What is a yo yo diet?

Yo-yo diet is often called weight cycling, which is the repeated weight loss and regain of body weight on some particular diet. Yo-yo diet is characterized by: (1) restricting your diet to lose weight; (2) stopping the diet once you’ve lost weight; (3) regaining the weight you lost, and often more; (4) starting a new period of restrictive eating to lose weight again. Repeated bouts of weight loss followed by weight regain forms a pattern known as weight cycling or “yo yo diet”. Weight cycling or “yo-yo dieting” is an inevitable process in human, because of subsequent weight loss and regain of body weight due to poor diet and irregular dieting. Human weight cycle (yo-yo dieting) is the major factor for causing global epidemic diseases in human beings ¹. Research indicates that weight cycling, or “yo-yo dieting” is a common occurrence in overweight and obese populations. The long term negative health consequences of weight cycling are debated and it is unclear whether or not this weight change pattern poses a greater disease risk compared to obesity maintenance ².

Every year, scores of millions of people – as diverse as obese and lean, teenagers and older adults, sedentary and elite athletes, commoners and celebrities – attempt to lose weight on some form of diet. People on the yo-yo diet or weight cycling can usually change their body weight from small weight loss and to small weight regains of 5-10 lbs per cycle, to large body weight changes in weight of 50 lbs. or more per cycle. The National Institutes of Health suggest that small weight cycles range from loss and regain of 2.3–4.5 kg, whereas a large cycle may be characterized by 23 kg or more ³. Weight regain is generally the rule, with one-third to two-thirds of the weight lost being regained within 1 year and almost all is regained within 5 years ⁴. With studies of the long-term outcomes showing that at least one-third of dieters regain more weight than they lost, together with prospective studies indicating that dieting during childhood and adolescence predicts future weight gain and obesity, there is concern as to whether dieting may paradoxically be promoting exactly the opposite of what it is intended to achieve.

It has been estimated 24% of American men and 38% of women are currently attempting to lose weight ⁵, ⁶, ⁷. When individuals with an obese body mass index (BMI) are considered, 65% of men and 68% of women are trying to lose weight, which is a fivefold increase compared to those within the normal BMI (18–24.9 kg/m2) range that are trying to lose weight ⁷. While successful weight loss is achieved, researchers have indicated that long-term maintenance of a reduced weight appears to be rare.

The probability of weight regain increases in the time following initial weight loss ⁸. Researchers believe this is due to the energy gap created during caloric restriction where decreased energy expenditure is paired with an increased drive to eat ⁸. Rodent studies have demonstrated that this gap persists regardless of the duration of weight reduction, which increases the probability of weight regain ⁹. This drive to eat causes a hyperphagic response when free access to food is allowed and when paired with suppressed lipid utilization, weight regain is often rapid and efficient ⁹, ⁸. While this finding was elucidated through use of a rodent model, human weight regain data supports this concept. One year after a modest weight loss (14.5% of body weight), Votruba et al. ¹⁰ reported that within a year of weight loss, 16 out of 28 women regained weight and had a 19% increase in body weight and a 26% increase in percent fat mass. Weiss ¹¹ reported that by one year after a modest weight loss (10% of body weight), 33% of adult subjects regained all lost weight. Furthermore, they concluded that the odds of regaining were positively associated with the percentage of initial weight lost ¹¹. Field et al. reported that approximately 55% of overweight and obese women who lost 10% of their body weight regained all lost weight within 4 years ¹². In support of this finding, within 9 years of the initial weight loss (5% of body weight), 95% of women and 93% of men were unable to maintain the reduced body weight ¹³. Collectively, these studies suggest that while initial weight loss is possible, long-term maintenance is problematic, especially when large amounts of weight are lost or an individual is overweight or obese.

Some research links weight cycling or yo-yo dieting with certain health risks. To avoid potential risks, most experts recommend that obese adults adopt healthy eating and regular physical activity habits to achieve and maintain a healthier weight for life. Non-obese adults should try to maintain their weight through healthy eating and regular physical activity.

Links between yo-yo diet and increased body weight, hypertension and eating-disordered cognitions have been proposed, however, studies on the physical and/or psychological health risks associated with yo-yo diet have produced mixed results. Some studies report no relation between yo-yo diet and physical health ¹⁴, while others suggest that cycling increases health risks. Specifically, yo-yo diet has been associated with increased weight and central adiposity ¹⁵, ¹⁶, hypertension (high blood pressure) ¹⁶, ¹⁷ and type 2 diabetes ¹⁸.

Who are the demographic of yo-yo dieters?

According to research yo-yo dieters and non-yo-yo dieters did not differ on demographic information including age, education, employment status, income, marriage, or medication use ¹⁹. See Table 1 for a list of all demographic information.

Survey data collected by Williamson and colleagues ⁷ indicated that 25% of men and 27% of women trying to lose weight have made long-term attempts (classified as trying for over 1 year or “always trying to lose weight”). It has also been shown that 7% of men and 10% of women can be classified as severe weight cyclers (intentionally lost at least 5 kg and regained at least three different times), while 11% of men and 19% of women are mild weight cyclers (lost and regained at least 5 kg on one or two occasions) ²⁰. While these results were generated from a group of adults in Finland, the conclusion that 18% of men and 27% of women weight cycle is comparable to the prevalence described by Williamson et al. ⁷. These numbers are likely a conservative estimate of the prevalence of weight cycling, which may be even greater in the United States.

Interestingly, more than half of yo-yo dieters had tried yo-yo diet more than three times. Yo-yo dieters weighed more, had a higher body mass index (BMI) and reported a higher peak weight compared to non-yo-yo dieters, despite reporting no differences in ideal weight.

Yo-yo dieters were more likely to binge eat and reported greater body image disturbance.

Yo-yo dieters reported significantly lower self-esteem for their appearance and greater body dissatisfaction and drive for thinness compared to non-yo-yo dieters, however, all self-esteem scores were within clinically normal limits ¹⁹. Average total self-esteem scores, symptoms of anxiety, and symptoms of depression were all clinically non-significant and did not differ between yo-yo dieters and non-yo-yo dieters, suggesting that the relationship between psychological health and yo-yo dieters may be limited to the domain of body image and eating ²¹, ²².

Table 1. Demographics of Yo-yo dieters and Non-yo-yo dieters

	Yo-yo dieters	Non-yo-yo dieters
Age	41.57	41
Education, ≥16 years	52%	50%
Full-time employment	90%	95%
Individual income, >$40,000	67%	65%
Married	47%	60%
High blood pressure (hypertension) classification, mm Hg
Normal, <120/<80 mm Hg	28%	32%
Pre-hypertension (pre high blood pressure), 120–139/80–89 mm Hg	44%	46%
Stage 1 hypertension (stage 1 high blood pressure), 140–159/90–99 mm Hg	21%	19%
Stage 2 hypertension (stage 2 high blood pressure), >160/>100 mm Hg	6%	4%

[Source ¹⁹]

Does Weight Regain in Yo-yo Diet Disrupts Normal Physiology?

The physiological changes associated with weight cycling, such as energy expenditure, metabolism and fuel utilization, have been documented using a rat model. MacLean and colleagues ²³ have documented the physiological alterations occurring in obesity-prone rats that contribute to the rapid, efficient regain during relapse following weight loss and maintenance. Their focus has been on the energy gap created during a period of caloric restriction that is characterized by decreased energy expenditure and an increased drive to eat ²³. They found that in addition to changes in energy intake, alterations in metabolic efficiency and fuel utilization (favoring carbohydrate oxidation) may significantly affect the propensity to regain weight ⁸. For instance, in the 16 weeks following moderate weight loss (14%), food efficiency was increased 10-fold upon the first day of a 56-day re-feeding in weight cycle rats compared to rats with established obesity. While this dramatic rise was reduced within several days, food efficiency remained elevated above levels in obese mice for the first 4 weeks of relapse ²⁴. The most dramatic changes occurred during the first week of relapse, a time when nearly 40% of lost weight, which was primarily fat mass, was regained ²⁴, ²⁵. Researchers also noted that as the length of maintenance increased, the amount of weight regained upon relapse also increased. Furthermore, regain was accompanied by a 30% increase in adipocyte concentration per fat pad.

Based on the above literature, it is clear that weight gain during relapse appears to induce more rapid adipose tissue growth and hyperplasia due to metabolic shifts favoring lipid storage. Because adipose tissue is a metabolically active tissue, responsible for production of leptin, cytokines and adiponectin as well as responding to traditional hormone systems ²⁶, it is possible that the consequences of weight gain during relapse may also differ from that of initial weight gain. In recent years, lay literature has asserted that weight cycling may be more detrimental to health than simply remaining overweight or obese ²⁷, ²⁸. Researchers have found associations between weight cycling and an overshoot of lipogenic enzyme, triglyceride and cholesterol levels in animals and increased risk of heart attack and stroke in humans ²⁹, ³⁰, ³¹, ³². However, other researchers noted no long term adverse effects on body composition, blood pressure, lipid profile or risk of developing type II diabetes ¹⁴, ³³, ³⁴, ³⁵, ³⁶ (13, 22, 37, 49, 56). Due to limited research in the area of weight cycling all of the negative consequences may not be known. Existing studies differ considerably in their research design, subject population used, duration of treatment, incorporation of exercise, magnitude and frequency of weight cycles. The lack of a universal definition of weight cycling is perhaps a great contributor to the variability within experimental design. This variability is discussed in greater detail in the following sections.

Evaluation of Weight Cycling: Human Models

Some existing scientific literature supports the theory that weight cycling increases disease risk (directly or indirectly) in humans. Wallner and colleagues ¹⁵ found that a history of weight cycling was associated with a more pronounced android fat distribution in women compared to those who were normal-weight or overweight without a history of weight cycling ¹⁵. It is possible that women who are prone to the accumulation of abdominal adiposity may be more likely to weight cycle for a more aesthetically desirable figure ³⁷. Regardless of whether weight cycling causes the accumulation of android adiposity or vice versa, other researchers have found that a history of weight cycling was independently associated with an increased risk of developing hypertension ¹⁶ and clinically significant decreases in HDL-cholesterol in women ³⁸. French et al. ³⁰ and Vergnaud et al. ³⁹ demonstrated associations between weight cycling and risk for heart attack and stroke, as well as the development of metabolic syndrome ³⁹, ³⁰. Blair et al. ²⁹ studied men enrolled in the Multiple Risk Factor Intervention Trial who were at elevated risk for coronary heart disease due to smoking, hypertension and hypercholesterolemia, finding that greater weight variability over 4 years of follow up was associated to increase all-cause mortality.

In contrast to the preceding reports, several other researchers reported that weight cycling has no independent impact on health status. Prentice et al. found that weight cycling did not significantly alter body composition ³⁵. However, unlike Wallner et al. ¹⁵, who asked for 4 years worth of weight history, this study was completed in only 18 weeks. It may be possible that any deleterious effects of weight cycling do not manifest immediately or that the magnitude of the weight loss was not sufficient to induce long-term change. Li et al. ³⁴ studied obese patients, in a multi-disciplinary weight loss program, who had relapsed and re-entered. Multiple attempts at weight loss over 12 years showed no effect on the rate at which weight could be lost each time or on blood pressure or lipid profile; in fact, these measurements at baseline were significantly lower at the time of re-entry compared to the initial start for men and women. Initial blood pressure in men (134/88 mmHg) and women (126/82 mmHg) was recorded at the restart baseline at 129/85 mmHg and 121/78 mmHg, respectively. While no subjects were hypertensive, all values remained within the pre-hypertensive range. Furthermore, BP has been documented to fluctuate throughout the day ⁴⁰. Triglyceride levels in men and women were reduced by 0.1 and 0.2 mmol/L between initial and restart baselines and cholesterol was reduced by 0.1 and 0.5 mmol/L, respectively. Women’s values were all within the normal/low risk range and men’s values remained in the borderline high range. Cholesterol values for both genders were all in the borderline high risk range. While deemed statistically significant, the differences between baselines may not be physiologically relevant as disease risk did not appear to change. Even though this study was longitudinal in nature, perhaps the use of regular exercise as part of the program acted as a confounding factor, as aerobic exercise is independently and positively correlated with decreases in blood pressure and cholesterol ⁴¹, ⁴².

A similar exercise effect was reported by Field et al. ¹⁴ where mild and severe weight cycling was strongly associated with weight gain and hypertension, controlling the statistical analysis for weight and weight gain greatly attenuated this correlation; however, the questionnaire data also revealed that severe weight cyclers exercised significantly more that non weight cyclers. Graci et al. ³³ noted that weight cycling had no effect on cardiovascular disease risk factors; weight cycling throughout adulthood was not associated with changes in body composition, fat distribution blood pressure or insulin levels. One major difference in this study, compared to those with competing findings, was that Graci et al. ³³ used morbidly obese subjects (BMI up to 69 kg/m2) and perhaps there is a less-pronounced response to weight cycling in this population because the subjects already have an elevated disease risk. Similar results by Wing et al. ⁴³ and Jeffery et al. ⁴⁴ may have been effected by the short duration of measurement period (2.5 years) or the failure to use appropriate blood pressure cuffs for obese patients ¹⁶. Field et al. ⁴⁵ concluded that 4 years of weight cycling, prior to diagnosis of type 2 diabetes, was not predictive of disease development while Wannamethee et al. ⁴⁶ and Mehta et al. ⁴⁷ found that weight fluctuation does not directly increase risk of death.

There is only one published study that examined the effect weight variability has on pro-inflammatory or related factors. Yatsuya et al. ⁴⁸ reported that Japanese men with a history of weight variability had an independently increased odds ratio of elevated C-Reactive Protein (CRP). One limitation of this study was that it was a cross-sectional design thus it was not possible to evaluate cause and effect, no information on intentionality of weight change and the cross-sectional design with a majority of subjects having final BMIs less than 25 kg/m2. This lack of literature suggests that in order to fully understand the possible effects of weight cycling, we must include examination of pro-inflammatory responses to this pattern.

Yo yo diet consequences on health

As obesity is becoming increasingly more prevalent in the United States, weight loss to reduce adipose tissue mass is strongly promoted as a means to decrease the disease risk associated with excess adiposity ⁴⁹, ⁵⁰. Unfortunately, the majority of individuals who lose weight are unlikely to maintain the reduced weight for an extended period of time ¹³, ¹⁰. Repeated periods of weight loss and regain form a pattern known as weight cycling or yo-yo dieting. Hill ⁵¹ indicates that popular and lay literature have asserted that weight cycling (i.e. “yo-yo dieting”) may increase the risk of developing cardiovascular disease or type II diabetes to a greater extent than remaining weight stable at an obese Body Mass Index (BMI; ≥30 kg/m2). The scientific literature is inconsistent regarding the long-term consequences of weight cycling. Because there is no universally-accepted definition of yo-yo dieting, differences in experimental design may have contributed to discrepancies in scientific outcomes.

Weight gain and obesity have significant implications concerning disease risk, which is believed to be mediated by an elevated level of systemic inflammation. Low-grade systemic inflammation is associated with obesity and it may serve as a link between adiposity and the development of cardiovascular disease and type 2 diabetes ⁵². The pro-inflammatory effects of yo-yo dieting have not been examined. Discerning a difference in disease risk between maintenance of obesity and yo-yo dieting is important and may provide insight concerning individual differences in disease progression. If yo-yo dieting is associated with an increased disease risk, continually recommending weight loss to those unable to maintain reduced weights may be a major public health issue.

What is the best way to lose weight?

There is no one best way to lose weight, which is why doctors and dietitians work to understand your personal circumstances when making recommendations. There is no quick fix. Improving your diet and increasing activity can be key to losing weight, although are not the only factors that need to be considered. When aiming to lose weight it is important to have realistic goals that are achievable. Success boosts confidence in your ability to lose weight. A weight loss of between 0.5 to 2 pounds (0.5 to 1kg) a week is a safe and realistic target. Experts recommend losing 5 to 10 percent of your body weight within the first 6 months of treatment ⁵³. In most people, a 10% weight loss target can be achieved with a calorie deficit of 500 to 1,000 calories per day, leading to weight losses of one pound to two pounds per week (i.e. total calories deficit of 3,500 to 7,000 per week) ⁵⁴. Cutting down on alcohol, dietary fats and sugary carbohydrates is a practical way to produce this calorie deficit ⁵⁵. A comprehensive analysis of data that focuses on dieting and weight loss found that increased lean tissue (muscle tissue) is lost if the energy deficit of the diet is too large in combination with rapid weight loss ⁵⁶. In contrast, inclusion of exercise (both cardio workout and weightlifting) and adequate dietary protein (60 grams per day, ranging from 0.8 g to 1.5 g per kg of body weight) helps to minimize muscle tissue loss ⁵⁶. These dietary strategies should be incorporated into dietary treatment plans to minimize muscle mass reduction and maximize fat loss ⁵⁴.

For women, a weight reduction plan of eating approximately 1,000 to 1,200 calories per day is suitable. According to the National Institutes of Health and the National Heart, Lung, and Blood Institute, a 1,200 – 1,600 calorie allowance for men or women who weigh 165 pounds, or more, and who exercise regularly is recommended ⁵⁴. These calorie amounts along with increased physical activity and behavioral modification will likely produce a caloric deficit to achieve the targeted weight loss plan of one to two pounds per week ⁵⁷. With a caloric deficit of 500 to 1000 calories per day, if followed with perfect adherence, after six months, weight loss of 26 to 52 pounds would be expected. However, in reality, losses are usually between 20 to 25 pounds, since adherence is never perfect ⁵⁸.

It is recommended that you dieting should last for 6 months or less, because according to research after about six months, most people have great difficulty sticking to any diet, especially if it is very strict ⁵⁴. Furthermore, your weight will plateau as your energy intake fluctuates and as your resting metabolic rate and energy output decrease. After six months of weight loss, you should focus on maintenance of the weight loss through a combination of diet therapy, physical activity, and behavior modification. If successful, after several months you can start a new weight loss cycle again ⁵⁴. If further weight reduction is necessary after 10% of initial body weight is lost, it can be attempted with an increased calorie deficit after prior weight loss has been maintained for several months.

