Archive | November, 2015

The Skinny on “Skinny Fat” (Normal-Weight Obesity)

16 Nov

Tim Skwiat, MEd, CSCS, Pn2

There’s a common misconception that body weight is a reliable and accurate depiction of health. However, the number on a scale says very little about one’s level of fitness, body fatness, fat storage patterns, and levels of lean body mass.

Typically, an “ideal” or “normal” weight is calculated as a ratio of body weight to height. The most commonly used tool is called the Body Mass Index (BMI), which is a person’s weight (in kilograms) divided by his/her height (in meters) squared (i.e., kg/m2). Using this ratio, the BMI separates folks into the following categories:

  • Underweight (BMI < 18.5)
  • Normal weight (BMI 18.5 – 24.9)
  • Overweight (BMI 25 – 29.9)
  • Obese (BMI > 30)

Hence, the notion of “normal” weight is born, but as mentioned above, there are many limitations associated with the BMI and using this avenue to assess health and fitness. Along those lines, recent research suggests that where folks store body fat—even if they fit into the “normal weight” category—may drastically increase their risk of disease and death.

In a study published in the journal Annals of Internal Medicine, a group of researchers led by Dr. Francisco Lopez-Jimenez, director of preventive cardiology at the Mayo Clinic, examined 14 years worth of data including over 15,000 study participants to determine the potential connection between “normal-weight obesity” and the risk of cardiovascular disease and death. They found that folks who are “normal weight” but store an excessive amount of fat in their mid-sections were more than twice as likely to die from cardiovascular disease compared to “obese” people whose body fat was more equally distributed throughout their bodies.1

It’s not like obese folks have a reduced risk of morbidity and mortality either. In fact, as you might imagine, traditionally defined obesity is a substantial, independent risk factor for cardiovascular disease, and it’s associated with diabetes, high blood pressure, sleep apnea, and a host of metabolic issues.2 This research suggests that “normal-weight obesity” appears to be even worse than that.

To put the increased risk of disease and death into perspective, Dr. Lopez-Jimenez said, “Being normal weight with mid-section obesity is comparable to smoking a half to a full pack of cigarettes daily.”

While the effect of “normal-weight obesity” on mortality has gained a significant amount of attention, it shouldn’t come as a complete shock. Previous research has shown that abdominal obesity is associated with a “constellation of metabolic abnormalities,” including:3,4

  • High triglycerides
  • Low levels of “good” cholesterol (i.e., HDL)
  • High levels of apolipoprotein B (which is considered a better predictor of cardiovascular risk than the more commonly used LDL5)
  • Small, dense LDL and HDL particles (small, dense particles are considered more detrimental than large, fluffy particles6)
  • Unhealthy levels of inflammation
  • Insulin resistance
  • Poor carbohydrate tolerance and metabolism
  • Leptin resistance

A number of important lessons and practical applications can be gleaned from this research and information. For one, it’s possible to be “normal weight” and “metabolically obese,” which Dr. Lopez-Jiminez and colleagues4 have defined as having:

  • Normal BMI
  • High visceral fat
  • High body fat percentage
  • Low muscle mass
  • Reduced insulin sensitivity
  • High blood sugar
  • High triglycerides
  • Reduced HDL cholesterol

Secondly, using a ratio of body weight to height (i.e., BMI) can be a relatively poor indicator of health and fitness. With that in mind, it’s important to use other measurements to determine health risk. While body composition testing (i.e., ratio of fat to lean mass) is arguably the most accurate means to discern health status, using waist circumference and waist-hip ratios may be alternative options.7–9

In general, women who have a waist circumference greater than 35 inches and men whose waist measurement is 40 inches or more are considered to have “central obesity” and be at “substantially increased” risk for cardiovascular disease and metabolic complications. With that said, according to the World Health Organization (WHO), women with a waist circumference greater than 31.5 inches and men with a waist circumference greater than 37 inches are at an “increased” risk for metabolic complications.10

Some research suggests that waist-hip ratio may be an even better predictor of health risk than waist circumference. According to the WHO and other professional health organizations, abdominal obesity is defined as a waist–hip ratio of 0.85 for females and 0.9 or more for men, and folks that fit into these categories are considered to be at “substantially increased” health risk because of their fat distribution.10,11

There appears to be a number of factors that contribute to excessive storage of belly fat. While genetics play a role, there are several modifiable lifestyle and behavioral factors, well within your control, that can be addressed to prevent the accumulation of and/or reduce the amount of existing visceral fat.

