patients in the US and abroad.