When you do not engage in a weight management program that includes all three components (i.e., diet therapy, physical activity, and behavior modification) you’re risking regaining all or extra weight increase ⁵⁹, ⁵⁸. Most people regain one-third of their lost weight in one year, and nearly half return to their original weight within five years ⁶⁰. The more frequently you have has contact with your healthcare provider (doctor and dietitian), the weight loss and maintenance outcomes tend to be more successful ⁵⁹.

You weight loss programs and weight loss maintenance programs should focus on changing your behavior to reduce energy intake by cutting unhealthy foods, decreasing sugar‐sweetened beverage consumption and fat intake, portion control, increasing fruit and vegetable intake, and adhering to a diet ⁶¹. Additionally, energy expenditure should be promoted through increasing physical activity.

American College of Sports Medicine recommendations for physical activity for Weight Loss and Prevention of Weight Regain for Adults ⁶²:

• Maintain and improving health: 150 minutes/week
• Prevention of weight gain: 150 – 250 minutes/week
• Promote clinically significant weight loss: 225 – 420 minutes/week
• Prevention of weight gain after weight loss: 200 – 300 minutes/week

Strong evidence exists that exercise (physical activity) can reduce weight gain in those at risk for obesity, and many exercise training programs are capable of producing at least modest weight loss (~2 kg) ⁶². A question often encountered in the clinical setting from patients is how much exercise is needed to lose weight and what type of exercise training should be performed. Overall, the changes in weight in response to exercise training without caloric restriction are highly heterogeneous and individual differences can span weight gain to clinically significant weight loss ⁶³. Patients should should consult their clinicians or dietitians on what are reasonable expectations based on their specific weight loss program. However, research data suggest that physical activity has an important role in the amount of weight regain following successful weight loss ⁶⁴. Therefore, patients attempting to reduce recidivism after weight loss should engage in physical activity levels above 200 minutes/week ⁶².

Furthermore, high levels of physical activity and cardiorespiratory fitness (fitness) are inversely associated with cardiovascular disease, type 2 diabetes and all-cause mortality ⁶⁵. Several epidemiological studies even suggest that high levels of physical activity or cardiorespiratory fitness reduces the health risk of obesity ⁶⁶, ⁶⁷. Moreover, cardiorespiratory fitness levels have been shown to alter the relationship of the obesity paradox, where high cardiorespiratory fitness level is associated with greater survival in all body mass index (BMI) categories ⁶⁸. In summary, patients are encourage to adhere to exercise programs or engage in regular physical activity regardless of the weight loss achieved.

Another question that is often encountered in the clinical setting is if there is a difference between weight loss achieved through dietary means or through exercise training in terms of cardiovascular and type 2 diabetes mellitus risk factors. In an elegantly designed study, Ross et al. ⁶⁹ randomized obese men (n= 52) to diet-induced weight loss, exercise induced weight loss, exercise without weight loss, or a control group for 3 months. The diet-induced and exercise-induced weight loss groups lost approximately 7 kg of weight (8% weight reduction), and had significant reductions in total fat mass, visceral fat and increased glucose disposal ⁶⁹. However, the exercise-induced weight loss group had a greater reduction in total fat mass compared to the diet induced weight loss group ⁶⁹. Importantly, the exercise-induced weight loss improved cardiorespiratory fitness (fitness) whereas the dietary group did not. In the group who performed exercise training without weight loss, the participants still experienced reductions in visceral fat and increased cardiorespiratory fitness.

The observations by Ross et al. ⁶⁹ reaffirm that an exercise training program still confers health benefits to obese patients even in the absence of weight loss. Although dieting without exercise training has potential cardiovascular benefits, exercise training should be encouraged by to help patients improve cardiorespiratory fitness levels, which is an independent risk factor for cardiovascular diseases, type 2 diabetes mellitus and mortality 10, and may further augment the negative energy balance created by caloric restriction. Lastly, Ross’ observations suggest that there is a rationale for exercise training to be a part of weight loss programs as the authors observed greater changes in visceral fat, oral glucose tolerance, and glucose disposal in the exercise training group with clinically significant weight loss compared to the group with exercise without weight loss group ⁶⁹.

Now you know the basics about calories and healthy weight loss, the key to weight loss for most people is simply finding the right combination of exercise, healthy foods and cutting back on portions will help you lose those extra pounds. No fad diet required. In other words, eat healthily, watch your portions and get moving more. By losing just a few pounds with healthy eating and exercise, you’ll start to feel better. You’ll have more energy. To prevent the weight creeping back on, you need to keep going with the healthy habits you’ve formed.

How to lose weight?

To lose weight you’ll need to start with finding a way to eat fewer calories than you need. A calorie is a unit of energy, which is in the foods and drinks you consume. Scientifically, the calorie (a unit of energy) was originally defined as the amount of heat required at a pressure of 1 standard atmosphere to raise the temperature of 1 gram of water 1° Celsius. When you hear something contains 100 calories, it’s a way of describing how much energy your body could get from eating or drinking it. However, since calories are too small of a measurement to use when discussing nutrition and exercise, kilocalorie (kcal) measurements are used instead and the term is interchangeable with calories. Kilocalorie (kcal) is a unit of measurement for energy that is equivalent to 1,000 calories. Also,1 kcal or 1 kilocalorie is equivalent to 1 large Calorie (with an uppercase C) or 1,000 calories.

Some countries use kilojoules (kJ) to measure how much energy people get from consuming a food or drink.

• 1 calorie = 4.184 joule
• 1 kilocalorie (kcal) = 4.184 kilojoules (kJ)
• 1 Calorie (1,000 calories) = 4.184 kilojoules (kJ)

Here’s how many calories are in your foods and drinks ⁷⁰:

• 1 gram of carbohydrate = 4 calories
• 1 gram of protein = 4 calories
• 1 gram of fat = 9 calories
• 1 gram of water = 0 calorie

Most foods and drinks contain calories. You can find out how many calories are in a food by looking at the nutrition facts label. The label also will describe the components of the food such as how many grams of carbohydrate, protein, and fat it contains.

That means if you know how many grams of each one are in a food, you can calculate the total calories. You would multiply the number of grams by the number of calories in a gram of that food component. For example, if a serving of potato chips (about 20 chips) has 10 grams of fat, 90 calories are from fat. That’s 10 grams x 9 calories per gram. Some foods, such as lettuce, contain few calories (1 cup of shredded lettuce has less than 10 calories). Other foods, like peanuts, contain a lot of calories (½ cup of peanuts has 427 calories).

There are many unhealthy misconceptions about weight loss. There are no magical foods or ways to combine foods that melt away excess body fat. To reduce your weight, you’ll have to reduce your calorie intake.

Calories aren’t bad for you. Your body needs calories for energy. Your body uses energy (calorie) for everything you do from breathing and sleeping to exercising. Some people mistakenly believe they have to burn off all the calories they eat or they will gain weight. This isn’t true. Your body needs some calories just to operate — to keep your heart beating and your lungs breathing. When you eat, you’re replacing the energy (calorie) you’ve used, which helps you to maintain a healthy weight. But eating more calories than your body needs and not burning enough of them off through activity can lead to weight gain and other health problems such as type 2 diabetes, heart disease, high blood pressure, certain cancers (e.g., uterine, gallbladder, kidney, liver, and colon cancers) and death ⁷¹, ⁷², ⁵⁴, ⁷³.

Being overweight or obese is the result of an energy imbalance between your daily energy intake and your energy expenditure resulting in excessive weight gain ⁷⁴. The amount of energy or calories you get from food and drinks (energy IN) is balanced with the energy your body uses for things like breathing, digesting, and being physically active (energy OUT):

• The same amount of energy IN and energy OUT over time = weight stays the same (Energy Balance)
• More energy IN than OUT over time = Weight Gain
• More energy OUT than IN over time = Weight Loss

In order to lose weight, energy expenditures must exceed energy intake. To lose weight, most people need to reduce the number of calories they get from food and beverages (energy IN) and increase their physical activity (energy OUT). To achieve this imbalance, you can decrease energy intake, increase energy expenditures or combine a decrease in intake with an increase in expenditures. Being physically active and eating fewer calories will help you lose weight and keep the weight off over time. As a result, most weight loss recommendations advise combining a low caloric diet with an exercise program in order to achieve a significant energy deficit ⁷⁵. A long-standing consistent observation is that regular exercise by itself is prescribed in small to moderate amounts resulting in modest weight loss or in some cases weight gain ⁷⁶.

Weight loss of about 1 to 1 ½ pounds per week is considered reasonable and more likely to be maintained. For a weight loss of 1 to 1 ½ pounds per week, daily intake should be reduced by 500 to 750 calories. In general ⁷⁷:

• Eating plans that contain 1,200–1,500 calories each day will help most women lose weight safely.
• Eating plans that contain 1,500–1,800 calories each day are suitable for men and for women who weigh more or who exercise regularly.

Very low calorie diets of fewer than 800 calories per day should not be used unless you are being monitored by your doctor. Because dieting can be harmful because your body responds to these periods of semi-starvation by lowering its metabolic rate. When you lose weight too quickly, you lose fat and muscle. Muscle burns kilojoules, but fat doesn’t. So, when you stop dieting and return to your usual habits, your body will burn even fewer calories than before because the relative amount of muscle in your body has decreased and your metabolic rate is slower. This kind of eating pattern can also affect your general health – just one cycle of weight loss and weight gain can contribute to an increased risk of coronary heart disease (regardless of your body fat levels). That’s why it’s more important to be able to maintain weight loss.

Energy balance is also important for maintaining a healthy weight. To maintain a healthy weight, your energy IN and OUT don’t have to balance exactly every day. It’s the balance over time that helps you maintain a healthy weight.

You can reach and maintain a healthy weight if you:

• Follow a healthy diet, and if you are overweight or obese, reduce your daily intake by 500 calories for weight loss
• Are physically active
• Limit the time you spend being physically inactive

While people vary quite a bit in the amount of physical activity (exercise) they need for weight control, many can maintain their weight by doing 150 to 300 minutes (2 ½ to 5 hours) a week of moderate-intensity activity such as brisk walking. People who want to lose a large amount of weight (more than 5 percent of their body weight) and people who want to keep off the weight that they’ve lost may need to be physically active for more than 300 minutes of moderate-intensity activity each week.

You now know the basics about calories – the key to weight loss for most people is simply finding the right combination of exercise, healthy foods and cutting back on portions will help you lose those extra pounds. No fad diet required. In other words, eat healthily, watch your portions and get moving more. By losing just a few pounds with healthy eating and exercise, you’ll start to feel better. You’ll have more energy. To prevent the weight creeping back on, you need to keep going with the healthy habits you’ve formed.

How many calories do I need per day?

The total number of calories you need each day varies depends on a number of factors, namely your age, sex, height, weight, level of physical activity, and pregnancy or lactation status. According to the Dietary Guidelines for Americans, American female adult estimated calorie needs range from 1,600 to 2,400 calories per day and for males 2,000 to 3,000 calories per day ⁷⁸. The average, healthy, adult, American male consumes approximately 2,800 calories per day, and the average female about 1,800 calories ⁵⁴. But most people need different amounts of calories based on how their bodies work, how active they are and any weight management goals. And if you want to lose weight you’ll have to reduce your calorie intake.

Here is a general estimate of calories you need each day:

• Sedentary lifestyle (little to no exercise)
  • Women: 1,800 to 2,400 calories
  • Men: 2,200 to 3,000 calories
• Moderately active lifestyle (engages in moderate exercise/physical activity like walking or light yard work:
  • Women: 2,000 to 2,600 calories
  • Men: 2,400 to 2,800 calories
• Very active lifestyle (engages in hard exercise/physical activity, or has a physically demanding job):
  • Women: 2,200 to 2,800 calories
  • Men: 2,800 to 3,200 calories

These are just general guidelines. It’s essential to consult with a nutritionist or a doctor who can give personalized advice based on your specific situation. Remember, it’s not just the quantity but also the quality of calories that matters for overall health.

Obesity results from the accumulation of excessive body fat, which is stored as adipose tissue. An energy deficit of approximately 3,500 calories is required to lose one pound of fat. However, there are several factors that can influence this particular number. These include compensatory changes in your resting metabolism (basal metabolic rate [BMR]), the energy cost of work, and discretionary physical activity, which can sometimes alter this figure by 100 to 200 calories. Your basal metabolic rate (BMR) also known as resting metabolic rate (RMR) is the number of calories your body burns while performing basic life-sustaining functions, such as breathing and keeping your heart beating. Your basal metabolic rate (BMR) is typically between 1,000 and 2,000 calories per day.

How to calculate calories you need for weight loss

You can calculate your basal metabolic rate (BMR) or resting metabolic rate (RMR) using the Mifflin-St Jeor equation ⁷⁹, which is considered more accurate than the Harris-Benedict equation, especially for lean people. According to the Academy of Nutrition and Dietetics Evidence Analysis Library (EAL), the Mifflin-St. Jeor equation accurately predicted resting metabolic rate (RMR) using actual body weight within +/- 10% of measured RMR in 70% of obese individuals ⁵⁹. Of the remaining 30%, 9% were overestimations and 21% were underestimations. The individual error range was a maximum overestimate of 15% to a maximum underestimate of 20%” ⁸⁰. While the Harris-Benedict and WHO equations are often used in clinical practice with reasonable accuracy, results have been mixed regarding their applications to individuals who are overweight or obese ⁵⁴.

The Mifflin-St Jeor formula for calculating your basal metabolic rate (BMR) or resting metabolic rate (RMR):

• Males Basal metabolic rate [BMR] (kcal/day) = (10 X weight in kilograms) + (6.25 X height in centimeters) – (5 X age in years) + 5 (kcal/day)
• Females Basal metabolic rate [BMR] (kcal/day) = (10 X weight in kilograms) + (6.25 X height in centimeters) – (5 X age in years) – 161 (kcal/day)

You can also use the free online Basal Metabolic Rate (BMR) calculator here: https://www.nasm.org/resources/calorie-calculator

Or the Body Weight Planner (https://www.niddk.nih.gov/health-information/weight-management/body-weight-planner).

The Body Weight Planner allows you to make personalized calorie and physical activity plans to reach a goal weight within a specific time period and to maintain it afterwards.

The Basal Metabolic Rate (BMR) calculator factor in your activity levels, overall goals, and calorie usage to help you craft a weight-loss plan.

Once you have found your basal metabolic rate (BMR), multiply your BMR by your Physical Activity Levels to provide a baseline daily caloric level for weight maintenance:

• Sedentary (light physical activity associated with typical day-to-day life) = 1
• Low Active (walking about 1.5 to 3 miles per day at 3 to 4 miles per hour, in addition to the light physical activity associated with typical day-to-day life), For males = 1.11 and females = 1.20
• Active (walking more than 3 miles per day at 3 to 4 miles per hour, in addition to light physical activity associated with typical day-to-day life: 60 minutes of at least moderate intensity physical activity). For males = 1.25 and females = 1.27
• Very Active (walking more than 7.5 miles per day at 3 to 4 miles per hour, in addition to light physical activity associated with typical day-to-day life: 60 minutes of at least moderate to vigorous intensity physical activity). For males = 1.48 and females = 1.45

Your Total Daily Energy Expenditure (TDEE) gives you the estimated number of calories you need to maintain your current weight based on your activity level.

To find your Total Daily Energy Expenditure (TDEE) multiply your Basal Metabolic Rate (BMR) by your Physical Activity Levels

For example:

• Sedentary (little to no exercise): BMR x 1
• Lightly active (walking about 1.5 to 3 miles per day at 3 to 4 miles per hour, in addition to the light physical activity associated with typical day-to-day life): BMR x For males = 1.11 and females = 1.20
• Moderately active (moderate exercise/sports 3-5 days/week): BMR x 1.55
• Very active (walking more than 7.5 miles per day at 3 to 4 miles per hour, in addition to light physical activity associated with typical day-to-day life: 60 minutes of at least moderate to vigorous intensity physical activity): BMR x For males = 1.48 and females = 1.45
• Super active (very hard exercise & physical job or 2x training): BMR x 1.9

You can increase your basal metabolic rate (BMR) by:

• Exercising more, especially interval training
• Weight training to build muscle mass
• Eating fat-burning foods
• Getting enough sleep

After calculating your basal metabolic rate (BMR) or resting metabolic rate (RMR), your RMR should be multiplied by an appropriate physical activity factor to provide your baseline daily caloric level for weight maintenance. Once your baseline caloric level is known, your recommended calorie intake should be reduced to facilitate your weight loss.

If you want to lose weight, subtract 500 to 1000 calories from your Total Daily Energy Expenditure (TDEE) to get a daily intake goal. For weight gain, add extra calories. Reducing your calorie intake by 500 calories is a common strategy to yield a weight loss of approximately one pound per week, although reductions of up to 750 calories per day are sometimes used ⁸¹.
Another approach is to reduce your current caloric intake by 30% ⁸¹. Diets that reduce caloric intake relative to energy expenditure result in weight loss, regardless of macronutrient composition ⁸¹.

Here’s how to estimate how long it will take to reach your goal:

Jessie’s current weight is 150 lbs. She wants to lose 20 lbs.

• 150lbs – 20lbs = 130lbs.
• 20lbs loss at 2lbs/week = 10 weeks.
• It will take Jessie about 10 week to lose the weight.

Remember, these are general guidelines only. It’s crucial to monitor your progress and adjust as necessary. Consulting with a nutritionist or health professional is always recommended for personalized advice.

How many calories should I eat to lose weight?

For a healthy and sustainable weight loss journey, it’s typically recommended you not to shed more than 2 pounds of fat weekly. This translates to a daily calorie deficit of 1,000 calories. It’s essential to note that when weight loss surpasses 2lbs within a week, it’s often water weight being lost, not just fat.

For those leading a more sedentary lifestyle, aiming to lose 1lb per week is a good starting point. This means creating a daily calorie deficit of 500 calories.