Exercise. A sedentary lifestyle, an overall lack of physical activity, and low levels of fitness are associated with abdominal obesity. As mentioned above, it should be noted that “normal-weight obesity” is typically associated with lower levels of muscle mass. This is often described as being “skinny fat.”

Fortunately, a number a studies have examined the impact of exercise on visceral fat, and while the exact amount (i.e., volume) and intensity is still be investigated, a substantial body of evidence suggests that a combination of resistance training and aerobic conditioning (including moderate and intense cardiovascular activity) may be optimal to reduce/attenuate abdominal obesity.12–15 The additional advantage to including resistance training is that it is the primary means by which to increase muscle mass, and it is also very effective at improving carbohydrate tolerance and insulin sensitivity.16,17

According to the American College of Sports Medicine (ACSM), a combination of moderate- to high-intensity exercise performed for a total of at least 250 minutes per week (i.e., 5 – 6 days of 45 – 60 minutes of exercise) is associated with significant weight loss.18

Nutrition. Not surprisingly, nutrition behaviors and food intake appear to have a direct impact on central obesity, and what’s more, studies that combine regular physical activity with diet interventions (i.e., resistance and/or aerobic exercise PLUS a reduced-calorie diet) result in even more significant reductions in visceral fat than either individually.12,19 As cited above, poor insulin sensitivity and carbohydrate tolerance coincide with excessive abdominal obesity, and there’s evidence to suggest that diets rich in refined carbohydrates (e.g., sugar-sweetened beverages) may selectively promote the storage of belly fat.20,21 In addition, excessive consumption of saturated fats also appears to be linked to visceral fat storage.22

Perhaps overtly obvious, long-term energy excess (i.e., overconsumption of calories) also leads to increases in overall body fatness and increases in abdominal obesity, and along those lines, research suggests that reduced-calorie diets (regardless of macronutrient composition) are effective at decreasing abdominal obesity.23,24 With that said, there is evidence that higher-protein (i.e., > 0.5 grams of protein per pound of body weight per day), “controlled carbohydrate” (i.e., <40% of calories from carbohydrate) reduced-calorie diets may be more effective at reducing visceral fat.25–28

Stress management. Excessive stress or the inability to cope with stress may also be a contributing factor to central obesity. You may be familiar with the “stress hormone” cortisol, which appears to have a direct connection to fat accumulation, and in particular, abdominal fat. Studies have shown that folks with high waist-hip ratios tend to have poor coping skills and secrete more cortisol when faced with a stressful situation. This suggests a relationship between cortisol and abdominal fat accumulation, and additional studies have identified a similar association between cortisol concentrations, coping skills, chronic stress, and excess belly fat.29,30

There are a number of potential explanations for the stress-cortisol-visceral fat connection. For instance, the enzyme (HSD) that “activates” cortisol from its inactive form (i.e., cortisone) is more prevalent in visceral fat than subcutaneous fat tissue.31 What’s more, visceral fat tissue has greater blood flow and four times as many cortisol receptors (compared to subcutaneous).30

It’s worth noting that there are a number of factors that can contribute to the stress equation—and subsequently, influence the release of cortisol—including psychosocial stressors, food intake, sleep quality and quantity, exercise, and more. Thus, it’s a good idea to examine your overall “stress web” to identify how various domains (e.g., physical, mental, emotional, environmental, financial, spiritual) may contribute to your overall stress levels (i.e., allostatic load).

