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Sunday, September 20, 2015

Can Exercise Maintain Weight Loss: Controversy at #NLAPittsburgh

Maintain Weight Loss with Exercise Controversy

Can you maintain weight loss with exercise?
(Fast answer go to:
 these two minute videos by Freedhoff and Weil: excellent)

This question came up at the NLA meeting at Pittsburgh on Sept. 20, 2015.
There were 3 experts present to answer the question.

Eric Westman MD
Diplomate of the American Board of Obesity Medicine
President of the American Society of Bariatric Physicians
Answered: No.

 Harold Bays MD
Board Certified in Endocrinology and Internal Medicine
Diplomate of the American Board of Clinical Lipidology
Diplomate of the American Board of Obesity Medicine
Answered: Yes

 Daniel H. Bessesen MD
Professor, Endocrinology, Metabolism and Diabetes
University of Colorado
Answered: Yes

I am
Brian S Edwards MD
Board Certified Internal Medicine and Geriatrics
Board Certified Infectious Disease
Diplomate of the American Board of Clinical Lipidology
Board eligible to be a Diplomate in Obesity Medicine

Last April I took a course at Columbia College of Physicians and Surgeons to prepare for the Boards in Obesity.

The slide below presented by Richard Weil from the conference tries to answer this question.

It’s interesting to me that Dr Bays and Dr. Bessesen qualified their answered with saying you can’t lose weight with exercise but you can maintain weight loss with exercise.

The slide below tells you exactly how much exercise to lose weight and how much exercise to maintain weight loss.
Richard Weil  questions the validity of these numbers if the number of calories taken in is not reported. 
 I asked Dr. Bays about this afterwards and he said of course, but he still felt you could maintain weight loss with exercise.  I pointed out only 5-15% of people maintain weight loss after five to ten years.

I exercised 2.5 hours a day for 5 years after a 80 pound weight loss.  I slowly gained 1.5 pounds a month for a total regain of 50 pounds.

In Jan 2011 I went on LCHF diet and stopped regaining weight.  I reduced my exercise to 20 to 40 minutes a day.  Dr. Westman said the exercise prescription correlates with the amount of carbohydrate you eat.  I ate quite a bit of fruit during those five years of slow weight gain.

Final Answer: Watch these 2 short videos if you have not done so already link

In all fairness to Dr Bays and Dr Bessesen I will quote the Handbook of Obesity:

pg. 282: "Is Exercise associated with reduction in body weight and total adiposity in a dose-response manner?"

"A total of 39 studies met the inclusion criteria...On average, studies with longer duration reported smaller weight loss for a given EE, whereas shorter duration reported greater weight loss."
"Not surprisingly, the exercise-induced changes in fat mass revealed a similar pattern to that observed for weight loss."
"It is also possible that adherence to dietary intake instructions was more readily adhered to in short-term as opposed to long-term trials."
pg. 290: "Clearly, there is a need for additional well-controlled trials that consider the independent effects of exercise on obesity reduction."
"However, although exercise alone is associated with reduction in total and abdominal fat in a dose-responsive manner,  gaps in knowledge persist."
"Nevertheless, the dose-response relationship observed in the short-term studies indicates that to reduce bodyweight by about 0.25kg/week, the required EE (energy expenditure) approximates 2700 kcal/week. 
 Our observations suggest that EE of this magnitude will require exercising for about 50 minutes, five times a week at 70% VO2max (83% of maximum heart rate). 
 It is important to reinforce the observation that these calculations are derived from short-term studies alone. "
 "It is evident that in long term trials, despite the similarity in the EEs prescribed, that the corresponding reduction in both total and abdominal obesities is substantially less."
"demonstration that the adoption of exercise alone as a treatment strategy for obesity reduction can be sustained long term remains a challenge." 

However, I believe the above paragraph is discussing losing weight with exercise which Dr Brays and Dr Bessesen did not believe in.
I don't think the above addresses exercise maintaining weight loss. 

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