On the other hand, those who are more active naturally have higher daily calorie needs. So, when they’re trying to lose weight, they can afford to eat a bit more since their maintenance calories are already elevated.

For such individuals, aiming for a daily calorie deficit of 500-1,000 calories is realistic, potentially leading to a weight loss rate of up to 2lbs weekly.

What happens when your calories are too low?

Consuming calories below your body’s needs for an extended period can lead to various physiological and psychological consequences. Here’s what can happen when your caloric intake is too low:

• Slower metabolism: Your body might slow down its metabolic rate as a defense mechanism to conserve energy. This can make weight loss harder over time and weight regain more likely once normal eating resumes.
• Nutrient deficiencies: Low calorie intake can lead to inadequate intake of essential vitamins and minerals. Over time, this can result in conditions like anemia, osteoporosis, and impaired immune function.
• Loss of muscle mass: Your body might start breaking down muscle tissue for energy, especially if protein intake is inadequate. This can further slow down metabolism and lead to weakness.
• Hormonal changes: Reduced calorie intake can affect hormone levels, leading to disruptions in menstrual cycles for women, reduced bone density, and other hormonal imbalances.
• Reduced energy and fatigue: You might feel constantly tired or find it difficult to concentrate.
• Mood changes: Low caloric intake can influence mood. This can result in irritability, depression, or anxiety.
• Impaired Immune Function: Your body might become more susceptible to infections due to a weakened immune system.
• Hair and skin problems: You might experience hair loss, dry skin, or brittle nails due to inadequate nutrient intake.
• Digestive problems: Constipation or other digestive issues can occur as a result of reduced fiber and fluid intake.
• Fertility issues: Low calorie and nutrient intake can lead to fertility problems in both men and women.
• Cardiovascular problems: Chronic low calorie intake can affect heart health, leading to low blood pressure, irregular heart rhythms, or other cardiovascular issues.
• Increased risk of gallstones: Rapid weight loss from very low-calorie diets can lead to the development of gallstones.

What should I eat if I want to lose weight?

Most of dieters can meet all of their nutritional needs from food. Tips for making healthy eating choices:

• Eat a variety of foods. Eat a variety of foods from each of the five food groups daily. Healthy choices include fruits, vegetables, whole grains, protein foods, and fat-free or low-fat dairy. Foods are grouped together because they provide similar amounts of key nutrients. For example, key nutrients of the milk, yoghurt, cheese and alternatives group include calcium and protein, while the fruit group is a good source of vitamins, minerals, antioxidants. As a bonus, choosing a variety of foods will help to make your meals interesting, so that you don’t get bored with your diet.
• Eat fruit instead of drinking it. Eating fruit is linked to a reduced risk of several health conditions, but fruit juices are more likely to spike blood sugar levels.
• Add healthy fats. Healthy fats like monounsaturated and polyunsaturated fats can help lower cholesterol and protect your heart. You can find healthy fats in foods like olive oil, nuts, avocados, and some types of fish.
• Drink water. Sipping water throughout the day can help keep you full and hydrated. Sometimes thirst is mistaken for hunger.
• Reduce added sugar. Too much added sugar in your diet can contribute to weight gain, obesity, type 2 diabetes, and heart disease.
• Chew your food well. Chewing your food well can help you make healthier food choices.
• Sit at the table to eat. Sitting at the table to eat can help you focus on your food and internal cues for hunger or fullness.

Some bodybuilders and athletes use dietary supplements to try to improve their strength, muscle mass, and energy. However, many of these types of products contain harmful ingredients. Also, for some substances, including glutamine, choline, methoxyisoflavone, quercetin, zinc/magnesium aspartate, nitric oxide, and L-arginine, there’s no clear evidence that they improve athletic performance.

Carbohydrates

Carbohydrates are your body’s fuel. Carbohydrates also play roles in gut health and immune function ⁸². For healthy children and adults, carbohydrates should make up approximately 45 to 65% of energy intake based on the minimum required glucose for brain function ⁸². However, some carbohydrates are more nutritious than others.

Foods that contain the most carbohydrates include:

• Fruit.
• Vegetables, especially potatoes and corn.
• Legumes, including dried beans, peas and lentils.
• Grains.
• Bread.
• Breakfast cereal.
• Rice, pasta and noodles.
• Low-fat milk and yoghurt.

These foods are rich in vitamins, minerals and antioxidants and are generally low in fat. This makes them well suited to a healthy eating plan. Some are excellent sources of dietary fibre, including wholegrain varieties, legumes, fruit and vegetables.

Foods with lots of added sugar like soft drinks, alcohol and sweets are another source of carbohydrates, but these contribute extra kilojoules with few vitamins and minerals.

Optimal carbohydrate intake should consist of high fiber, nutrient-dense whole grains, fruits, vegetables and legumes, without the added sugar ⁷⁰.

The Dietary Guidelines for Americans recommends that carbohydrates should make up 45 to 65% of one’s daily calories ⁸³. To calculate how many grams of carbohydrates you need, multiply your daily calorie requirements by 0.45 and 0.65 to obtain calories from carbohydrates.

• (A) 0.45 x 2000 = 900 calories
• (B) 0.65 x 2000 = 1300 calories

Divide answers in step 1 by 4 since there are 4 calories per 1 gram of carbohydrate

• (A) 900/4 = 225g of carbohydrate
• (B) 1300/4 = 325g of carbohydrate

Carbohydrates are eaten in the form of simple carbohydrates, like monosaccharides and disaccharides, or complex carbohydrates, like oligosaccharides and polysaccharides ⁸². Monosaccharides are the basic building blocks of all carbohydrates and include glucose, fructose, and galactose. Glucose is the simplest type of carbohydrates and is the major source of energy for your body’s cells ⁸². Glycogen is the storage form of glucose in animals and is present in the liver and muscle, but there is little to none in the diet.

Disaccharides contain two sugar units and include lactose, sucrose, and maltose. Lactose is a carbohydrate found in milk, and sucrose is basic table sugar.

Oligosaccharides consist of 3 to 10 sugar units and include raffinose and stachyose, which are in legumes.

Polysaccharides include greater than ten sugar units and consist of starches, glycogen, and fibers, like pectin and cellulose. Starches like amylose are in grains, starchy vegetables, and legumes and consist of glucose monomers.

Fibers are plant polysaccharides like pectin and cellulose found in whole grains, fruits, vegetables, and legumes but are not digestible by humans. However, fibers play a major role in gut health and function and can be digested by microbiota (microorganisms) in the large intestine ⁸⁴. The recommended fiber intake is greater than 38 g for men and 25 g for women, which is the intake that research has observed to lower the risk of coronary artery disease (a heart disease that affects the main blood vessels that supply blood to the heart).

Does eating more carbohydrates cause body fat?

If carbohydrates control body fat, then you would expect that low-carb diets are less “fattening” than higher carbohydrate diets. This means that low carb diets should add less body fat to people than higher carbohydrate diets do. This is true in the most basic sense in that when you overconsume calories (Calorie IN more than Calorie OUT). You do store at least some of the excess calories as body fat. But studies don’t support that view that low-carb diets are less “fattening” than higher carbohydrate diets. It turns out that excess carbohydrates are relatively difficult to store as body fat, at least compared to fats.

In one study where people were overfed carbohydrates and fats, fats were stored ~20% more efficiently than carbs ⁸⁵. In another study where people were overfed carbohydrates, there was a very minimal conversion of carbohydrates to stored body fat, indicating that it is very inefficient to turn carbohydrates into body fat ⁸⁶.

Furthermore, low-carb diets are not necessary for weight loss, nor are they alone sufficient for weight loss. Carbs don’t necessarily control body fat after all. Over the last several decades there have been dozens of scientific studies comparing low-carb diets to other diets to examine their efficacy ⁸⁷. There are plenty of studies whose results do not support the idea that carbohydrates per se control body fat. For example, in one study of 4,451 people, there was a lower risk of being obese or overweight if you consumed a moderate to high carbohydrate diet when compared to a lower carbohydrate diet ⁸⁸. That study found consuming a low-carbohydrate (approximately <47% energy) diet is associated with greater likelihood of being overweight or obese among healthy, free-living adults ⁸⁸.

Another study found that there was no real association between BMI and daily carbohydrate intake, suggesting that if carbohydrates did control body fat, it would be a relatively minor effect ⁸⁹.

Ultimately, science tells us that carbohydrates are not more fattening than fats; in fact, it would make more sense to eat a few too many carbohydrates than a few too many fats. Indeed, this is what you see when you follow people who over-consume carbohydrates versus fats – they tend to gain a little less body fat ⁹⁰.

Are low-carb diets are better for weight loss than other diets?

The majority of the clinical trials that have examined whether low-carb diets are better than other diets for fat loss show that low-carb diets result in the same amount of weight loss as other diets ⁹¹.

When you tightly control people’s diets and measure virtually every part of their metabolism, it is apparent that low-carb diets are not better for weight loss ⁹². They might be slightly worse for body fat loss than low-fat diets. This holds true even if you go to very low levels of carbohydrate intake ⁹³.

Furthermore, when people adopt a low-carb diet in the real world and over more extended periods, they still see very similar results for weight-loss.

The primary findings from these studies have been:

1. Low-carb diets are not necessary for weight loss. Virtually all types of diets can and do result in weight loss when there is a negative energy balance (i.e. an energy deficit).
2. From a body fat mass perspective, low-carb diets may result in inferior fat mass reductions in shorter term diets.
3. Adherence to low-carb diets is no better or worse compared to most other forms of dieting.
4. Low-carb diets often result in more immediate water weight loss and glycogen depletion than moderate-carb diets.

In conclusion, although the idea that carbohydrates control body fat has been popular in the media, there is little scientific evidence to support it. Unless you have extreme levels of carbohydrate intake (Calorie IN more than Calorie OUT), there is no real link between carbohydrates and body fat. From scientific studies, it turns out that carbohydrates are less fattening than dietary fat. When followed in the real-world, low-carb diets can be useful for weight loss, but they are not any more effective than other low calorie diets.

Very low-carb diets can often result in a state called ketosis. This occurs when dietary carbohydrates are low enough, or fat is high enough, such that the body begins producing ketones at a level that allows them to accumulate.

It is often touted that being in a state of ketosis increases fat loss, but there is no good evidence to suggest that is true. In fact, one recent study showed that fat loss is similar, if not inferior, in a state of ketosis ⁹⁴. If you choose to adopt a low-carb diet, ketosis may be a result of that process, but should not be the primary focus.

Furthermore, there is some evidence that if someone is an athlete engaging in higher intensity, higher volume exercise, ketogenic diets should be avoided as they can impair performance ⁹⁵, ⁹⁶.

Very low carbohydrate diets can come with unwanted and potentially dangerous side effects when followed for extended periods. For example, cardiac dysfunction, impairment of physical activity, hair loss, nausea, digestive issues, and lipid abnormalities are all common side effects.

How many carbs should you eat a day to lose weight?

For otherwise healthy individuals with no underlying medical conditions, there does not appear to be a truly minimal amount of carbohydrates that need to be consumed daily.

Your daily recommendations for carb intake are based on two primary criteria:

1. Your total daily calorie requirements (your basal metabolic rate [BMR] or resting metabolic rate [RMR])
2. Your intensity or volume of physical activity.

Higher total daily calorie needs come with higher recommendations for total daily carb intake, while lower total daily calorie needs come with lower recommendations. Furthermore, as your body relies heavily on carbohydrate intake for moderate to higher intensity physical activity, carb recommendations will increase as your total volume and intensity of activity increase.

Your total daily calorie intake can be estimated using the Mifflin-St Jeor formula above. However, there are also online tools that can be used that can help you determine how many calories you should consume daily. Such as the free online Basal Metabolic Rate (BMR) calculator here: https://www.nasm.org/resources/calorie-calculator

Or the Body Weight Planner (https://www.niddk.nih.gov/health-information/weight-management/body-weight-planner).

The Body Weight Planner allows you to make personalized calorie and physical activity plans to reach a goal weight within a specific time period and to maintain it afterwards.

After that, the number of carbs grams per unit of body weight can be estimated based on current guidelines from the American College of Sports Medicine and the Academy of Nutrition and Dietetics. These recommendations are generalized as follows ⁹⁷:

• Light Activity: 3-5 g carb/kg/day
• Moderate Activity (1 hour of moderate exercise): 5-7 g carb/kg/day
• High Activity (1-3 hours of intense, endurance exercise): 6-10 g carb/kg/day
• Very High (4-5 hours of intense, endurance exercise): 8-12 g carb/kg/day

It is often recommended that more moderate carbohydrate intakes (1 to 3 g/kg/day) are consumed even in the context of weight loss.

Your muscles need carbs to fuel and recover from your workouts. At least 40% of your total daily calories should come from good carbs. Eat carbs 60 to 90 minutes prior to your workout, and then eat a combo of carbs and protein (2:1 ratio) within an hour after you finish.

Although many nutrition labels count all carbohydrates toward calorie intake, the truth is not all carbohydrates provide a meaningful number of calories as the human body does not digest and extract energy from all forms of carbohydrates.

In most situations, dietary fiber is considered a non-digestible carb and does not contribute to the total carbohydrate intake. As such, in many cases, fiber is subtracted from total carb intake. The grams of fiber is often subtracted from the total carbs grams to yield a total of usable carbs grams. For example, a food label may list 34 g total carbohydrate consisting of 4 g fiber and 6 g added sugar. By subtracting dietary fiber (4 grams of fiber) from total carbohydrates (34 grams) = 30 grams of usable carbs.

Protein

Protein is an essential nutrient that you need throughout life. Proteins are the building blocks of life. Protein is in every cell in your body. The basic structure of protein is a chain of amino acids ⁹⁸. A protein is a chain of amino acids bound to one another via peptide bonds (chemical bond linking amino acids together to form a protein). When someone eats protein, it is broken down into its amino acids.

Your body needs protein to make, maintain, repair and renew bones, muscles, cartilage, hormones, enzymes, neurotransmitters, vitamins, blood and skin cells ⁸², ⁹⁹, ¹⁰⁰. Proteins provide energy (calories) if necessary, the others are fat and carbohydrates. Proteins do everything from fighting infections to helping cells divide. Protein is also important for growth and development in children, teens, and pregnant women.

Excess or deficiency of protein can lead to disease, resulting in nervous system defects, metabolic problems, organ failure, and even death ⁹⁸. Clinical symptoms of inadequate intake of essential amino acids may include depression, anxiety, insomnia, fatigue, weakness, and growth stunting in the young. These symptoms are mostly caused by a lack of protein synthesis in the body because of the lack of essential amino acids ¹⁰⁰. Kwashiorkor and marasmus are examples of more severe clinical disorders caused by malnutrition and inadequate intake of essential amino acids as a macronutrient ¹⁰⁰.

High protein diets can promote weight loss via increased insulin sensitivity, fatty acid oxidation, appetite suppression, and feeling full. However, caution is necessary for people with diabetes who have gout because protein can elevate niacin levels, which may exacerbate gout-related symptoms.

The protein in your food is broken down into parts called amino acids during digestion. Your body needs a number of amino acids in large enough amounts to maintain good health. While there are hundreds of amino acids, humans use only 20 amino acids ⁹⁸, ¹⁰⁰.

Amino acids are classified into three groups ⁹⁸:

1. Essential amino acids. Essential amino acids cannot be made by your body, and must be supplied by food. Essential amino acids do not need to be eaten at every meal. The balance over the whole day is more important. There are 9 essential amino acids:
   • Histidine
   • Isoleucine
   • Leucine
   • Lysine
   • Methionine
   • Phenylalanine
   • Threonine
   • Tryptophan
   • Valine
2. Nonessential amino acids. Nonessential amino acids are made by your body from essential amino acids or in the normal breakdown of proteins. There are 5 amino acids that are termed non-essential amino acids:
   • Alanine
   • Asparagine
   • Aspartic acid
   • Glutamic acid
   • Serine
3. Conditionally Essential amino acids. Conditionally Essential amino acids are needed in times of illness, stress, starvation or inborn errors of metabolism. A healthy body can make conditionally essential amino acids under normal physiologic conditions. There are 6 amino acids that are called conditionally essential amino acids:
   • Arginine
   • Cysteine
   • Glutamine
   • Glycine
   • Proline
   • Tyrosine

You get protein (amino acids) in your diet from animal and plant-based foods such as meat, fish, eggs, dairy products, nuts, and certain grains, beans, peas, and lentils ¹⁰¹. Proteins from meat and other animal products are complete proteins. This means they supply all of the amino acids your body can’t make on its own. Most plant proteins are incomplete. So you should eat different types of plant proteins every day to get all nine essential amino acids your body needs. For example, pairing protein sources like rice and beans, hummus, pita bread, or oatmeal topped with almond butter. Regarding volume, it may be necessary to eat more plant-based foods to get a similar amount of protein and amino acid profile provided by animal-based proteins ¹⁰².

• Animal protein – protein-containing foods from animals are meat, chicken, fish, eggs and dairy products. Meat and poultry foods should be lean or low-fat, like 93% lean ground beef, pork loin, and skinless chicken breasts. Choose seafood options that are higher in healthy fatty acids called omega-3s fatty acid and lower in methylmercury, such as salmon, anchovies, and trout. And stay away from processed meats or artificial (fake) meat.
• Vegetable protein – protein-containing foods from plants include tofu, nuts, seeds, lentils, dried beans and peas, and soy milk.

Good protein choices include:

• Soy protein
• Beans
• Nuts
• Fish
• Lean chicken with no skin
• Lean beef
• Pork
• Salmon
• Anchovies
• Trout
• Low-fat dairy products

It is important to get enough dietary protein. You need to eat protein every day, because your body doesn’t store it the way it stores fats or carbohydrates. Furthermore, protein foods provide nutrients important for maintaining your health and body. How much protein you need depends on your age, sex, height, weight, health, and level of physical activity. The amount can also depend on whether or not you are pregnant or breastfeeding.