While stress management can be tricky, yoga, meditation, mindful breathing (i.e., deep belly breathing), healthy levels of physical activity, optimizing sleep, purposeful relaxation, managing finances, and cultivating healthy relationships can all contribute to maintaining healthy stress levels. What’s more, there are certain herbs called adaptogens (e.g., Rhodiola Rosea; Relora®, which is a combination of Magnolia bark extract and Phellodendron bark extract) that may be helpful in reducing cortisol, improving stress levels, and promoting resilience.32,33 Also, phosphatidylserine may blunt cortisol release, reduce stress, and help promote an optimal hormonal status.34

Supplementation. In addition to the suggestions above, there may be additional nutrients that have a beneficial impact on central obesity. Of course, any dietary supplement that can promote a negative energy balance (e.g., increase energy expenditure, reduce calorie intake) has the potential to reduce visceral fat. There is also some evidence that supplementation with conjugated linoleic acids, fatty acids found in small amounts in dairy and meat, may preferentially reduce abdominal fat (i.e., waist circumference) in populations with central obesity.35,36

Take-Home Points

  • Using one’s body weight (and therefore, the scale) as the primary end point for assessing health and fitness may be unreliable and inaccurate.
  • “Skinny fat” (i.e., normal-weight obesity), which is characterized by a relatively high body fat percentage, excess visceral fat, and low levels of muscle mass, may put one at significantly greater health risk than folks who are “fat and fit” (i.e., metabolically healthy but overweight/obese).
  • While using the scale is one way to assess progress, consider using other measurements (e.g., body composition testing, circumference measurements, waist-hip ratios) to paint a more comprehensive picture of levels of body fat, fat storage patterns, and levels of lean body mass.
  • In addition to some factors that may be out of your control (i.e., genetics), there are a number of behavioral factors, well within in your control, that you can modify to reduce visceral fat or attenuate the risk of developing it in the first place.
  • Consider your current physical activity patterns, nutrition behaviors, and stress management tactics and how those areas may be playing a role in your health and fitness. If you could work on just one of those areas, which would it be? More specifically, what’s one thing that you might consider doing more of in one of these domains?

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References:

