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The “Eat Less, Exercise More” Prescription and Why It Has Failed You - by Sasha High MD

Oct 11, 2020

For decades, we’ve been prescribing the “Eat less, exercise more” strategy and wondering why everyone is failing at managing their weight. Today, I want to explain that you haven’t failed, but rather, this prescription has failed you! I’m going to provide some practical tips to help you in your journey. This is by no means going to cover everything, because weight management is so complex, but it will be a good starting point.

Let’s start with where this “eat less, exercise more”, or “calories in, calories out” idea came from. We all need a certain amount of energy in the form of calories for daily functioning. We have our basal metabolic rate - which is how many calories our body burns at rest, and then we have the calories used for our activity level and then something called the thermal effect of food (a small number of calories needed to digest food itself). All of this makes up our energy expenditure in a 24 hour period. 

So it seems very logical that if you need x number of calories in a day, then if you eat less or burn more through exercise, you should lose weight. Right? Basic math. 

Minor problem - your body doesn’t function as a math equation!

Our bodies are complex biological systems and these systems work really hard to keep everything in balance. Imagine your body’s heat regulation - trying to keep your body temperature right around 36.5C whether it’s winter or the middle of a heat wave... You have mechanisms to keep your blood sugar levels in a narrow range... Similarly, your brain has a number of mechanisms to try to keep your weight stable. For example, if you restrict your calories, your brain senses that change and will increase your cravings and hunger in an effort to get you to eat more. Additionally, not all calories are created equal. Because calories don’t account for the hormonal effects of different foods on our bodies.And studies looking at exercise have found that if you burn let’s say 400 calories on the treadmill, your body will just conserve 400 calories elsewhere in the day to make sure that everything stays in balance. Essentially working very hard to make sure that whether you exercised or not today, your total energy expenditure stays the exact same as yesterday. 

You see, your brain is very smart. It doesn’t want you to die of starvation, and so if it senses a drop in your intake or your fat stores, it will revv up the compensatory mechanisms to make you want food more so you go out and eat to avoid starvation, and it will slow down your metabolism to make you ultra-efficient with the few calories you are taking in.

Not fair right? If you think about it, all of this had a survival advantage way back in the day. You know, when we used to have to forage and hunt for food it was advantageous to have mechanisms to keep fat on our bodies during times of famine. It’s just not really serving us in today’s world when we have no shortage of food around us.

The other problem with the whole “Eat Less, Exercise More” prescription is that it doesn’t take into account the fact that we really like eating, and generally we don’t really like exercising. So how do we factor in the emotional and psychological factors that prevent us from eating less and exercising more? That part needs a lot more support.

So what to do?! 

Well, the first step is to understand that not all calories are created equal. Different foods affect our hormones, hunger pathways and brain differently. In particular, it’s important to know that refined carbohydrates (anything made out of flour) and sugar have a particularly strong effect on our reward brain, the part of the brain that drives eating for pleasure rather than for nutritional requirements. So if you find yourself struggling with a lot of hunger and cravings - take a look at the flour and sugar in your diet. Focus on consuming whole foods, less processed, boxed and bagged food products, lots of veggies, protein and healthy fats and find a sustainable eating plan that works for you. Keep it simple. Be mindful about your eating and notice when you’re most at risk for going into autopilot. Write it down. Be consistent. Don’t give up just because the scale isn’t meeting your expectations after 2 weeks.

The next step is to continue your exercise routine but take it out of the weight loss equation. Exercise is amazing. It’s so good for you, it’s good for motivation, energy, focus, mood, your bones, your blood sugar, your heart, your brain… it’s good for pretty much every health condition, but it’s not a great weight loss strategy. Study after study has found that exercise is great for weight maintenance and preventing weight gain, but doesn’t yield much by way of weight loss. This is important because most people who decide they want to lose weight will think: ok, I need to increase my exercise. But then what inevitably happens is they think they burned 600 calories on the treadmill and so they give themselves permission to eat more, and really they’re out-eating their activity level and this can even lead to weight gain.

Step number three is to look beyond diet and exercise. There are so many other factors that can affect weight. I won’t get into all of them today, but a couple key lifestyle factors are sleep and stress. Sleep is a big one, especially since COVID started. Many people are staying up later because they’re not having to go to work the next day, but sleep is a major weight modulator. Poor sleep or late night sleeping can increase cortisol levels, insulin resistance, hunger hormones and contribute to less restraint in the face of impulse. So work toward an earlier bedtime and lights out by 11pm!

Stress is another one that’s high right now. I could spend a whole hour talking about how stress affects your brain and your weight, but to keep things simple: look for ways to actively recharge your battery when you’re facing stress. TV, Netflix and scrolling instagram or Facebook are NOT active stress relieving measures. Go for a walk. Talk to a friend. Take a hot shower. Sit outside in nature. Practice mindfulness.

Next, mindset. Notice the stories your brain tells you around weight loss. I don’t have time to go into this today but you’ve heard me start introducing some concepts around this over the past few weeks and I’ll be sure to keep bringing you more insight in the future.

Finally, I left this to the end but it is really important. For some people, there is such a significant biological disruption to their weight controlling mechanisms that behavioural and cognitive interventions just aren’t enough. And sometimes, weight management medications are needed to treat that underlying biology. This isn’t a failure, it doesn’t mean that you’re weak, it just means this is a real medical condition with real biology that sometimes needs real medical help. So don’t be shy to discuss medical options for weight management with your doctor if you feel like you’re really stuck.

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