The recommended protein intake is 0.8 to 1 gram per kilogram of body weight per day ¹⁰³. For strength training athletes adequate protein intake should range between 1.2 and 1.7 grams of protein per kilogram of body weight per day or 0.5 to 0.8 grams per pound of body weight ¹⁰⁴, ¹⁰⁵, ¹⁰⁶, ¹⁰⁷.

For healthy children ages 1 to 3 approximately 5 to 20% and children ages 4 to 18 approximately 10 to 30% of daily energy intake should come from protein. The daily recommended intake of protein for healthy adults is 10% to 35% of your daily energy intake based on the adequate amount needed for nitrogen equilibrium ⁷⁰. One gram of protein supplies 4 calories. Therefore, if you consume 2,000 calories per day, this would work out to be between 200 to 700 calories of protein per day, you could eat 100 grams of protein, or 400 calories from protein, which would supply 20% of your total daily calories.

The recommended daily intakes (RDIs) can also be calculated by your body weight. The Academy of Nutrition and Dietetics recommends that the average individual should consume 0.8 grams of protein per kilogram or 0.35 grams per pound of body weight per day for general health. So a person that weighs 75 kg (165 pounds) should consume an average of 60 grams of protein per day. Since there are approximately four calories per gram of protein, 60 grams of protein would result in the intake of 240 calories.

How much protein do I need?

How much protein you need depends on your age, sex, height, weight, health, and level of physical activity. The amount can also depend on whether or not you are pregnant or breastfeeding. The recommended protein intake is 0.8 to 1 gram per kilogram of body weight per day ¹⁰³. For strength training athletes adequate protein intake should range between 1.2 and 1.7 grams of protein per kilogram of body weight per day or 0.5 to 0.8 grams per pound of body weight ¹⁰⁴, ¹⁰⁵, ¹⁰⁶, ¹⁰⁷.

How to calculate your daily protein needs:

Convert body weight in pounds to kilograms (round to the nearest 10th).
 Multiply weight in kilograms by the range that best fits your activity levels.

Let’s look at an example:

• Convert pounds into kilograms 150lbs / 2.2 = 68.2kg

The recommended protein intake is 0.8 to 1 gram per kilogram of body weight per day

• 68.2kg (0.8g grams of protein per kilogram) = 54.6g
• 68.2kg (1g grams of protein per kilogram) = 68.2g

For strength training athletes adequate protein intake should range between 1.2 and 1.7 grams of protein per kilogram of body weight per day.

• 68.2kg (1.2g grams of protein per kilogram) = 81.8g
• 68.2kg (1.7g grams of protein per kilogram) = 115.9g

Here are some practical protein equivalents in common foods. One ounce (30 grams) of most protein-rich foods contains 7 grams of protein. An ounce (30 grams) equals:

• 1 oz (30 g) of meat fish or poultry
• 1 large egg has six grams of protein
• ¼ cup (60 milliliters) tofu
• ½ cup (65 grams) cooked beans or lentils
• 1 cup of dry beans has about 16 grams of protein
• 1 cup of milk has eight grams of protein
• 1 cup of soy milk has about seven grams of protein

Low fat dairy is also a good source of protein. An eight ounce container of yogurt has about 11 grams of protein

Most Americans eat enough protein in their diet but need to select leaner varieties of meat and poultry. Americans may also need to increase the variety of protein foods selected and choose meats less often. However, if you are vegetarian or vegan, the advice to eat meat, poultry, and seafood does not apply to you. Vegetarian protein options include beans, peas, lentils, nuts, seeds, and soy products.

What counts as an ounce-equivalent in the protein foods group?

The following examples count as 1 ounce-equivalent from the protein foods group ⁹⁹:

• 1 ounce of meat, poultry, or fish
• ¼ cup cooked beans
• 1 egg
• 1 tablespoon of peanut butter
• ½ ounce of nuts or seeds
• ¼ cup (about 2 ounces) of tofu
• 1 ounce tempeh, cooked

The table below lists amounts that count as 1 ounce-equivalent in the protein foods group towards your daily recommended amount.

Table 2. Daily protein foods general recommendations by age

Daily Protein Recommendation* in Ounce-Equivalents
Toddlers	12 to 23 months	2 ounce-equivalent
Children	2-3  yrs 4-8 yrs	2 to 4  ounce-equivalent 3 to  5½ ounce-equivalent
Girls	9-13 yrs 14-18 yrs	4 to 6  ounce-equivalent 5 to 6½ ounce-equivalent
Boys	9-13 yrs 14-18 yrs	5 to 6½ ounce-equivalent 5½ to 7 ounce-equivalent
Women	19-30 yrs 31-59  yrs 60+ yrs	5 to 6½ ounce-equivalent 5 to 6 ounce-equivalent 5 to 6 ounce-equivalent
Men	19-30 yrs 31-59  yrs 60+ yrs	6½ to 7 ounce-equivalent 6 to 7 ounce-equivalent 5½ to 6½ ounce-equivalent

How much protein do you need for optimal muscle maintenance?

The recommended protein intake is 0.8 to 1 gram per kilogram of body weight per day ¹⁰³. For strength training athletes adequate protein intake should range between 1.2 and 1.7 grams of protein per kilogram of body weight per day or 0.5 to 0.8 grams per pound of body weight ¹⁰⁴, ¹⁰⁵, ¹⁰⁶, ¹⁰⁷, ¹⁰⁸, ¹⁰⁹. That’s because your skeletal muscle is made up of 75 percent water and 20 percent protein, with the remainder from other materials including fat, glycogen, inorganic salts, and minerals ¹¹⁰. Given the protein content of your skeletal muscle, it is not surprising resistance trained athletes emphasize the importance of dietary protein in their meal plans ¹¹¹. This is also reflected in the scientific literature with significant attention given to protein focused nutritional interventions to facilitate resistance training induced adaptations ¹¹², including manipulation of total daily dietary protein intake ¹¹³, protein dosage per meal ¹¹⁴, ¹¹⁵, ¹¹⁶, protein quality ¹¹⁷ and protein distribution ¹¹⁸.

Higher-protein diets have been shown to ¹¹⁹, ¹²⁰, ¹⁰⁸, ¹⁰⁹:

1. Promote gains in muscle mass, especially when paired with resistance training;
2. Spare muscle mass loss during caloric restriction; and
3. Reduce the natural loss of muscle mass that accompanies aging.

Protein quality is also important to the gain and maintenance of muscle mass ¹²¹. Protein quality is a function of protein digestibility, amino acid content, and the resulting amino acid availability to support metabolic function ¹²¹. Whey protein is one of the highest-quality proteins given its amino acid content (high essential, branched-chain, and leucine amino acid content) and rapid digestibility. Consumption of whey protein has a strong ability to stimulate muscle protein synthesis ¹²¹. In fact, whey protein has been found to stimulate muscle protein synthesis to a greater degree than other proteins such as casein and soy.

A recent meta-analysis suggested dietary protein supplementation enhances resistance training induced gains in muscle mass and strength, at least when dietary protein intake is suboptimal (<1.6 g per kg body weight daily) ¹²², resistance training alone provides a far greater stimulus than whey protein supplementation ¹¹⁵.

How to calculate your daily protein needs:

Convert body weight in pounds to kilograms (round to the nearest 10th).
 Multiply weight in kilograms by the range that best fits your activity levels.

Let’s look at an example:

• Convert pounds into kilograms 150lbs / 2.2 = 68.2kg

The recommended protein intake is 0.8 to 1 gram per kilogram of body weight per day

• 68.2kg (0.8g grams of protein per kilogram) = 54.6g
• 68.2kg (1g grams of protein per kilogram) = 68.2g

For strength training athletes adequate protein intake should range between 1.2 and 1.7 grams of protein per kilogram of body weight per day.

• 68.2kg (1.2g grams of protein per kilogram) = 81.8g
• 68.2kg (1.7g grams of protein per kilogram) = 115.9g

Muscle mass is built when the net protein balance is positive: that is muscle protein synthesis exceeds muscle protein breakdown. Research shows muscle protein turnover is the greatest after working out. Additionally, it has been shown that muscle mass increases over time when resistance exercise (i.e. weight lifting, body weight exercises, etc) is combined with nutrient intake.

However, as you age, you need to increase your protein intake ¹⁰⁴. Around 50 years of age, you need to increase the protein in your diets to 1 gram per kilogram of your body weight to maintain muscle mass ¹⁰⁴. People that exercise regularly also need to eat more protein than the recommended daily intake ¹⁰⁴.

Several studies performed by the group of Philip and others showed that protein supplementation did not further increase muscle strength among individuals who consumed adequate amounts of dietary protein ¹⁰⁷, ¹²³, ¹⁰⁵, ¹²⁴. However, with the aim of maximizing performance, individuals seeking to gain muscle mass are likely to consume more protein with the misconceived belief that large quantities of protein consumption might generate more muscle protein ¹²⁵.

To increase muscle mass in combination with physical activity, it is recommended that a person that lifts weights regularly or is training for a running or cycling event eat a range of 1.2 to 1.7 grams of protein per kilogram of body weight per day, or 0.5 to 0.8 grams per pound of body weight ¹⁰⁴. Consequently, the same 75
kilogram individual should increase their protein intake to 75 grams (300 calories) to 128 grams (512 calories) in order to gain muscle mass. This level of intake can generally be met through diet alone and without additional protein and amino acid supplementation ¹⁰⁴.

When should I consume protein?

The process of protein turnover is increased with resistance training and can remain elevated for up to 48 hours in people beginning a new resistance training program ¹⁰⁴. Therefore it is important to provide enough energy including protein so there is a sufficient pool of amino acids available to repair and build new muscle. You do not want to exercise on an empty stomach. In fact, exercising in an unfed state leads to an increase in protein loss making it more difficult for your body to both repair and build muscle ¹⁰⁴. Your body can only use approximately 20–40 g of protein per meal. For best results, eat around this much protein every 3 to 4 hours.

Research suggests there are several benefits to pre-exercise protein supplementation ¹⁰⁴. Pre-exercise protein supplementation helps to improve body composition by increasing resting energy expenditure up to 48 hours after exercise ¹⁰⁴. This is important because it suggests that pre-exercise protein ingestion will not only help increase lean muscle mass and strength, but will also simultaneously reduce fat mass ¹⁰⁴. However, the most scientifically supported and most significant benefits of consuming protein prior to exercise may be improved recovery and hypertrophy. This is thought to occur because of improved amino acid delivery ¹⁰⁴.

Make sure you have a healthy diet that meets the current protein intake recommendations and then use supplements to add anything else you might need. A good diet will not make a mediocre athlete into a champion, but poor food choices can turn a champion into a mediocre athlete. The International Olympic Committee (IOC) position stand is that “the use of supplements does not compensate for poor food choices and an inadequate diet”. Reinforcing this importance of food, researchers have found that athletes eating a diet rich in nitrates from vegetables (not supplements) for just 10 days were able to enhance their exercise performance, compared to when they were eating their usual diet ¹²⁶.

Protein supplement

Protein supplementation has been shown to improve muscle building with regular exercise training. Protein supplementation should contain a high amount of the amino acid leucine, which is responsible for muscle protein synthesis. Whey protein is a great option for leucine. Eating less protein may not be enough to rebuild muscles, and eating more doesn’t usually give you more benefits.

Whey protein is beneficial in supporting muscle adaptations due to its rapid absorption rate in addition to casein that has a slower and more sustained rate of amino acid absorption over a few hours ¹⁰⁴. Branched chain amino acids are similarly beneficial and have been shown to aid in recovery from exercise with respect to not only protein synthesis but also aiding in replacing our muscle glycogen and delaying fatigue associated with exercise.

Protein supplementation after exercise may have a more profound impact on skeletal muscle hypertrophy. Several studies have demonstrated that protein ingestion following an acute bout of resistance training stimulates muscle protein synthesis for up to three hours ¹⁰⁴. In contrast, failing to eat after exercise
may limit protein synthesis and therefore limit potential progress in lean muscle tissue development. Research actually suggests there may be an “anabolic window” such that protein intake within an hour of exercise has the greatest influence on resistance training adaptations ¹⁰⁴.

Generally, naturally occurring animal proteins contain 2:1:1 ratio of leucine, isoleucine and valine. These proteins have been identified as providing optimal support of muscle adaptations with exercise training. In order to meet the recommended RDA a consumption of approximately 45 mg/kg/day of leucine and 22.5 mg/kg/day of isoleucine and valine is suggested ¹⁰⁴.

What is the best protein powder supplement?

Creatine monohydrate is generally safe and can help you build more muscle mass ¹²⁷, ¹²⁸, ¹²⁹, ¹³⁰, ¹³¹, ¹³². Always check with your doctor before starting any supplement.

Creatine (N-[aminoiminomethyl]-N-methyl glycine) is an amino acid–like compound that is produced in your liver, kidney, pancreas, and possibly the brain from the biosynthesis of the essential amino acids methionine, glycine, and arginine, or obtained from dietary sources ¹³³. The primary dietary sources are high-protein foods including meat, fish, and poultry. Once synthesized or ingested, creatine is transferred from the plasma through the intestinal wall into other tissues by specific creatine transporters located in skeletal muscles, the kidney, heart, liver, and brain.

Creatine as a dietary supplement is a tasteless, crystalline powder that readily dissolves in liquids and is marketed as creatine monohydrate or as a combination with phosphorous ¹³⁴. The majority of creatine (95%) is stored in skeletal muscle (fast twitch, type 2): two-thirds in a phosphorylated form and one-third as free creatine ¹³⁵. Creatine serves as an energy substrate for the contraction of skeletal muscle. The intention of creatine supplementation is to increase resting phosphocreatine levels in muscles, as well as free creatine, with the goal of postponing fatigue, even briefly, for sports-enhancing results ¹²⁷.

Creatine is one of the most widely used dietary supplements. Athletes, body builders, and military personnel use creatine to enhance muscle mass and increase strength. Creatine is also used as an ergogenic aid to improve performance of high-intensity exercise of short duration ¹³⁶, ¹³⁷, ¹³⁸. Creatine’s popularity as a dietary supplement was further increased by a 2006 study demonstrating its positive effect on cognitive and psychomotor performance ¹³⁹.

Experiments among athletes and military personnel indicate that creatine taken at levels commonly available in supplements produces minimal, if any, side effects ¹³⁸, ¹⁴⁰. Using evidence from well-designed, randomized controlled human clinical trials of creatine, Shao and Hathcock ¹⁴⁰ concluded that chronic intake of 5 g/ day of creatine was safe and posed no significant health risks.

Muscle creatine concentrations are increased by 20% with creatine monohydrate supplementation ¹³⁵. Creatine monohydrate supplements increase lean body mass, as well as strength, power and effectiveness in short-duration, high-intensity exercises ¹⁴¹. The increase in body mass may be a result of the increase in intracellular water related to the osmotic properties of creatine ¹⁴². Studies on creatine monohydrate supplementation have shown short-duration improvements in sports performance and strength: specifically, in maximum-intensity exercises, muscle power, number of repetitions, muscle endurance, speed and total strength ¹⁴³.

The use of creatine monohydrate can yield increases in power during short sprints of maximum intensity, which can be even more evident when repeated sprints are accompanied by short recovery periods ¹³². Furthermore, with creatine monohydrate supplementation, effects are also observed in muscle glycogen stores ¹⁴². This is important because the availability of muscle glycogen is the main determinant of sports performance in resistance exercises, and its depletion can lead to muscle fatigue ¹⁴⁴. In addition, creatine monohydrate is one of the few sports foods supplements or ergogenic aids (substance used for the purpose of enhancing performance) with health claims authorised by the EFSA and the European Commission (EC), due to its evident effects on the health and sports performance of athletes ¹⁴⁵, ¹⁴⁶.

The approved health claims are ‘Creatine increases physical performance in repeated bursts of high-intensity exercise in the short term’ and ‘Daily creatine consumption can enhance the effect of resistance training on muscle strength in adults over the age of 55’. These health claims refer to the 3-g dose of creatine monohydrate ¹⁴⁶. Resistance training should be performed at least three times per week for several weeks, at an intensity of at least 65–75% of one repetition maximum (1RM). The target population is adults over the age of 55, who are engaged in regular resistance training ¹⁴⁶. Creatine in combination with resistance training and improvement in muscle strength ¹⁴⁶.

Fat

You need to eat some fat even when you are trying to lose weight. The human body needs small amounts (3 to 6 grams) of essential fatty acids (Omega-6 and Omega-3 fatty acids). Fat is important for many body processes. Fat helps your body absorb nutrients and move nutrients around your body. Some fat is necessary as a carrier for the fat-soluble vitamins A, D, E, and K. Fat is the main source of energy storage in your body, fat contributes to cellular structure and function, fat keeps you warm, and protects your organs ¹⁴⁷, ¹⁴⁸, ¹⁴⁹. Fat also helps with hormone production. Therefore your diet should not be devoid of fat. However, because fat is calorically dense (1 gram of fat has 9 calories of energy), it is often decreased on weight-loss diets to reduce energy intake.

Fat needs will vary by individual and will depend largely on your body composition goals and body types. For example, dietary fat recommendations are slightly higher in competitive athletes than non-athletes to promote health, maintain healthy hormone function, and maintain energy balance. Typical recommendations for athletes are 30 to 50% of total energy intake.