  1. Sahakyan KR, Somers VK, Rodriguez-Escudero JP, et al. Normal-Weight Central Obesity: Implications for Total and Cardiovascular Mortality. Ann Intern Med. November 2015. doi:10.7326/M14-2525.
  2. Poirier P. Obesity and Cardiovascular Disease: Pathophysiology, Evaluation, and Effect of Weight Loss: An Update of the 1997 American Heart Association Scientific Statement on Obesity and Heart Disease From the Obesity Committee of the Council on Nutrition, Physical Activity, and Metabolism. Circulation. 2006;113(6):898-918. doi:10.1161/CIRCULATIONAHA.106.171016.
  3. Despres J-P. Body Fat Distribution and Risk of Cardiovascular Disease: An Update. Circulation. 2012;126(10):1301-1313. doi:10.1161/CIRCULATIONAHA.111.067264.
  4. Oliveros E, Somers VK, Sochor O, Goel K, Lopez-Jimenez F. The Concept of Normal Weight Obesity. Prog Cardiovasc Dis. 2014;56(4):426-433. doi:10.1016/j.pcad.2013.10.003.
  5. Walldius G, Jungner I. Apolipoprotein B and apolipoprotein A-I: risk indicators of coronary heart disease and targets for lipid-modifying therapy. J Intern Med. 2004;255(2):188-205.
  6. Toft-Petersen AP, Tilsted HH, Aarøe J, et al. Small dense LDL particles – a predictor of coronary artery disease evaluated by invasive and CT-based techniques: a case-control study. Lipids Health Dis. 2011;10(1):21. doi:10.1186/1476-511X-10-21.
  7. Ahima RS, Lazar MA. The Health Risk of Obesity–Better Metrics Imperative. Science. 2013;341(6148):856-858. doi:10.1126/science.1241244.
  8. Janssen I, Katzmarzyk PT, Ross R. Waist circumference and not body mass index explains obesity-related health risk. Am J Clin Nutr. 2004;79(3):379-384.
  9. Welborn TA, Dhaliwal SS, Bennett SA. Waist-hip ratio is the dominant risk factor predicting cardiovascular death in Australia. Med J Aust. 2003;179(11-12):580-585.
  10. World Health Organization. Waist Circumference and Waist-Hip Ratio: Report of a WHO Expert Consultation, Geneva, 8-11 December 2008. Geneva: World Health Organization; 2011.
  11. Ilanne-Parikka P, Eriksson JG, Lindström J, et al. Prevalence of the metabolic syndrome and its components: findings from a Finnish general population sample and the Diabetes Prevention Study cohort. Diabetes Care. 2004;27(9):2135-2140.
  12. Dutheil F, Lac G, Lesourd B, et al. Different modalities of exercise to reduce visceral fat mass and cardiovascular risk in metabolic syndrome: the RESOLVE randomized trial. Int J Cardiol. 2013;168(4):3634-3642. doi:10.1016/j.ijcard.2013.05.012.
  13. Slentz CA, Bateman LA, Willis LH, et al. Effects of aerobic vs. resistance training on visceral and liver fat stores, liver enzymes, and insulin resistance by HOMA in overweight adults from STRRIDE AT/RT. Am J Physiol Endocrinol Metab. 2011;301(5):E1033-E1039. doi:10.1152/ajpendo.00291.2011.
  14. Schmitz KH, Hannan PJ, Stovitz SD, Bryan CJ, Warren M, Jensen MD. Strength training and adiposity in premenopausal women: strong, healthy, and empowered study. Am J Clin Nutr. 2007;86(3):566-572.
  15. Irwin ML, Yasui Y, Ulrich CM, et al. Effect of Exercise on Total and Intra-abdominal Body Fat in Postmenopausal Women: A Randomized Controlled Trial. JAMA. 2003;289(3):323. doi:10.1001/jama.289.3.323.
  16. Moore DR, Tang JE, Burd NA, Rerecich T, Tarnopolsky MA, Phillips SM. Differential stimulation of myofibrillar and sarcoplasmic protein synthesis with protein ingestion at rest and after resistance exercise. J Physiol. 2009;587(Pt 4):897-904. doi:10.1113/jphysiol.2008.164087.
  17. Hansen E, Landstad BJ, Gundersen KT, Torjesen PA, Svebak S. Insulin sensitivity after maximal and endurance resistance training. J Strength Cond Res Natl Strength Cond Assoc. 2012;26(2):327-334. doi:10.1519/JSC.0b013e318220e70f.
  18. Donnelly JE, Blair SN, Jakicic JM, Manore MM, Rankin JW, Smith BK. Appropriate Physical Activity Intervention Strategies for Weight Loss and Prevention of Weight Regain for Adults: Med Sci Sports Exerc. 2009;41(2):459-471. doi:10.1249/MSS.0b013e3181949333.
  19. Idoate F, Ibañez J, Gorostiaga EM, García-Unciti M, Martínez-Labari C, Izquierdo M. Weight-loss diet alone or combined with resistance training induces different regional visceral fat changes in obese women. Int J Obes 2005. 2011;35(5):700-713. doi:10.1038/ijo.2010.190.