There are 4 main types of fats:

1. Unsaturated fats are those that are liquid at room temperature. The two kinds of unsaturated fats are monounsaturated fat and polyunsaturated fat. Both of these unsaturated fats are typically liquid at room temperature. Unsaturated fats are in fish, such as salmon, trout and herring, and plant-based foods such as avocados, olives and walnuts. Liquid vegetable oils, such as soybean oil, corn oil, safflower oil, canola oil, olive oil, peanut oil, canola oil and sunflower oil, also contain unsaturated fats. Eaten in moderation, both kinds of unsaturated fats may help improve your blood cholesterol when used in place of saturated and trans fats. You want to include as many unsaturated fats in your diet because they can decrease bad cholesterol, contain high amounts of antioxidants such as Vitamin E, and contain essential omega-3 and omega-6 fatty acids. Unsaturated fats are typically classified by how many hydrogen bonds they have in their structure: either 1 (mono) or two or more (poly).
2. Monounsaturated fats. Monounsaturated fat is a type of unsaturated fat. Monounsaturated fats are liquid at room temperature but start to harden when chilled. Monounsaturated fats is one of the healthy fats, along with polyunsaturated fat. Monounsaturated fats are good for your health in several ways:
   • Monounsaturated fats can help lower your LDL (bad) cholesterol level. Cholesterol is a soft, waxy substance that can cause clogged, or blocked, arteries (blood vessels). Keeping your LDL level low reduces your risk for heart disease and stroke.
   • Eating plant foods high in monounsaturated fats, particularly extra virgin olive oil and tree nuts, may benefit heart health and blood sugar regulation. Monounsaturated fats from plants may lower bad cholesterol and raise good cholesterol. They also may improve the control of blood sugar levels. Replacing saturated fats with monounsaturated fats in your diet may lower the level of bad cholesterol and triglycerides in your blood. Triglycerides are fat cells that circulate in the bloodstream and are stored in the body’s fat cells. A high level of triglycerides in the blood increases the risk of diseases of the heart and blood vessels.
   • Monounsaturated fats help develop and maintain your cells.
   • Monounsaturated fats are found in plant foods, such as nuts, avocados, and vegetable oils. Monounsaturated fats are found in red meats and dairy products. About half the fats in these foods are saturated and half monounsaturated. Many plants and plant oils are high in monounsaturated fats but low in saturated fats. These include:
     • Oils from olives, peanuts, canola seeds, safflower seeds, and sunflower seeds.
     • Avocadoes.
     • Pumpkin seeds.
     • Sesame seeds.
     • Almonds.
     • Cashews.
     • Peanuts and peanut butter.
     • Pecans.
3. Polyunsaturated fats. Polyunsaturated fat is a type of unsaturated fat. Polyunsaturated fats are liquid at room temperature but start to harden when chilled. Polyunsaturated fats include omega-3 and omega-6 fats. These are essential fatty acids that your body needs for brain function and cell growth. Your body does not make essential fatty acids, so you must get them from food. Polyunsaturated fats can help lower your LDL (bad) cholesterol. Cholesterol is a soft, waxy substance that can cause clogged or blocked arteries (blood vessels). Having low LDL cholesterol reduces your risk for heart disease. Polyunsaturated fats is one of the healthy fats, along with monunsaturated fat. Polyunsaturated fat is found in plant and animal foods, such as salmon, vegetable oils, and some nuts and seeds.
   1. Omega-3 fatty acids are good for your heart in several ways. They help:
      • Reduce triglycerides, a type of fat in your blood
      • Reduce the risk of developing an irregular heartbeat (arrhythmia)
      • Slow the buildup of plaque, a substance comprising fat, cholesterol, and calcium, which can harden and clog your arteries
      • Slightly lower your blood pressure
   2. Sources of omega-3 fatty acids include:
      • Fish such as salmon, anchovies, mackerel, herring, sardines and tuna.
      • Oils from canola seeds, soybeans, walnuts and flaxseed.
      • Soybeans.
      • Chia seeds.
      • Flaxseed.
      • Walnuts.
   3. Omega-6 fatty acids may help:
      • Control your blood sugar
      • Reduce your risk for diabetes
      • Lower your blood pressure
   4. Sources of omega-6 fatty acids include:
      • Corn oil.
      • Cottonseed oil.
      • Peanut oil.
      • Soybean oil.
      • Sunflower oil.
4. Saturated fats. Saturated fats are those that are solid at room temperature. Examples include margarine, butter, whole fat dairy products, the fat marbling in meats, and coconut oil. Saturated fats don’t need to be avoided entirely, but diets high in saturated fats can increase bad cholesterol and triglycerides, increasing the risk for heart disease. The Dietary Guidelines for Americans suggest that less than 10% of calories a day should be from saturated fats. The American Heart Association recommends that saturated fats only make up 5 to 6% of your daily calories. For a 2,000 calorie diet, that is a total of 100 calories, or 11 grams a day. Foods high in saturated fats include:
   • Foods baked or fried using saturated fats.
   • Meats, including beef, lamb, pork as well as poultry, especially with skin.
   • Lard.
   • Dairy products like butter and cream.
   • Whole or 2% milk.
   • Whole-milk cheese or yogurt.
   • Oils from coconuts, palm fruits, or palm kernels.
5. Trans fats. Trans fatty acids are unhealthy fats that form when vegetable oil goes through a process called hydrogenation. This leads the fat to harden and become solid at room temperature. Hydrogenated fats, partially hydrogenated oils (PHOs) or “trans fats,” are often used to keep some foods fresh for a long time. Trans fats are unsaturated fats that are artificially turned into saturated fats and increase heart disease and stroke risk by raising bad LDL cholesterol and decreasing good HDL cholesterol levels. High LDL (bad) cholesterol along with low HDL (good) cholesterol levels can cause cholesterol to build up in your arteries (blood vessels). This increases your risk for heart disease and stroke. Trans fats have also been known to increase the risk of developing type 2 diabetes. Trans fats are most commonly found in fried foods, frozen baked products such as pizza, non-dairy coffee creamers, vegetable shortenings, some margarines, crackers, cookies, snack foods, and other foods made with or fried in partially hydrogenated oils (PHOs). Because of the health risks from trans fats, the United States Food and Drug Administration (FDA) has banned food manufacturers from adding partially hydrogenated oils (PHOs) to foods. Although the food industry has greatly reduced the use of trans fat in recent years, trans fat may still be found in many fried, packaged, or processed foods. There are very small amounts of naturally occurring trans fat in meats and dairy from grazing animals, such as cows, sheep and goats. You should avoid foods made with hydrogenated and partially hydrogenated oils (such as hard butter and margarine). They may contain high levels of trans fatty acids. It is important to read nutrition labels on foods. This will help you know what kinds of fats, and how much, your food contains.

How much fat do I need?

To prevent any fatty acid deficiencies it is recommended that you consume at minimum 1g of fat per kg of body weight per day. According to the Dietary Guidelines for Americans ⁸³, fats should make up 20 to 35% of your total daily calorie intake. For those attempting to lose body fat, 0.5 to 1 fat per kg of body weight per day should be consumed per day to avoid essential fatty acid deficiency. For healthy children ages 1 to 3, ages 4 to 18, and adults, approximately 30 to 40%, 25 to 15%, and 20 to 35% of daily energy intake should come from fat, respectively ⁸². Approximately 5 to 10% of your daily fat energy intake should consist of Omega−6 fatty acids (linoleic acid) and 0.6 to 1.2% of Omega−3 fatty acids (alpha-linolenic acid, eicosapentaenoic acid [EPA] and docosahexaenoic acid [DHA]) ⁷⁰. Both omega−6 fatty acids (linoleic acid) and omega−3 fatty acids (alpha-linolenic acid, eicosapentaenoic acid [EPA] and docosahexaenoic acid [DHA]) are considered essential fatty acids, meaning that they must be obtained from your diet ¹⁵⁰. Apha-linolenic acid can be converted into eicosapentaenoic acid (EPA) and then to docosahexaenoic acid (DHA), but the conversion (which occurs primarily in your liver) is very limited, with reported rates of less than 15% ¹⁵¹, ¹⁵². Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are essential fatty acids, meaning the body can’t produce them and they must come from your diet ¹⁵³. Therefore, consuming eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) directly from foods and/or dietary supplements is the only practical way to increase levels of these fatty acids in your body.

Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are omega-3 fatty acids found in varying amounts in seafood such as cold-water fish like salmon, tuna, herring, and mackerel, as well as in fish oil supplements and seaweed. Eating 8 ounces per week of seafood may help reduce the risk for heart disease.

Some researchers propose that the relative intakes of omega-6s and omega-3s, the omega-6/omega-3 ratio, may have important implications for the cause of many chronic diseases, such as heart and blood vessels disease (cardiovascular disease) and cancer ¹⁵⁴, but the optimal ratio, if any, has not been defined ¹⁵⁵. Others have concluded that the omega-6/omega-3 ratios are too nonspecific and are insensitive to individual fatty acid levels ¹⁵⁶, ¹⁵⁷, ¹⁵⁸.. Most agree that raising EPA and DHA blood levels is far more important than lowering linoleic acid or arachidonic acid levels ¹⁵².

For someone who weighs 150lbs (68kg), this would equate to 34-68g fat per day. Using both of these references you can calculate your daily fat needs:

To calculate your daily fat needs:

• Convert body weight in pounds to kilograms (round to the nearest 10th).
 Multiply weight in kilograms by 1.

Let’s look at an example:

• Convert pounds into kilograms 150lbs / 2.2 = 68.2kg

The recommended fat intake is 1 gram per kilogram of body weight per day

• 68.2kg (1g grams of fat per kilogram) = 68.2g of fat per day

Weight loss diets that are moderate to low in fat (20 to 30% of calories) are called “balanced deficit” diets because they maintain a reasonable balance among macronutrients similar to that recommended in MyPlate, DASH, and the Dietary Guidelines for Americans ⁸³, ¹⁵⁹. They tend to achieve most of the caloric deficit by reducing fat from the typical level in North American Diets of about 34% or more of calories to 20 to 30% fat, 15% protein, and 55 to 65% of calories from carbohydrates. Some examples of low fat diets are the Weight Watchers Diet (25% fat, 20% protein, and 55% carbohydrate, with 26 grams of dietary fiber), Jenny Craig, the National Cholesterol Education Program Step 1 diet (25% fat), diets based on the MyPlate, the DASH diet, the Shape up and Drop 10 diet of Shape Up! America and the Nutrisystem diet ⁵⁴. Popular diet books using this approach include The Biggest Loser Diet, The Mayo Clinic Diet and The Engine 2 Die ⁵⁴. These dietary patterns have been extensively reviewed and appear to be effective for weight reduction on low calorie diets for most individuals ⁵⁴.

Very low-fat diets such as the Pritikin Diet ¹⁶⁰, the Ornish Diet ¹⁶¹ and The Spark Solution Diet ¹⁶² have been advocated not only for weight reduction, but also for improving cardiovascular risk profiles. The Ornish Diet ¹⁶¹, which is very low in fat (13% of calories) and saturated fat, very high in carbohydrate (81% of calories) and very high in fiber (38 grams), is part of a program that includes nonsmoking, exercise and behavior modification. The Ornish Diet ¹⁶¹ was shown to reduce some cardiovascular risk factors in a limited long term study. For those who can adhere to the Ornish regime it may be helpful. However, it may not be appropriate for all populations, such as diabetics.

What are Healthy fats?

Healthy fats include:

• Monounsaturated fats
• Polyunsaturated fats (omega-3 and omega-6).

The healthier fats are unsaturated fats. They can be found in sunflower oil, safflower oil, peanut and olive oils, poly- and mono-unsaturated margarine spreads, nuts, seeds and avocado. These are much better for you than the saturated fat found in butter, cream, fatty meats, sausages, biscuits, cakes and fried foods.

Foods that contain healthy monounsaturated fats include:

• Avocados and their oils/spreads
• Unsalted nuts such as almonds, cashews and peanuts and their butters/spreads
• Olives and their oils/spreads
• Cooking oils made from plants or seeds, including: olive, canola, peanut, sunflower, soybean, sesame and safflower.

Foods that contain healthy polyunsaturated fats (omega-3 and omega-6) include:

• Oily fish like salmon, mackerel and sardines
• Tahini (sesame seed spread)
• Linseed (flaxseed) and chia seeds
• Soybean, sunflower, safflower, canola oil and margarine spreads made from these oils
• Pine nuts, walnuts and brazil nuts.

It is important to choose foods with the healthiest type of fat such as avocados, olives, nuts and seeds, and use healthy oils for cooking, for example, olive, canola, sunflower, peanut and soybean oil.

Reduce the amount of highly processed food you eat such as baked goods including cakes, biscuits and pastries, along with processed meat, and fried and takeaway foods. These foods are high in saturated and trans fats, added sugar and salt, and are not part of a heart-healthy eating pattern. Try to have these foods only sometimes and in small amounts.

Many Americans eat more fat than they need, which can lead to weight gain and heart disease.

What are Unhealthy fats?

Unhealthy fats include:

• Saturated fat
• Trans fat

Foods rich in unhealthy fats include:

• Animal fats including butter, ghee and lard along with the visible fat/skin on meat
• Hydrogenated plant oils like copha, vegetable shortening and some margarines
• Coconut oil
• Processed foods such as baked goods (cakes, biscuits and pastries), processed meat ( bacon, sausages, salami) and fried and takeaway foods.

Replace foods rich in saturated and trans fats with foods rich in healthy unsaturated fats as part of a healthy diet.

It is important to choose foods with the healthiest type of fat such as avocados, olives, nuts and seeds, and use healthy oils for cooking, for example, olive, canola, sunflower, peanut and soybean oil.

Reduce the amount of highly processed food you eat such as baked goods including cakes, biscuits and pastries, along with processed meat, and fried and takeaway foods. These foods are high in saturated and trans fats, added sugar and salt, and are not part of a heart-healthy eating pattern. Try to have these foods only sometimes and in small amounts.

Many Americans eat more fat than they need, which can lead to weight gain and heart disease.

Weight loss exercise

Regular physical activity is one of the most important things you can do to improve your health. Being active may help you live longer and protect you from developing serious health problems, such as type 2 diabetes, heart disease, stroke, and certain types of cancer.

Regular physical activity is linked to many health benefits, such as ¹⁶³:

• lower blood pressure and blood glucose, or blood sugar
• healthy bones, muscles, and joints
• a strong heart and lungs
• better sleep at night and improved mood.

A 2013 report estimated that 18.2% of deaths annually in the United States (approximately 465,000 deaths) could be attributable to overweight and obesity ¹⁶⁴. Another 2013 article asserted that there is no such thing as “healthy obesity” ¹⁶⁵.

Moving more and sitting less have tremendous benefits for everyone, regardless of age, sex, race, ethnicity, or current fitness level ¹⁶⁶. Individuals with a chronic disease or a disability benefit from regular physical activity, as do women who are pregnant ¹⁶⁶. The scientific evidence showed physical activity is linked with even more positive health outcomes than previously thought with benefits even with small amounts physical activity. The Physical Activity Guidelines for Americans, 2nd edition ¹⁶⁶, define regular physical activity as at least 150 minutes a week of moderate-intensity aerobic activity, such as brisk walking. Brisk walking is a pace of 3 miles per hour or faster. A moderate-intensity activity makes you breathe harder but does not overwork or overheat you. You should also do muscle-strengthening activities at least 2 days a week.You may reach this goal by starting with 5 minutes of physical activity several times a day, 5 to 6 days a week. You could then gradually work up to 10 minutes per session, 3 times a day. If you do even more activity, you may gain even more health benefits ¹⁶⁷.

For most healthy adults, the Department of Health and Human Services recommends these exercise guidelines:

• Aerobic activity. Get at least 150 minutes of moderate aerobic activity or 75 minutes of vigorous aerobic activity a week, or a combination of moderate and vigorous activity. The guidelines suggest that you spread out this exercise during the course of a week. Greater amounts of exercise will provide even greater health benefits. But even small amounts of physical activity are helpful. Being active for short periods of time throughout the day can add up to provide health benefits.
• Strength training. Do strength training exercises for all major muscle groups at least two times a week. Aim to do a single set of each exercise, using a weight or resistance level heavy enough to tire your muscles after about 12 to 15 repetitions.

When combined with healthy eating, regular physical activity may also help you control your weight. However, research shows that even if you can’t lose weight or maintain your weight loss, you still can enjoy important health benefits from regular physical activity ¹⁶⁸, ¹⁶³.

Physical activity also can be a lot of fun if you do activities you enjoy and are active with other people. Being active with others may give you a chance to meet new people or spend more time with family and friends. You also may inspire and motivate one another to get and stay active.

How much physical activity should I do to lose weight?

Physical activity is important in weight loss and all weight loss programs should include physical activity. If left on their own, most dieters become more sedentary during weight loss, especially if their diets are very low in calories ⁵⁴. This is because a markedly negative energy balance reduces your exercise tolerance, your body’s maximal power output and increases your body’s sense of perceived exertion ¹⁶⁹. Therefore, conscious efforts to increase physical activity while dieting should be attempted.

According to the 2008 Physical Activity Guidelines for Americans, recommendations for weight loss include engaging in 45 to 75 minutes of moderate-intensity activity per day ¹⁷⁰. This can include activities such as walking at least three miles per hour, participating in water aerobics, ballroom dancing, or gardening. Alternatively, individuals could instead participate in 22 minutes of vigorous activity per day, such as swimming, jogging, jumping rope, or hiking. However, physical activity alone, without a reduction of calories, only induces modest reductions in body weight ⁵⁴. Few studies to date have incorporated enough physical activity to achieve even a 5% weight loss using a physical activity intervention alone ⁵⁴. When physical activity is paired with calorie restriction, it has a synergistic effect on weight loss ⁵⁴. Despite physical activity modest effects on weight loss, physical activity is also essential for improving health-related outcomes relevant to many obesity related medical conditions (e.g., heart disease, type 2 diabetes, and possibly some cancers) ¹⁷¹. Physical activity is also vital in preventing weight regain and may enhance quality of life ¹⁷¹. There is a strong association between physical activity at follow-up and maintenance of weight loss. Data from the National Weight Control Registry, a registry of more than 3,000 individuals who have successfully maintained at least a 30-pound weight loss for a minimum of one year, shows that 90% of the individuals report that physical activity is crucial to their long-term weight maintenance. They report expending, on average, 2,700 calories per week in exercise, the energy equivalent of walking four miles seven days a week ⁵⁵.

Once you lose weight, physical activity and exercise are still important for maintaining weight loss. For weight maintenance, 60 minutes of moderate activity per day or 30 minutes of vigorous activity per day is recommended ⁵⁴. In addition, weight resistance activities, which involve all the major muscle groups, are recommended for two or more days per week ⁵⁴. Resistance training increases muscle strength by making your muscles work against a weight or force. Different forms of resistance training include using free weights, weight machines, resistance bands, your own body weight or any other object that causes your muscles to contract.