  20. Maersk M, Belza A, Stodkilde-Jorgensen H, et al. Sucrose-sweetened beverages increase fat storage in the liver, muscle, and visceral fat depot: a 6-mo randomized intervention study. Am J Clin Nutr. 2012;95(2):283-289. doi:10.3945/ajcn.111.022533.
  21. Stanhope KL, Schwarz JM, Keim NL, et al. Consuming fructose-sweetened, not glucose-sweetened, beverages increases visceral adiposity and lipids and decreases insulin sensitivity in overweight/obese humans. J Clin Invest. 2009;119(5):1322-1334. doi:10.1172/JCI37385.
  22. Rosqvist F, Iggman D, Kullberg J, et al. Overfeeding Polyunsaturated and Saturated Fat Causes Distinct Effects on Liver and Visceral Fat Accumulation in Humans. Diabetes. 2014;63(7):2356-2368. doi:10.2337/db13-1622.
  23. de Souza RJ, Bray GA, Carey VJ, et al. Effects of 4 weight-loss diets differing in fat, protein, and carbohydrate on fat mass, lean mass, visceral adipose tissue, and hepatic fat: results from the POUNDS LOST trial. Am J Clin Nutr. 2012;95(3):614-625. doi:10.3945/ajcn.111.026328.
  24. Bradley U, Spence M, Courtney CH, et al. Low-Fat Versus Low-Carbohydrate Weight Reduction Diets: Effects on Weight Loss, Insulin Resistance, and Cardiovascular Risk: A Randomized Control Trial. Diabetes. 2009;58(12):2741-2748. doi:10.2337/db09-0098.
  25. Miyashita Y, Koide N, Ohtsuka M, et al. Beneficial effect of low carbohydrate in low calorie diets on visceral fat reduction in type 2 diabetic patients with obesity. Diabetes Res Clin Pract. 2004;65(3):235-241. doi:10.1016/j.diabres.2004.01.008.
  26. Skov AR, Toubro S, Rønn B, Holm L, Astrup A. Randomized trial on protein vs carbohydrate in ad libitum fat reduced diet for the treatment of obesity. Int J Obes Relat Metab Disord J Int Assoc Study Obes. 1999;23(5):528-536.
  27. Due A, Toubro S, Skov AR, Astrup A. Effect of normal-fat diets, either medium or high in protein, on body weight in overweight subjects: a randomised 1-year trial. Int J Obes Relat Metab Disord J Int Assoc Study Obes. 2004;28(10):1283-1290. doi:10.1038/sj.ijo.0802767.
  28. Noakes M, Keogh JB, Foster PR, Clifton PM. Effect of an energy-restricted, high-protein, low-fat diet relative to a conventional high-carbohydrate, low-fat diet on weight loss, body composition, nutritional status, and markers of cardiovascular health in obese women. Am J Clin Nutr. 2005;81(6):1298-1306.
  29. Moyer AE, Rodin J, Grilo CM, Cummings N, Larson LM, Rebuffé-Scrive M. Stress-induced cortisol response and fat distribution in women. Obes Res. 1994;2(3):255-262.
  30. Epel ES, McEwen B, Seeman T, et al. Stress and body shape: stress-induced cortisol secretion is consistently greater among women with central fat. Psychosom Med. 2000;62(5):623-632.
  31. Morris KL, Zemel MB. 1,25-dihydroxyvitamin D3 modulation of adipocyte glucocorticoid function. Obes Res. 2005;13(4):670-677. doi:10.1038/oby.2005.75.
  32. Olsson EM, von Schéele B, Panossian AG. A randomised, double-blind, placebo-controlled, parallel-group study of the standardised extract shr-5 of the roots of Rhodiola rosea in the treatment of subjects with stress-related fatigue. Planta Med. 2009;75(2):105-112. doi:10.1055/s-0028-1088346.
  33. Talbott SM, Talbott JA, Pugh M. Effect of Magnolia officinalis and Phellodendron amurense (Relora®) on cortisol and psychological mood state in moderately stressed subjects. J Int Soc Sports Nutr. 2013;10(1):37. doi:10.1186/1550-2783-10-37.
  34. Starks MA, Starks SL, Kingsley M, Purpura M, Jäger R. The effects of phosphatidylserine on endocrine response to moderate intensity exercise. J Int Soc Sports Nutr. 2008;5(1):11. doi:10.1186/1550-2783-5-11.
  35. Risérus U, Berglund L, Vessby B. Conjugated linoleic acid (CLA) reduced abdominal adipose tissue in obese middle-aged men with signs of the metabolic syndrome: a randomised controlled trial. Int J Obes Relat Metab Disord J Int Assoc Study Obes. 2001;25(8):1129-1135. doi:10.1038/sj.ijo.0801659.
  36. Risérus U, Arner P, Brismar K, Vessby B. Treatment with dietary trans10cis12 conjugated linoleic acid causes isomer-specific insulin resistance in obese men with the metabolic syndrome. Diabetes Care. 2002;25(9):1516-1521.
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Habits of Highly Effective Nutrition Plans