Recent evidence supports the benefits of resistance training in increasing and/or maintaining lean body mass and bone mineral density ¹⁷², ¹⁷³ and highlights their effects on muscular strength and muscle building ¹⁷⁴, ¹⁷⁵. Muscle building occurs when the size and/or number of myofibrils (actin and myosin) within a muscle fiber increases. It’s more common in fast-twitch muscles than slow-twitch muscles, and Type 2A fibers grow the most. Muscle building is a slow process. When you lift heavy weights, your muscles tear and your body experiences metabolic stress. In response, your body tells the proteins to increase, and your muscles slowly grow ¹⁷⁶.

Exercise and weight maintenance

The American College of Sports Medicine position stand on physical activity intervention strategies to promote weight loss and weight regain emphasize the distinction between the minimum levels of physical activity to maintain health (150 minutes per week) and higher levels of physical activity to prevent weight regain (200 minutes per week) ⁶². Therefore, obese individuals who have successfully lost weight require a substantial amount of physical activity to maintain this weight loss ⁶². As indicated in the American College of Sports Medicine position, several major limitations to research of physical activity on weight regain exist including the observational and the retrospective nature of the existing literature from randomized trials ⁶². However, several studies in this area deserve mentioning. Using data from a physical activity weight loss study, Jakicic et al. ¹⁷⁷ observed a dose response between the amount of self-reported physical activity per week and long-term success with weight loss at 18 months of intervention (composed of caloric restriction and exercise training). Adults who exercised greater than 200 minutes per week (−13.1 kg) lost more weight compared to those who exercised between 150-199 min per week (−8.5 kg), and those that exercised less than 150 minutes week (−3.5 kg) ¹⁷⁷. A different study by Jakicic et al. ¹⁷⁸ observed similar findings in post hoc analyses of a weight loss intervention composed of both caloric restriction and exercise training in women. After 12 months of intervention, women with greater than 200 min/week (13.6%) had maintained significantly greater percentage of weight loss compared to those who had exercised at 150-199 min/week (9.5%), and less than 150 min/week (4.7%). Lastly, Andersen et al. ¹⁷⁹ evaluated the effect of low-fat diet (1200 kcals/day) in combination with either structured aerobic exercise training or lifestyle activity (patients were advised to increase their physical activity to recommended levels), and both groups lost approximately 8 kg of weight following 16 weeks of intervention. Weight maintenance was monitored for 1 year after the intervention, and those who were the most active lost additional weight (1.9 kg) whereas the group that was the least active regained a substantial amount of weight (4.9 kg). These data suggest that physical activity has an important role in the amount of weight regain following successful weight loss. Therefore patients attempting to reduce recidivism after weight loss are encouraged to engage in physical activity levels above 200 minutes/week ⁶².

What kinds of physical activities can I do?

You don’t need to be an athlete or have special skills or equipment to make physical activity part of your life. Many types of activities you do every day, such as walking your dog or going up and down steps at home or at work, may help improve your health. Try different activities you enjoy. If you like an activity, you’re more likely to stick with it. Anything that gets you moving around, even for a few minutes at a time, is a healthy start to getting fit.

The four main types of physical activity are aerobic, muscle-strengthening, bone-strengthening, and stretching. Aerobic activity is the type that benefits your heart and lungs the most. Table 3 summarizes the expected weight change from different exercise training programs in obese patients and describe the overall likelihood for clinically significant weight loss.

A well-known physiologic effect of exercise or physical activity is that it expends energy. A metabolic equivalent of task or MET, is a unit useful for describing the energy expenditure of a specific physical activity. A MET is the ratio of the rate of energy expended during an activity to the rate of energy expended at rest. For example, 1 MET is the rate of energy expenditure while at rest. A 4 MET activity expends 4 times the energy used by the body at rest. If a person does a 4 MET activity for 30 minutes, they have done 4 x 30 = 120 MET-minutes (or 2.0 MET-hours) of physical activity. A person could also achieve 120 MET-minutes by doing an 8 MET activity for 15 minutes.

Table 3. Expected weight loss from different modalities of exercise training

Exercise modality	Weight Loss	Clinically significant weight loss
Pedometer-based step goal	Range: 0 to 1 kg of weight loss	Unlikely
Aerobic Exercise Training only	Range: 0 to 2kg of weight loss	Possible, but only with extremely high exercise volumes
Resistance Training only	None	Unlikely
Aerobic and Resistance training only	Range: 0 to 2kg of weight loss	Possible, but only with extremely high volumes of aerobic exercise training
Caloric restriction combined with aerobic exercise training	Range: −9 kg to −13 kg	Possible

[Source ⁶⁴ ]

Walking

Walking is free and easy to do—and you can do it almost anywhere. Walking will help you:

• burn calories
• improve your fitness
• lift your mood
• strengthen your bones and muscles

You can download fitness apps that let you enter information to track your progress using a computer or smart phone or other mobile device.

Devices you can wear, such as pedometers and fitness trackers, may help you count steps, calories, and minutes of physical activity. Trackers can help you set goals and monitor progress. You wear most of these devices on your wrist like a watch, or clipped to your clothing.

Keeping an activity journal is another good way to help you stay motivated and on track to reach your fitness goals.

If you are concerned about safety, try walking in a shopping mall or park where it is well lit and other people are around. Many malls and parks have benches where you can take a quick break. Walking with a friend or family member is safer than walking alone and may provide the social support you need to meet your activity goals.

If you don’t have time for a long walk, take several short walks instead. For example, instead of a 30-minute walk, add three 10-minute walks to your day. Shorter spurts of activity are easier to fit into a busy schedule.

Aerobic exercise

Aerobic exercise is also called endurance activity, moves your large muscles, such as those in your arms and legs. Running, swimming, walking, bicycling, dancing, and doing jumping jacks are examples of aerobic activity. Aerobic exercise makes your heart beat faster than usual. You also breathe harder during this type of activity. Over time, regular aerobic activity makes your heart and lungs stronger and able to work better.

Below are examples of aerobic activities. Depending on your level of fitness, they can be light, moderate, or vigorous in intensity:

• Pushing a grocery cart around a store
• Gardening, such as digging or hoeing that causes your heart rate to go up
• Walking, hiking, jogging, running
• Water aerobics or swimming laps
• Bicycling, skateboarding, rollerblading, and jumping rope
• Ballroom dancing and aerobic dancing
• Tennis, soccer, hockey, and basketball

You can do aerobic activity with light, moderate, or vigorous intensity. Moderate- and vigorous-intensity aerobic exercises are better for your heart than light-intensity activities. However, even light-intensity activities are better than no activity at all.

The level of intensity depends on how hard you have to work to do the activity. To do the same activity, people who are less fit usually have to work harder than people who are more fit. So, for example, what is light-intensity activity for one person may be moderate-intensity for another.

Absolute rates of energy expenditure during physical activity are commonly described as light, moderate, or vigorous intensity. Energy expenditure is expressed by multiples of the metabolic equivalent of task (MET), where 1 MET is the rate of energy expenditure while sitting at rest.

• Light-intensity activity
  • Light-intensity activities are common daily activities that don’t require much effort.
  • Light-intensity activity is non-sedentary waking behavior that requires less than 3.0 METs; examples include walking at a slow or leisurely pace (2 miles per hour [mph] or less), cooking activities, or light household chores.
• Moderate-Intensity activity
  • Moderate-intensity activities make your heart, lungs, and muscles work harder than light-intensity activities do.
  • On a scale of 0 to 10, moderate-intensity activity is a 5 or 6 and produces noticeable increases in breathing and heart rate. A person doing moderate-intensity activity can talk but not sing.
  • Moderate-intensity activity requires 3.0 to less than 6.0 METs; examples include walking briskly (2.5 to 4 mph), playing doubles tennis, or raking the yard.
• Vigorous-Intensity activity
  • Vigorous-intensity activities make your heart, lungs, and muscles work hard. On a scale of 0 to 10, vigorous-intensity activity is a 7 or 8. A person doing vigorous-intensity activity can’t say more than a few words without stopping for a breath. Vigorous-intensity activity examples include jogging, running, carrying heavy groceries or other loads upstairs, shoveling snow, or participating in a strenuous fitness class. Many adults do no vigorous-intensity physical activity.
  • Vigorous-intensity activity requires 6.0 or more METs.

Bicycling

Riding a bicycle spreads your weight among your arms, back, and hips. For outdoor biking, you may want to try a mountain bike. Mountain bikes have wider tires and are sturdier than road bikes with thinner tires. You can buy a larger gel padded seat to make biking more comfortable.

For indoor biking, you may want to try a recumbent bike. On this type of bike, you sit lower to the ground with your legs reaching forward to the pedals. Your body is in more of a reclining position, which may feel better than sitting straight up. The seat on a recumbent bike is also wider than the seat on a regular bike.

Water workouts

Swimming and water workouts put less stress on your joints than walking, biking, or dancing. If your feet, back, or joints hurt when you stand, water activities may be best for you. If you feel self-conscious about wearing a bathing suit, you can wear shorts and a T-shirt while you swim.

You don’t need to know how to swim to work out in water. You can do shallow- or deep-water exercises at either end of the pool without swimming. For instance, you can do laps while holding onto a kickboard and kicking your feet. You also can walk or jog across the width of the pool while moving your arms.

For shallow-water workouts, the water level should be between your waist and chest. During deep-water workouts, most of your body is underwater. For safety and comfort, wear a foam belt or life jacket.

Exercising in water

lets you be more flexible. You can move your body in water in ways you may not be able to on land.
reduces your risk of hurting yourself. Water provides a natural cushion, which keeps you from pounding or jarring your joints.
helps prevent sore muscles.
keeps you cool, even when you are working hard.

Dancing

Dancing can be a lot of fun while it tones your muscles, strengthens your heart and lungs, and boosts your mood. You can dance at a health club, dance studio, or even at home. Just turn on some lively music and start moving. You also can dance to a video on your TV or phone.

If you have trouble standing on your feet for a long time, try dancing while sitting down. Chair dancing lets you move your arms and legs to music while taking the weight off your feet.