5 Nov

Habits of Highly Effective Nutrition Plans

Tim Skwiat, CSCS, Pn2

While there are quite a few effective nutrition programs out there, there’s not necessarily a single, universal “best” option. In fact, in a recent article published in the prestigious Journal of the American Medical Association, researchers compared various popular diets differing in macronutrient composition, and they found that differences in weight loss and metabolic risk factors were small (i.e., less than a couple of pounds) and inconsistent.1

What they did find, however, was that the single-most important factor influencing weight loss and improvements overall health (i.e., disease-risk outcomes) was adherence, or the ability of folks to stick with a program and consistently meet program goals for diet and physical activity. This led for the researchers to “call for an end to the diet debates.”

In the POUNDS Lost study, published in the New England Journal of Medicine, researchers compared four different diets (with varying amounts of carbohydrates, proteins, and fats), and they found that “reduced-calorie diets result in meaningful weight loss regardless of which macronutrients they emphasize.”2

With all of that being said, there are some common themes—criteria, if you will—amongst the most effective nutrition plans, including:3

  • They raise awareness and attention.
  • They focus on food quality.
  • They help eliminate nutrient deficiencies.
  • They help control appetite and food intake.
  • They promote regular exercise and physical activity.

While there may be no universal “best” diet, there may be a best option for you, and that’s what’s most important. How can you begin to find what works best for you? The following Habits of Highly Effective Nutrition Plans is a great place to start.

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Habit 1: Eat slowly and mindfully. For fat loss, there are two habits that you’ll need to master, and speaking generally—when combined with good food quality and done consistently—these two simple tools are typically enough for almost all clients to lose fat:

  • Eat slowly.
  • Eat until 80% full (i.e., just until satisfied; no longer hungry, but not “full”).

Slow eating provides a host of benefits:

  • Slow eating helps you “check in” and be present, pay attention, and sense into the cues that your body is sending you, why you’re eating, etc.
  • Slow eating allows you to sense into your body’s internal hunger/satiety cues.
  • Slow eating creates awareness of food textures, tastes, and smells.
  • Slow eating enhances digestion.
  • Slow eating doesn’t depend on controlling what you eat. It can be done any time, anywhere, and no matter what’s on your plate or who’s around, you can always eat slowly.
  • Slow eating makes you and your body the boss. You don’t have to rely on eternal cues and control methods (e.g., calorie counting, weighing/measuring food, points, etc.), and relinquishing external control gives you more real control.

Slow eating also ties into another extremely important component of how to eat: Learning appetite awareness. This is key to distinguishing when you feel that want to eat, need to eat, and have eaten enough (or too much). This ties into the concept of eating until 80% full, which you can track using this handy 80% Full Food Journal. Incorporating an Appetite Awareness Tracker along with the aforementioned food journal can be quite helpful in this regard as well.

If you can master the art of eating slowly and mindfully and learn to sense into (and listen to) your physical cues, you will be well on your way to improving your health, body composition, and vitality. You’ll be a nutrition ninja!

Extra Credit ==> Mindful Eating: HOW Do You Eat?

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Habit 2: Eat protein-dense foods with each meal. When it comes to improving body composition (e.g., losing fat, building/retaining muscle), optimizing protein intake may be one of the single most important dietary and lifestyle changes that one can make. Protein-dense foods increase satiety (i.e., feeling of fullness) and thermogenesis (i.e., boost the metabolism), and high-protein diets have consistently been proven to be effective at improving body composition (e.g., fat loss), preserving metabolic rate, and improving overall health (e.g., better blood lipids, blood sugar management, insulin concentrations).4–6

Increasing protein intake means moving from “surviving” to “thriving” and from “adequate” to “optimal.” Ideally, you should aim to consume a portion of protein-dense foods with each meal. Generally speaking, one palm-sized portion of protein is equivalent to approximately 20 – 30 grams of protein, and we recommend that:

[If you like to “count,” then a good rule of thumb is probably somewhere around 0.18 grams of protein per pound of bodyweight per feeding.]

Your best protein options include:

  • Lean meats, poultry, fish/seafood, and/or wild game (preferably grass-fed, pasture-raised, organic, etc., when appropriate)
  • Eggs (preferably pasture-raised, which is distinct from free-range and cage-free)
  • Lean dairy, especially Greek yogurt (with live cultures) and cottage cheese (preferably grass-fed, pasture-raised)

As noted above, there are a number of beneficial outcomes associated with a higher protein intake, and most experts tend to agree that folks can optimize protein intake by consuming about 0.7 – 0.9 grams per pound of bodyweight per day. This can be tricky, and this is why a protein supplement like BioTRUST Low Carb is “foundational” for the overwhelming majority of folks.

Bonus recommendation ==> Branched-chain amino acids, which play an intricate role in muscle building and recovery (particularly leucine), reduce muscle breakdown, and help regulate blood sugar levels. BCAAs are particularly useful during exercise, and they may also be especially applicable when protein needs aren’t being met (e.g., fasting, not enough protein at a given meal). What’s more, there’s some evidence to suggest that BCAA supplementation may be especially important (to help maintain muscle and metabolic rate) for older folks, whose protein absorption mechanisms may not be as effective.7

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Habit 3: Eat vegetables with each meal. Mom and grandma were right: Veggies are good for your health and your body composition. Studies show folks who eat more veggies tend to do a better job of losing fat and keeping it off. What’s more, a diet high in vegetables helps balance the body’s pH, which is important for both bone and muscle strength. Vegetables have a high nutrient-density and low energy-density, which means that you can consume a relatively large volume comparative to their calorie content. (See Move More, Eat MORE for more on this.)