1. Rajesh D, Muthukumar S, Siva D, Saibaba G, Dhanasekaran D, Archunan G. Examining and elucidation of human weight cycle model adopting e-cell simulation system. Bioinformation. 2015 Jul 31;11(7):336-42. doi: 10.6026/97320630011336[↩]
2. STROHACKER K, CARPENTER KC, MCFARLIN BK. Consequences of Weight Cycling: An Increase in Disease Risk? International Journal of Exercise Science. 2009;2(3):191-201. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4241770/[↩]
3. Consequences of Weight Cycling: An Increase in Disease Risk ? Strohacker K, Carpenter KC, McFarlin BK. Int J Exerc Sci. 2009; 2(3):191-201. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4241770/[↩]
4. Dulloo AG, Montani JP. Obes Rev. 2015 Feb;16 Suppl 1:1-6. doi: 10.1111/obr.12250. Pathways from dieting to weight regain, to obesity and to the metabolic syndrome: an overview. https://www.ncbi.nlm.nih.gov/pubmed/25614198[↩]
5. Attempting to lose weight: specific practices among U.S. adults. Kruger J, Galuska DA, Serdula MK, Jones DA. Am J Prev Med. 2004 Jun; 26(5):402-6. https://www.ncbi.nlm.nih.gov/pubmed/15165656/[↩]
6. 1985 NHIS findings: nutrition knowledge and baseline data for the weight-loss objectives. Stephenson MG, Levy AS, Sass NL, McGarvey WE. Public Health Rep. 1987 Jan-Feb; 102(1):61-7. https://www.ncbi.nlm.nih.gov/pubmed/3101125/[↩]
7. Weight loss attempts in adults: goals, duration, and rate of weight loss. Williamson DF, Serdula MK, Anda RF, Levy A, Byers T. Am J Public Health. 1992 Sep; 82(9):1251-7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1694328/[↩][↩][↩][↩]
8. Metabolic adjustments with the development, treatment, and recurrence of obesity in obesity-prone rats. MacLean PS, Higgins JA, Johnson GC, Fleming-Elder BK, Peters JC, Hill JO. Am J Physiol Regul Integr Comp Physiol. 2004 Aug; 287(2):R288-97. https://www.ncbi.nlm.nih.gov/pubmed/15044180/[↩][↩][↩][↩]
9. Peripheral metabolic responses to prolonged weight reduction that promote rapid, efficient regain in obesity-prone rats. MacLean PS, Higgins JA, Jackman MR, Johnson GC, Fleming-Elder BK, Wyatt HR, Melanson EL, Hill JO. Am J Physiol Regul Integr Comp Physiol. 2006 Jun; 290(6):R1577-88. https://www.ncbi.nlm.nih.gov/pubmed/16455763/[↩][↩]
10. Pattern and cost of weight gain in previously obese women. Votruba SB, Blanc S, Schoeller DA. Am J Physiol Endocrinol Metab. 2002 Apr; 282(4):E923-30. https://www.ncbi.nlm.nih.gov/pubmed/11882514/[↩][↩]
11. Weight regain in U.S. adults who experienced substantial weight loss, 1999-2002. Weiss EC, Galuska DA, Kettel Khan L, Gillespie C, Serdula MK. Am J Prev Med. 2007 Jul; 33(1):34-40. https://www.ncbi.nlm.nih.gov/pubmed/17572309/[↩][↩]
12. Relationship of a large weight loss to long-term weight change among young and middle-aged US women. Field AE, Wing RR, Manson JE, Spiegelman DL, Willett WC. Int J Obes Relat Metab Disord. 2001 Aug; 25(8):1113-21. https://www.ncbi.nlm.nih.gov/pubmed/11477495/[↩]
13. A descriptive study of weight loss maintenance: 6 and 15 year follow-up of initially overweight adults. Sarlio-Lähteenkorva S, Rissanen A, Kaprio J. Int J Obes Relat Metab Disord. 2000 Jan; 24(1):116-25. https://www.ncbi.nlm.nih.gov/pubmed/10702760/[↩][↩]
14. Weight cycling, weight gain, and risk of hypertension in women. Field AE, Byers T, Hunter DJ, Laird NM, Manson JE, Williamson DF, Willett WC, Colditz GA. Am J Epidemiol. 1999 Sep 15; 150(6):573-9. https://www.ncbi.nlm.nih.gov/pubmed/10489996/[↩][↩][↩]
15. Body fat distribution of overweight females with a history of weight cycling. Wallner SJ, Luschnigg N, Schnedl WJ, Lahousen T, Sudi K, Crailsheim K, Möller R, Tafeit E, Horejsi R. Int J Obes Relat Metab Disord. 2004 Sep; 28(9):1143-8. https://www.ncbi.nlm.nih.gov/pubmed/15263924/[↩][↩][↩][↩]
16. Risk factors for hypertension in obese women. The role of weight cycling. Guagnano MT, Ballone E, Pace-Palitti V, Vecchia RD, D’Orazio N, Manigrasso MR, Merlitti D, Sensi S. Eur J Clin Nutr. 2000 Apr; 54(4):356-60. https://www.ncbi.nlm.nih.gov/pubmed/10745288/[↩][↩][↩][↩]
17. Weight fluctuations could increase blood pressure in android obese women. Guagnano MT, Pace-Palitti V, Carrabs C, Merlitti D, Sensi S. Clin Sci (Lond). 1999 Jun; 96(6):677-80. https://www.ncbi.nlm.nih.gov/pubmed/10334976/[↩]
18. The association of lifetime weight and weight control patterns with diabetes among men and women in an adult community. Holbrook TL, Barrett-Connor E, Wingard DL. Int J Obes. 1989; 13(5):723-9. https://www.ncbi.nlm.nih.gov/pubmed/2583926/[↩]
19. Osborn RL, Forys KL, Psota TL, Sbrocco T. Yo-Yo Dieting in African American Women: Weight Cycling and Health. Ethnicity & disease. 2011;21(3):274-280. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3963267/[↩][↩][↩]
20. Prevalence of weight cycling and its relation to health indicators in Finland. Lahti-Koski M, Männistö S, Pietinen P, Vartiainen E. Obes Res. 2005 Feb; 13(2):333-41. https://www.ncbi.nlm.nih.gov/pubmed/15800292/[↩]
21. Weight cycling, psychological health, and binge eating in obese women. Venditti EM, Wing RR, Jakicic JM, Butler BA, Marcus MD. J Consult Clin Psychol. 1996 Apr; 64(2):400-5. https://www.ncbi.nlm.nih.gov/pubmed/8871424/[↩]
22. Weight cycling in treatment-seeking obese persons: data from the QUOVADIS study. Marchesini G, Cuzzolaro M, Mannucci E, Dalle Grave R, Gennaro M, Tomasi F, Barantani EG, Melchionda N, QUOVADIS Study Group. Int J Obes Relat Metab Disord. 2004 Nov; 28(11):1456-62. https://www.ncbi.nlm.nih.gov/pubmed/15314631/[↩]
23. Enhanced metabolic efficiency contributes to weight regain after weight loss in obesity-prone rats. MacLean PS, Higgins JA, Johnson GC, Fleming-Elder BK, Donahoo WT, Melanson EL, Hill JO. Am J Physiol Regul Integr Comp Physiol. 2004 Dec; 287(6):R1306-15. http://ajpregu.physiology.org/content/287/6/R1306.long[↩][↩]
24. Peripheral metabolic responses to prolonged weight reduction that promote rapid, efficient regain in obesity-prone rats. MacLean PS, Higgins JA, Jackman MR, Johnson GC, Fleming-Elder BK, Wyatt HR, Melanson EL, Hill JO. Am J Physiol Regul Integr Comp Physiol. 2006 Jun; 290(6):R1577-88. http://ajpregu.physiology.org/content/290/6/R1577.long[↩][↩]
25. Enhanced metabolic efficiency contributes to weight regain after weight loss in obesity-prone rats. MacLean PS, Higgins JA, Johnson GC, Fleming-Elder BK, Donahoo WT, Melanson EL, Hill JO. Am J Physiol Regul Integr Comp Physiol. 2004 Dec; 287(6):R1306-15. https://www.ncbi.nlm.nih.gov/pubmed/15331386/[↩]
26. Adipose tissue as an endocrine organ. Kershaw EE, Flier JS. J Clin Endocrinol Metab. 2004 Jun; 89(6):2548-56. https://academic.oup.com/jcem/article-lookup/doi/10.1210/jc.2004-0395[↩]
27. Does dieting make you fat ? Hill AJ. Br J Nutr. 2004 Aug; 92 Suppl 1:S15-8. https://www.ncbi.nlm.nih.gov/pubmed/15384316/[↩]
28. Does weight cycling present a health risk ? Jeffery RW. Am J Clin Nutr. 1996 Mar; 63(3 Suppl):452S-455S. http://ajcn.nutrition.org/content/63/3/452S.long[↩]
29. Body weight change, all-cause mortality, and cause-specific mortality in the Multiple Risk Factor Intervention Trial. Blair SN, Shaten J, Brownell K, Collins G, Lissner L. Ann Intern Med. 1993 Oct 1; 119(7 Pt 2):749-57. https://www.ncbi.nlm.nih.gov/pubmed/8363210/[↩][↩]
30. Weight variability and incident disease in older women: the Iowa Women’s Health Study. French SA, Folsom AR, Jeffery RW, Zheng W, Mink PJ, Baxter JE. Int J Obes Relat Metab Disord. 1997 Mar; 21(3):217-23. https://www.ncbi.nlm.nih.gov/pubmed/9080261/[↩][↩][↩]
31. The effects of weight cycling on serum leptin levels and lipogenic enzyme activities in adipose tissue. Kochan Z, Karbowska J, Swierczynski J. J Physiol Pharmacol. 2006 Nov; 57 Suppl 6():115-27. https://www.ncbi.nlm.nih.gov/pubmed/17228092/[↩]
32. Weight cycling-induced alteration in fatty acid metabolism. Sea MM, Fong WP, Huang Y, Chen ZY. Am J Physiol Regul Integr Comp Physiol. 2000 Sep; 279(3):R1145-55. https://www.ncbi.nlm.nih.gov/pubmed/10956277/[↩]
33. Weight cycling and cardiovascular risk factors in obesity. Graci S, Izzo G, Savino S, Cattani L, Lezzi G, Berselli ME, Balzola F, Liuzzi A, Petroni ML. Int J Obes Relat Metab Disord. 2004 Jan; 28(1):65-71. https://www.ncbi.nlm.nih.gov/pubmed/14647176/[↩][↩][↩]
34. Weight cycling in a very low-calorie diet programme has no effect on weight loss velocity, blood pressure and serum lipid profile. Li Z, Hong K, Wong E, Maxwell M, Heber D. Diabetes Obes Metab. 2007 May; 9(3):379-85. https://www.ncbi.nlm.nih.gov/pubmed/17391166/[↩][↩]
35. Effects of weight cycling on body composition. Prentice AM, Jebb SA, Goldberg GR, Coward WA, Murgatroyd PR, Poppitt SD, Cole TJ. Am J Clin Nutr. 1992 Jul; 56(1 Suppl):209S-216S. https://www.ncbi.nlm.nih.gov/pubmed/1615886/[↩][↩]
36. Repetitive weight loss and weight regain: effects on weight reduction, resting metabolic rate, and lipolytic activity before and after exercise and/or diet treatment. van Dale D, Saris WH. Am J Clin Nutr. 1989 Mar; 49(3):409-16. https://www.ncbi.nlm.nih.gov/pubmed/2923073/[↩]
37. The effects of the ideal of female beauty on mood and body satisfaction. Pinhas L, Toner BB, Ali A, Garfinkel PE, Stuckless N. Int J Eat Disord. 1999 Mar; 25(2):223-6. https://www.ncbi.nlm.nih.gov/pubmed/10065400/[↩]
38. Weight cycling and high-density lipoprotein cholesterol in women: evidence of an adverse effect: a report from the NHLBI-sponsored WISE study. Women’s Ischemia Syndrome Evaluation Study Group. Olson MB, Kelsey SF, Bittner V, Reis SE, Reichek N, Handberg EM, Merz CN. J Am Coll Cardiol. 2000 Nov 1; 36(5):1565-71. https://www.ncbi.nlm.nih.gov/pubmed/11079659/[↩]
39. Weight fluctuations and risk for metabolic syndrome in an adult cohort. Vergnaud AC, Bertrais S, Oppert JM, Maillard-Teyssier L, Galan P, Hercberg S, Czernichow S. Int J Obes (Lond). 2008 Feb; 32(2):315-21. https://www.ncbi.nlm.nih.gov/pubmed/17968381/[↩][↩]
40. Effects of age and gender on ambulatory blood pressure and heart rate. Jaquet F, Goldstein IB, Shapiro D. J Hum Hypertens. 1998 Apr; 12(4):253-7. https://www.ncbi.nlm.nih.gov/pubmed/9607695/[↩]
41. Effects of high- and low-intensity exercise training on aerobic capacity and blood lipids. Gaesser GA, Rich RG. Med Sci Sports Exerc. 1984 Jun; 16(3):269-74. https://www.ncbi.nlm.nih.gov/pubmed/6748925/[↩]
42. The effectiveness of exercise training in lowering blood pressure: a meta-analysis of randomised controlled trials of 4 weeks or longer. Halbert JA, Silagy CA, Finucane P, Withers RT, Hamdorf PA, Andrews GR. J Hum Hypertens. 1997 Oct; 11(10):641-9. https://www.ncbi.nlm.nih.gov/pubmed/9400906/[↩]
43. A prospective study of effects of weight cycling on cardiovascular risk factors. Wing RR, Jeffery RW, Hellerstedt WL. Arch Intern Med. 1995 Jul 10; 155(13):1416-22. https://www.ncbi.nlm.nih.gov/pubmed/7794091/[↩]
44. Weight cycling and cardiovascular risk factors in obese men and women. Jeffery RW, Wing RR, French SA. Am J Clin Nutr. 1992 Mar; 55(3):641-4. https://www.ncbi.nlm.nih.gov/pubmed/1550037/[↩]
45. Weight cycling and the risk of developing type 2 diabetes among adult women in the United States. Field AE, Manson JE, Laird N, Williamson DF, Willett WC, Colditz GA. Obes Res. 2004 Feb; 12(2):267-74. https://www.ncbi.nlm.nih.gov/pubmed/14981219/[↩]
46. Weight change, weight fluctuation, and mortality. Wannamethee SG, Shaper AG, Walker M. Arch Intern Med. 2002 Dec 9-23; 162(22):2575-80. https://www.ncbi.nlm.nih.gov/pubmed/12456229/[↩]
47. Mehta T, Smith DL, Muhammad J, Casazza K. Impact of weight cycling on risk of morbidity and mortality. Obesity reviews : an official journal of the International Association for the Study of Obesity. 2014;15(11):870-881. doi:10.1111/obr.12222. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4205264/[↩]
48. Association between weight fluctuation and fasting insulin concentration in Japanese men. Yatsuya H, Tamakoshi K, Yoshida T, Hori Y, Zhang H, Ishikawa M, Zhu S, Kondo T, Toyoshima H. Int J Obes Relat Metab Disord. 2003 Apr; 27(4):478-83. https://www.ncbi.nlm.nih.gov/pubmed/12664081/[↩]
49. Promoting weight loss in type II diabetes. Brown SA, Upchurch S, Anding R, Winter M, Ramìrez G. Diabetes Care. 1996 Jun; 19(6):613-24. https://www.ncbi.nlm.nih.gov/pubmed/8725861/[↩]
50. The beneficial effects of modest weight loss on cardiovascular risk factors. Van Gaal LF, Wauters MA, De Leeuw IH. Int J Obes Relat Metab Disord. 1997 Mar; 21 Suppl 1:S5-9. https://www.ncbi.nlm.nih.gov/pubmed/9130034/[↩]
51. Does dieting make you fat ? Hill AJ. Br J Nutr. 2004 Aug; 92 Suppl 1():S15-8. https://www.ncbi.nlm.nih.gov/pubmed/15384316/[↩]
52. The inflammatory syndrome: the role of adipose tissue cytokines in metabolic disorders linked to obesity. Wisse BE. J Am Soc Nephrol. 2004 Nov; 15(11):2792-800. http://jasn.asnjournals.org/content/15/11/2792.long[↩]
53. Jensen MD, Ryan DH, Apovian CM, et al. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults. Circulation. 2014;129:S102–S138.[↩]
54. Dwyer JT, Melanson KJ, Sriprachy-anunt U, et al. Dietary Treatment of Obesity. [Updated 2015 Feb 28]. In: Feingold KR, Anawalt B, Blackman MR, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK278991[↩][↩][↩][↩][↩][↩][↩][↩][↩][↩][↩][↩][↩][↩][↩][↩][↩]
55. Seagle HM, Strain GW, Makris A, Reeves RS; American Dietetic Association. Position of the American Dietetic Association: weight management. J Am Diet Assoc. 2009 Feb;109(2):330-46. doi: 10.1016/j.jada.2008.11.041[↩][↩]
56. Chaston TB, Dixon JB, O’Brien PE. Changes in fat-free mass during significant weight loss: a systematic review. Int J Obes (Lond). 2007 May;31(5):743-50. doi: 10.1038/sj.ijo.0803483[↩][↩]
57. U.S.Department of Health and Human Services, National Institues of Health, National Heart LaBI. Aim for a Healthy Weight. NIH publication No. 05-5213. 2005.[↩]
58. National Heart LaBI. Guidelines on Overweight and Obesity: Electronic Textbook 2000. https://www.nhlbi.nih.gov/files/docs/guidelines/prctgd_c.pdf[↩][↩]
59. American Dietetic Association (ADA). Adult Weight Management Guideline: Major Recommendations. ADA Evidence Analysis Library 2014. https://www.andeal.org/vault/pq132.pdf[↩][↩][↩]
60. Van Dorsten B, Lindley EM. Cognitive and behavioral approaches in the treatment of obesity. Endocrinol Metab Clin North Am. 2008 Dec;37(4):905-22. doi: 10.1016/j.ecl.2008.08.003[↩]
61. Varkevisser, R., van Stralen, M. M., Kroeze, W., Ket, J., & Steenhuis, I. (2019). Determinants of weight loss maintenance: a systematic review. Obesity reviews : an official journal of the International Association for the Study of Obesity, 20(2), 171–211. https://doi.org/10.1111/obr.12772[↩]
62. Donnelly JE, Blair SN, Jakicic JM, Manore MM, Rankin JW, Smith BK; American College of Sports Medicine. American College of Sports Medicine Position Stand. Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults. Med Sci Sports Exerc. 2009 Feb;41(2):459-71. doi: 10.1249/MSS.0b013e3181949333. Erratum in: Med Sci Sports Exerc. 2009 Jul;41(7):1532.[↩][↩][↩][↩][↩][↩][↩]
63. Church TS, Martin CK, Thompson AM, Earnest CP, Mikus CR, Blair SN. Changes in weight, waist circumference and compensatory responses with different doses of exercise among sedentary, overweight postmenopausal women. PLoS One. 2009;4(2):e4515. doi: 10.1371/journal.pone.0004515[↩]
64. Swift, D. L., Johannsen, N. M., Lavie, C. J., Earnest, C. P., & Church, T. S. (2014). The role of exercise and physical activity in weight loss and maintenance. Progress in cardiovascular diseases, 56(4), 441–447. https://doi.org/10.1016/j.pcad.2013.09.012[↩][↩]
65. Swift DL, Lavie CJ, Johannsen NM, Arena R, Earnest CP, O’Keefe JH, Milani RV, Blair SN, Church TS. Physical activity, cardiorespiratory fitness, and exercise training in primary and secondary coronary prevention. Circ J. 2013;77(2):281-92. doi: 10.1253/circj.cj-13-0007[↩]
66. Lee CD, Blair SN, Jackson AS. Cardiorespiratory fitness, body composition, and all-cause and cardiovascular disease mortality in men. Am J Clin Nutr. 1999 Mar;69(3):373-80. doi: 10.1093/ajcn/69.3.373[↩]
67. Wei M, Kampert JB, Barlow CE, Nichaman MZ, Gibbons LW, Paffenbarger RS Jr, Blair SN. Relationship between low cardiorespiratory fitness and mortality in normal-weight, overweight, and obese men. JAMA. 1999 Oct 27;282(16):1547-53. doi: 10.1001/jama.282.16.1547[↩]
68. McAuley, P. A., Kokkinos, P. F., Oliveira, R. B., Emerson, B. T., & Myers, J. N. (2010). Obesity paradox and cardiorespiratory fitness in 12,417 male veterans aged 40 to 70 years. Mayo Clinic proceedings, 85(2), 115–121. https://doi.org/10.4065/mcp.2009.0562[↩]
69. Ross R, Dagnone D, Jones PJ, Smith H, Paddags A, Hudson R, Janssen I. Reduction in obesity and related comorbid conditions after diet-induced weight loss or exercise-induced weight loss in men. A randomized, controlled trial. Ann Intern Med. 2000 Jul 18;133(2):92-103. doi: 10.7326/0003-4819-133-2-200007180-00008[↩][↩][↩][↩][↩]
70. Trumbo P, Schlicker S, Yates AA, Poos M; Food and Nutrition Board of the Institute of Medicine, The National Academies. Dietary reference intakes for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein and amino acids. J Am Diet Assoc. 2002 Nov;102(11):1621-30. doi: 10.1016/s0002-8223(02)90346-9. Erratum in: J Am Diet Assoc. 2003 May;103(5):563.[↩][↩][↩][↩]
71. Adams KF, Schatzkin A, Harris TB, et al. Overweight, obesity, and mortality in a large prospective cohort of persons 50 to 71 years old. N Engl J Med. 2006;355:763–78. doi: 10.1056/NEJMoa055643[↩]
72. Field AE, Barnoya J, Colditz G. Epidemiology and health and economic consequences of obesity. In: Wadden TA, Stunkard AJ, editors. Handbook of Obesity Treatment. New York: The Guilford Press; 2002. pp. 3–18.[↩]
73. 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. J Am Coll Cardiol. 2014 Jul 1;63(25 Pt B):2985-3023. doi: 10.1016/j.jacc.2013.11.004. Erratum in: J Am Coll Cardiol. 2014 Jul 1;63(25 Pt B):3029-3030.[↩]