While vegetables are also packed with important micronutrients (e.g., vitamins and minerals), they are also loaded with important phytochemicals that are necessary for optimal physiological functioning. These same plant chemicals often serve as anti-oxidants that combat oxidative stress, one of the most important factors mediating the deleterious effects of aging.8–10

Vegetables can essentially be prepared any way that you like (and it’s a good idea to include some healthy fats to maximize absorption of key nutrients),11–13 and while there’s not a limit on the number of non-starchy vegetables that you can include, the following is a good starting point:

Generally speaking, the more color (and the more varieties of colors) means the greatest array of beneficial phythonutrients, and it’s a good idea to consume a variety of vegetables each day. To optimize health, you may consider trying to include at least one serving of each of the primary colors each day:

  • Greens: Various lettuces, spinach, kale, arugula, Brussels sprouts, broccoli, asparagus, zucchini
  • Reds: Tomatoes, red bell peppers, red cabbage
  • Oranges: Carrots, orange bell peppers, various squashes, pumpkin
  • Whites: Onions, garlic, parsnips, cauliflower, yellow squash
  • Purples: Eggplant, purple cabbage, beets

For more examples, please see the World’s Healthiest Foods list.
Bonus recommendation ==> Supplement with a greens powder, which contain vegetables, fruits, grasses, etc., that have been distilled into powder form. While not necessarily a substitute for eating whole vegetables and fruits, greens powders are a good option to add to smoothies, when traveling, and for folks who struggle with adding vegetables to each meal.

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Habit 4: Carbohydrate intake should match activity levels. For fat loss, most people will do better by reducing carbohydrate intake, but it doesn’t mean that a low-carb diet is necessary. Rather, a controlled-carbohydrate diet seems to work best. Generally speaking, most people will do best with some carbs, with appropriate adjustments made for activity level, goals, and body type. In other words, the more active you are, the more smart carbs you’ll need; on the other hand, sedentary folks, especially those who are trying to lose fat and/or have more endomorphic body types, typically need fewer carbohydrates.

While there is often debate about low-fat versus low-carbohydrate diets and whether or not there are any metabolic advantages (there doesn’t seem to be any given the data at this time), there is some evidence to suggest that an individual’s insulin sensitivity status may influence the outcome of a reduced-calorie diet.14 For instance, in a study published in the journal Diabetes, Obesity and Metabolism, researchers found that folks with poor insulin sensitivity lost less weight on a low-fat, high-carbohydrate diet compared to more insulin sensitive folks (as well as compared to folks who followed a high-fat, low-carbohydrate diet, regardless of insulin sensitivity status).15

Why? Adherence (or lack thereof): Folks with a poor insulin sensitivity status had a much more difficult time sticking to the low-fat, high-carbohydrate diet, and as a result, they were much less likely to lose weight. Why did they have trouble sticking to it? It’s hard to say for certain, but we can speculate that their less-than-stellar carbohydrate metabolism induced a sequence of hormonal and metabolic changes that increases hunger and energy intake (after consuming a low-fat, high-carbohydrate meals).

Overall, when it comes to choosing smart carbs, the emphasis should be placed on whole, minimally-processed foods that are slow-digesting and high in fiber. Some folks find that consuming the majority of these carbs after exercise is best for body composition and recovery. When carbohydrates are added to meals (not necessarily every meal), the following is a good starting point:

Again, carb intake should be proportionate to activity levels, and particularly when the goal is fat loss, a portion may not be included at each feeding. For advanced folks, focusing on including carbs in the hours after exercise may be optimal. When you do choose to add carbs to a meal, the following are the best choices:

  • Colorful, starchy vegetables (e.g., sweet potatoes, purple potatoes, winter squashes)
  • Colorful fruits (e.g., berries)
  • Other sweet/starchy fruits and vegetables (e.g., bananas, plantains, potatoes)
  • Legumes (e.g., lentils and beans)
  • Whole, intact grains (rather than foods made from processed flours), including whole or steel-cut oats; wild, brown, or red rice; quinoa, amaranth, or buckwheat groats; sprouted grains; kamut or spelt grains; maize; millet; and barley
  • Other whole grain products (e.g., sprouted grains)

Bonus recommendation ==> Managing blood sugar and insulin concentrations are key to optimizing body composition, health, and performance. Supplements like IC-5 can help improve carb tolerance, insulin sensitivity, and metabolic flexibility, which are key players in weight management.

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Habit 5: Eat healthy fats daily. Don’t fear the fat! Despite a bad rap, fat does NOT make you fat. In fact, healthy fats from whole foods play important roles in manufacturing and balancing hormones. They also form our cell membranes and brains and nervous systems. They also transport important vitamins and minerals.

Healthy fats are critical for recovery and repair and supporting mental health and feelings of wellbeing. Fats slow gastric emptying and the release of glucose into the bloodstream (i.e., reduce the glycemic response), and furthermore, studies show that consuming fats can reduce the amount of food eaten in subsequent meals.

Generally speaking, the following are good starting points for portion sizes:

The key is to balance fats, and a variety of healthy fats usually does the trick:

  • Raw nuts (e.g., walnuts, almonds, cashews, etc.) and nut butters (e.g., almond butter)
  • Raw seeds (e.g., pumpkin seeds, chia seeds, hemp seeds)
  • Olives and extra-virgin olive oil
  • Avocado
  • Butter (preferably from grass-fed cows, e.g., Kerrygold)
  • Fresh coconut, coconut milk, and extra-virgin coconut oil
  • Cold-pressed, extra-virgin oils (e.g., walnut, macadamia nut, avocado, hemp, pumpkin, flax)
  • Fatty fish (e.g., wild salmon, mackerel)

Bonus recommendation ==> Supplement with omega-3 fatty acids, which, for the overwhelmingly majority of folks, will be “foundational.” For more on why this (i.e., fish oil) is such an important supplement, please refer to the following article:

The Benefits Of Omega-3 Fatty Acid Supplementation

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In sum, for most people who are eating 3 – 4 meals per day, the following is a good starting point:

  • 1 – 2 palm-sized portions of protein
  • 1 – 2 fist-sized portions of vegetables
  • 1 – 2 thumb-sized portions of healthy fats
  • 1 – 2 cupped-handful portions of carbohydrates can be added as needed (i.e., not every meal), depending on activity levels, goals, and body type.

With all of that being said, this is just a starting point. Remember to practice the first Habit, which emphasizes how you eat. Tune into your internal cues (e.g., satiety, appetite) to gauge what works best for you. In other words, find and do what works (for you). Focus on food quality and emphasize building a solid foundation of high-quality nutrition, done consistently.

Depending on where you are in your journey, you might start with something small, like adding a fish oil supplement to help balance your fat intake and reduce inflammation. From there, you might want to make sure that you consume a portion of lean protein at each feeding. Once you’ve nailed that, you might make sure that you’re consuming some colorful vegetables and/or fruits with each feeding.

In other words, take it one step at a time and focus on working on one change or new habit. Direct all of your time and energy into something that you are ready, willing, and able to do. Master that task or habit, and then take that next step. As Robert Collier said, “Success is the sum of small efforts, repeated day in and day out.”

Many find this step-like, habit-based approach to be far more tolerable, and more importantly, successful for long-term behavior change and weight management. However, some folks need or desire to make bigger changes, faster (e.g., athletes making weight, preparing for an event). In these cases, it’s important to understand that you’ll need to tolerate a greater amount of discomfort and disruption to your routine. Worry not, we’re here to support and encourage you every step of the way.

Notice and name what you do well and where you need help. Are there certain challenges that you face? The more awareness (here’s that mindfulness thing again) that you have of your habits, behaviors, and triggers, the more proactive that you can be in your approach to good nutrition. Remember, good nutrition (and being healthy) is not about perfection; it’s about improvement. It’s about the process—the journey. It’s about making the best, wise choices, as often as possible. It’s about living with purpose and getting up each day being your “best self,” with integrity. It’s about chasing health and wellness.

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Bonus resources:

Additional references used for this article: 16,17

References:

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