74. Thomas, D. M., Bouchard, C., Church, T., Slentz, C., Kraus, W. E., Redman, L. M., Martin, C. K., Silva, A. M., Vossen, M., Westerterp, K., & Heymsfield, S. B. (2012). Why do individuals not lose more weight from an exercise intervention at a defined dose? An energy balance analysis. Obesity reviews : an official journal of the International Association for the Study of Obesity, 13(10), 835–847. https://doi.org/10.1111/j.1467-789X.2012.01012.x[↩]
75. Aim for Healthy Weight. https://www.nhlbi.nih.gov/health/educational/lose_wt/index.htm[↩]
76. Slentz CA, Duscha BD, Johnson JL, Ketchum K, Aiken LB, Samsa GP, Houmard JA, Bales CW, Kraus WE. Effects of the amount of exercise on body weight, body composition, and measures of central obesity: STRRIDE–a randomized controlled study. Arch Intern Med. 2004 Jan 12;164(1):31-9. doi: 10.1001/archinte.164.1.31[↩]
77. Velthuis-te Wierik EJ, Westerterp KR, Van den Berg H. Effect of a moderately energy-restricted diet on energy metabolism and body composition in non-obese men. Int J Obes Relat Metab Disord. 1995;19:318–24.[↩]
78. U.S. Department of Agriculture and U.S. Department of Health and Human Services. Dietary Guidelines for Americans, 2020-2025. 9th Edition. December 2020. https://www.dietaryguidelines.gov/sites/default/files/2021-03/Dietary_Guidelines_for_Americans-2020-2025.pdf[↩]
79. Mifflin MD, St Jeor ST, Hill LA, Scott BJ, Daugherty SA, Koh YO. A new predictive equation for resting energy expenditure in healthy individuals. Am J Clin Nutr. 1990 Feb;51(2):241-7. doi: 10.1093/ajcn/51.2.241[↩]
80. Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults–The Evidence Report. National Institutes of Health, 6: 51S-179S. https://doi.org/10.1002/j.1550-8528.1998.tb00690.x[↩]
81. American College of Cardiology/American Heart Association Task Force on Practice Guidelines, Obesity Expert Panel, 2013. Expert Panel Report: Guidelines (2013) for the management of overweight and obesity in adults. Obesity (Silver Spring). 2014 Jul;22 Suppl 2:S41-410. doi: 10.1002/oby.20660[↩][↩][↩]
82. Morris AL, Mohiuddin SS. Biochemistry, Nutrients. [Updated 2023 May 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK554545[↩][↩][↩][↩][↩][↩]
83. Dietary Guidelines for Americans. https://www.dietaryguidelines.gov/[↩][↩][↩]
84. Cummings JH, Stephen AM. Carbohydrate terminology and classification. Eur J Clin Nutr. 2007 Dec;61 Suppl 1:S5-18. doi: 10.1038/sj.ejcn.1602936[↩]
85. Horton TJ, Drougas H, Brachey A, Reed GW, Peters JC, Hill JO. Fat and carbohydrate overfeeding in humans: different effects on energy storage. Am J Clin Nutr. 1995 Jul;62(1):19-29. doi: 10.1093/ajcn/62.1.19[↩]
86. Minehira K, Vega N, Vidal H, Acheson K, Tappy L. Effect of carbohydrate overfeeding on whole body macronutrient metabolism and expression of lipogenic enzymes in adipose tissue of lean and overweight humans. Int J Obes Relat Metab Disord. 2004 Oct;28(10):1291-8. doi: 10.1038/sj.ijo.0802760[↩]
87. Hall KD. A review of the carbohydrate-insulin model of obesity. Eur J Clin Nutr. 2017 Mar;71(3):323-326. doi: 10.1038/ejcn.2016.260. Epub 2017 Jan 11. Erratum in: Eur J Clin Nutr. 2017 May;71(5):679. doi: 10.1038/ejcn.2017.21[↩]
88. Merchant AT, Vatanparast H, Barlas S, Dehghan M, Shah SM, De Koning L, Steck SE. Carbohydrate intake and overweight and obesity among healthy adults. J Am Diet Assoc. 2009 Jul;109(7):1165-72. doi: 10.1016/j.jada.2009.04.002[↩][↩]
89. Yunsheng Ma, Barbara Olendzki, David Chiriboga, James R. Hebert, Youfu Li, Wenjun Li, MaryJane Campbell, Katherine Gendreau, Ira S. Ockene, Association between Dietary Carbohydrates and Body Weight, American Journal of Epidemiology, Volume 161, Issue 4, 15 February 2005, Pages 359–367, https://doi.org/10.1093/aje/kwi051[↩]
90. Do Carbohydrates Control Body Fat? https://blog.nasm.org/do-carbohydrates-control-body-fat[↩]
91. Nordmann AJ, Nordmann A, Briel M, Keller U, Yancy WS Jr, Brehm BJ, Bucher HC. Effects of low-carbohydrate vs low-fat diets on weight loss and cardiovascular risk factors: a meta-analysis of randomized controlled trials. Arch Intern Med. 2006 Feb 13;166(3):285-93. doi: 10.1001/archinte.166.3.285. Erratum in: Arch Intern Med. 2006 Apr 24;166(8):932.[↩]
92. Hall KD, Bemis T, Brychta R, et al. Calorie for Calorie, Dietary Fat Restriction Results in More Body Fat Loss than Carbohydrate Restriction in People with Obesity. Cell Metab. 2015 Sep 1;22(3):427-36. doi: 10.1016/j.cmet.2015.07.021[↩]
93. Hall KD, Chen KY, Guo J, et al. Energy expenditure and body composition changes after an isocaloric ketogenic diet in overweight and obese men. Am J Clin Nutr. 2016 Aug;104(2):324-33. doi: 10.3945/ajcn.116.133561[↩]
94. Hall KD, Chen KY, Guo J, Lam YY, Leibel RL, Mayer LE, Reitman ML, Rosenbaum M, Smith SR, Walsh BT, Ravussin E. Energy expenditure and body composition changes after an isocaloric ketogenic diet in overweight and obese men. Am J Clin Nutr. 2016 Aug;104(2):324-33. doi: 10.3945/ajcn.116.133561[↩]
95. Burke, L.M. (2021), Ketogenic low-CHO, high-fat diet: the future of elite endurance sport?. J Physiol, 599: 819-843. https://doi.org/10.1113/JP278928[↩]
96. Burke LM, Ross ML, Garvican-Lewis LA, Welvaert M, Heikura IA, Forbes SG, Mirtschin JG, Cato LE, Strobel N, Sharma AP, Hawley JA. Low carbohydrate, high fat diet impairs exercise economy and negates the performance benefit from intensified training in elite race walkers. J Physiol. 2017 May 1;595(9):2785-2807. doi: 10.1113/JP273230[↩]
97. How Many Carbs Should You Eat a Day to Lose Weight? https://blog.nasm.org/how-many-carbs-should-you-eat-a-day-to-lose-weight[↩]
98. LaPelusa A, Kaushik R. Physiology, Proteins. [Updated 2022 Nov 14]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK555990[↩][↩][↩][↩]
99. Protein Foods. https://www.myplate.gov/eat-healthy/protein-foods[↩][↩]
100. Lopez MJ, Mohiuddin SS. Biochemistry, Essential Amino Acids. [Updated 2024 Apr 30]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557845[↩][↩][↩][↩]
101. Pasiakos SM, Agarwal S, Lieberman HR, Fulgoni VL 3rd. Sources and Amounts of Animal, Dairy, and Plant Protein Intake of US Adults in 2007-2010. Nutrients. 2015 Aug 21;7(8):7058-69. doi: 10.3390/nu7085322[↩]
102. O’Neil CE, Keast DR, Fulgoni VL, Nicklas TA. Food sources of energy and nutrients among adults in the US: NHANES 2003–2006. Nutrients. 2012 Dec 19;4(12):2097-120. doi: 10.3390/nu4122097[↩]
103. Acheson KJ. Diets for body weight control and health: the potential of changing the macronutrient composition. Eur J Clin Nutr. 2013 May;67(5):462-6. doi: 10.1038/ejcn.2012.194[↩][↩][↩]
104. Protein Intake for Optimal Muscle Maintenance. https://www.acsm.org/docs/default-source/files-for-resource-library/protein-intake-for-optimal-muscle-maintenance.pdf[↩][↩][↩][↩][↩][↩][↩][↩][↩][↩][↩][↩][↩][↩][↩][↩][↩][↩]
105. Hector A. J., Phillips S. M. Protein recommendations for weight loss in elite athletes: a focus on body composition and performance. International Journal of Sport Nutrition and Exercise Metabolism . 2018;28(2):170–177. doi: 10.1123/ijsnem.2017-0273[↩][↩][↩][↩]
106. Passariello C. L., Marchionni S., Carcuro M., et al. The Mediterranean athlete’s nutrition: are protein supplements necessary? Nutrients . 2020;12(12):p. 3681. doi: 10.3390/nu12123681[↩][↩][↩]
107. Stokes T., Hector A., Morton R., McGlory C., Phillips S. Recent perspectives regarding the role of dietary protein for the promotion of muscle hypertrophy with resistance exercise training. Nutrients . 2018;10(2):p. 180. doi: 10.3390/nu10020180[↩][↩][↩][↩]
108. Areta J.L., Burke L.M., Ross M.L., Camera D.M., West D.W., Broad E.M., Jeacocke N.A., Moore D.R., Stellingwerff T., Phillips S.M., et al. Timing and distribution of protein ingestion during prolonged recovery from resistance exercise alters myofibrillar protein synthesis. J. Physiol. 2013;591:2319–2331. doi: 10.1113/jphysiol.2012.244897[↩][↩]
109. Cribb P.J., Williams A.D., Carey M.F., Hayes A. The effect of whey isolate and resistance training on strength, body composition, and plasma glutamine. Int. J. Sport Nutr. Exerc. Metab. 2006;16:494–509. doi: 10.1123/ijsnem.16.5.494[↩][↩]
110. Frontera WR, Ochala J. Skeletal muscle: a brief review of structure and function. Calcif Tissue Int. 2015 Mar;96(3):183-95. doi: 10.1007/s00223-014-9915-y[↩]
111. Mitchell L, Hackett D, Gifford J, Estermann F, O’Connor H. Do Bodybuilders Use Evidence-Based Nutrition Strategies to Manipulate Physique? Sports (Basel). 2017 Sep 29;5(4):76. doi: 10.3390/sports5040076[↩]
112. Morton RW, McGlory C, Phillips SM. Nutritional interventions to augment resistance training-induced skeletal muscle hypertrophy. Front Physiol. (2015) 6:245. doi: 10.3389/fphys.2015.00245[↩]
113. Tarnopolsky MA, Atkinson SA, MacDougall JD, Chesley A, Phillips S, Schwarcz HP. Evaluation of protein requirements for trained strength athletes. J Appl Physiol. (1992) 73:1986–95. doi: 10.1152/jappl.1992.73.5.1986[↩]
114. Moore DR, Robinson MJ, Fry JL, Tang JE, Glover EI, Wilkinson SB, et al. Ingested protein dose response of muscle and albumin protein synthesis after resistance exercise in young men. Am J Clin Nutr. (2009) 89:161–8. doi: 10.3945/ajcn.2008.26401[↩]
115. Witard OC, Jackman SR, Breen L, Smith K, Selby A, Tipton KD. Myofibrillar muscle protein synthesis rates subsequent to a meal in response to increasing doses of whey protein at rest and after resistance exercise. Am J Clin Nutr. (2014) 99:86–95. doi: 10.3945/ajcn.112.055517[↩][↩]
116. Macnaughton LS, Wardle SL, Witard OC, McGlory C, Hamilton DL, Jeromson S, et al. The response of muscle protein synthesis following whole-body resistance exercise is greater following 40 g than 20 g of ingested whey protein. Physiol Rep. (2016) 4:e12893. doi: 10.14814/phy2.12893[↩]
117. Devries MC, Phillips SM. Supplemental protein in support of muscle mass and health: advantage whey. J Food Sci. (2015) 80(Suppl. 1):A8–15. doi: 10.1111/1750-3841.12802[↩]
118. Areta JL, Burke LM, Ross ML, Camera DM, West DW, Broad EM, et al. Timing and distribution of protein ingestion during prolonged recovery from resistance exercise alters myofibrillar protein synthesis. J Physiol. (2013) 591:2319–31. doi: 10.1113/jphysiol.2012.244897[↩]
119. Devries MC, Phillips SM. Supplemental protein in support of muscle mass and health: advantage whey. J Food Sci. 2015 Mar;80 Suppl 1:A8-A15. Doi: 10.1111/1750-3841.12802[↩]
120. Spendlove J., Mitchell L., Gifford J., Hackett D., Slater G., Cobley S., O’Connor H. Dietary intake of competitive bodybuilders. Sports Med. 2015;45:1041–1063. doi: 10.1007/s40279-015-0329-4[↩]
121. Devries MC, Phillips SM. Supplemental protein in support of muscle mass and health: advantage whey. J Food Sci. 2015 Mar;80 Suppl 1:A8-A15. doi: 10.1111/1750-3841.12802[↩][↩][↩]
122. Morton RW, Murphy KT, McKellar SR, Schoenfeld BJ, Henselmans M, Helms E, et al. A systematic review, meta-analysis and meta-regression of the effect of protein supplementation on resistance training-induced gains in muscle mass and strength in healthy adults. Br J Sports Med. (2018) 52:376–84. doi: 10.1136/bjsports-2017-097608[↩]
123. Finger D., Goltz F. R., Umpierre D., Meyer E., Rosa L. H. T., Schneider C. D. Effects of protein supplementation in older adults undergoing resistance training: a systematic review and meta-analysis. Sports Medicine . 2015;45(2):245–255. doi: 10.1007/s40279-014-0269-4[↩]
124. Morton R. W., Murphy K. T., McKellar S. R., et al. A systematic review, meta-analysis and meta-regression of the effect of protein supplementation on resistance training-induced gains in muscle mass and strength in healthy adults. British Journal of Sports Medicine . 2018;52(6):376–384. doi: 10.1136/bjsports-2017-097608[↩]
125. Phillips S. M., Van Loon L. J. C. Dietary protein for athletes: from requirements to optimum adaptation. Journal of Sports Sciences . 2011;29(1):S29–S38. doi: 10.1080/02640414.2011.619204[↩]
126. Porcelli S, Pugliese L, Rejc E, Pavei G, Bonato M, Montorsi M, La Torre A, Rasica L, Marzorati M. Effects of a Short-Term High-Nitrate Diet on Exercise Performance. Nutrients. 2016 Aug 31;8(9):534. doi: 10.3390/nu8090534[↩]
127. Butts J, Jacobs B, Silvis M. Creatine Use in Sports. Sports Health. 2018 Jan/Feb;10(1):31-34. Doi: 10.1177/1941738117737248[↩][↩]
128. Bird SP. Creatine supplementation and exercise performance: a brief review. J Sports Sci Med. 2003 Dec 1;2(4):123-32. https://pmc.ncbi.nlm.nih.gov/articles/PMC3963244[↩]
129. Cooke WH, Grandjean PW, Barnes WS. Effect of oral creatine supplementation on power output and fatigue during bicycle ergometry. J Appl Physiol (1985). 1995 Feb;78(2):670-3. doi: 10.1152/jappl.1995.78.2.670[↩]
130. Rawson ES, Gunn B, Clarkson PM. The effects of creatine supplementation on exercise-induced muscle damage. J Strength Cond Res. 2001 May;15(2):178-84.[↩]
131. Ellery SJ, Walker DW, Dickinson H. Creatine for women: a review of the relationship between creatine and the reproductive cycle and female-specific benefits of creatine therapy. Amino Acids. 2016 Aug;48(8):1807-17. doi: 10.1007/s00726-016-2199-y[↩]
132. Molina Juan L, Sospedra I, Perales A, González-Díaz C, Gil-Izquierdo A, Martínez-Sanz JM. Analysis of health claims regarding creatine monohydrate present in commercial communications for a sample of European sports foods supplements. Public Health Nutr. 2021 Jan 20;24(4):1-9. doi: 10.1017/S1368980020005121[↩][↩]
133. Institute of Medicine (US) Committee on Nutrition, Trauma, and the Brain; Erdman J, Oria M, Pillsbury L, editors. Nutrition and Traumatic Brain Injury: Improving Acute and Subacute Health Outcomes in Military Personnel. Washington (DC): National Academies Press (US); 2011. 10, Creatine. Available from: https://www.ncbi.nlm.nih.gov/books/NBK209321[↩]
134. Stricker PR. Other ergogenic agents. Clin Sports Med. 1998 Apr;17(2):283-97. doi: 10.1016/s0278-5919(05)70081-8[↩]
135. Butts J, Jacobs B, Silvis M. Creatine Use in Sports. Sports Health. 2018 Jan/Feb;10(1):31-34. doi: 10.1177/1941738117737248[↩][↩]
136. Bemben MG, Lamont HS. Creatine supplementation and exercise performance: recent findings. Sports Med. 2005;35(2):107-25. doi: 10.2165/00007256-200535020-00002[↩]
137. Branch JD. Effect of creatine supplementation on body composition and performance: a meta-analysis. Int J Sport Nutr Exerc Metab. 2003 Jun;13(2):198-226. doi: 10.1123/ijsnem.13.2.198[↩]
138. Institute of Medicine (US) Committee on Dietary Supplement Use by Military Personnel; Greenwood MRC, Oria M, editors. Use of Dietary Supplements by Military Personnel. Washington (DC): National Academies Press (US); 2008. Available from: https://www.ncbi.nlm.nih.gov/books/NBK3977[↩][↩]
139. McMorris T, Harris RC, Howard AN, Langridge G, Hall B, Corbett J, Dicks M, Hodgson C. Creatine supplementation, sleep deprivation, cortisol, melatonin and behavior. Physiol Behav. 2007 Jan 30;90(1):21-8. doi: 10.1016/j.physbeh.2006.08.024[↩]
140. Shao A, Hathcock JN. Risk assessment for creatine monohydrate. Regul Toxicol Pharmacol. 2006 Aug;45(3):242-51. doi: 10.1016/j.yrtph.2006.05.005[↩][↩]
141. Burke LM. Practical Issues in Evidence-Based Use of Performance Supplements: Supplement Interactions, Repeated Use and Individual Responses. Sports Med. 2017 Mar;47(Suppl 1):79-100. doi: 10.1007/s40279-017-0687-1[↩]
142. Rawson ES, Miles MP, Larson-Meyer DE. Dietary Supplements for Health, Adaptation, and Recovery in Athletes. Int J Sport Nutr Exerc Metab. 2018 Mar 1;28(2):188-199. doi: 10.1123/ijsnem.2017-0340[↩][↩]
143. Kreider RB, Kalman DS, Antonio J, Ziegenfuss TN, Wildman R, Collins R, Candow DG, Kleiner SM, Almada AL, Lopez HL. International Society of Sports Nutrition position stand: safety and efficacy of creatine supplementation in exercise, sport, and medicine. J Int Soc Sports Nutr. 2017 Jun 13;14:18. doi: 10.1186/s12970-017-0173-z[↩]
144. Maughan RJ, Greenhaff PL, Hespel P. Dietary supplements for athletes: emerging trends and recurring themes. J Sports Sci. 2011;29 Suppl 1:S57-66. doi: 10.1080/02640414.2011.587446[↩]
145. European Comission (2018) EU Register on Nutrition and Health Claims. Brussels: European Commission.[↩]
146. EFSA NDA Panel (EFSA Panel on Dietetic Products, Nutrition and Allergies), 2016. Scientific opinion on creatine in combination with resistance training and improvement in muscle strength: evaluation of a health claim pursuant to Article 13(5) of Regulation (EC) No 1924/2006. EFSA Journal 2016; 14(2):4400, 17 pp. doi:10.2903/j.efsa.2016.4400[↩][↩][↩][↩]
147. Del Razo Olvera FM, Melgarejo Hernández MA, Mehta R, Aguilar Salinas CA. Setting the Lipid Component of the Diet: A Work in Process. Adv Nutr. 2017 Jan 17;8(1):165S-172S. doi: 10.3945/an.116.013672[↩]
148. Tvrzicka E, Kremmyda LS, Stankova B, Zak A. Fatty acids as biocompounds: their role in human metabolism, health and disease–a review. Part 1: classification, dietary sources and biological functions. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2011 Jun;155(2):117-30. doi: 10.5507/bp.2011.038[↩]
149. Jacobs DR, Tapsell LC. Food synergy: the key to a healthy diet. Proc Nutr Soc. 2013 May;72(2):200-6. doi: 10.1017/S0029665112003011[↩]
150. Jones PJH, Papamandjaris AA. Lipids: cellular metabolism. In: Erdman JW, Macdonald IA, Zeisel SH, eds. Present Knowledge in Nutrition. 10th ed. Washington, DC: Wiley-Blackwell; 2012:132-48.[↩]
151. Harris WS. Omega-3 fatty acids. In: Coates PM, Betz JM, Blackman MR, et al., eds. Encyclopedia of Dietary Supplements. 2nd ed. London and New York: Informa Healthcare; 2010:577-86.[↩]
152. Omega-3 Fatty Acids, https://ods.od.nih.gov/factsheets/Omega3FattyAcids-HealthProfessional[↩][↩]
153. Jones PJH, Rideout T. Lipids, sterols, and their metabolites. In: Ross AC, Caballero B, Cousins RJ, Tucker KL, Ziegler TR, eds. Modern Nutrition in Health and Disease. 11th ed. Baltimore, MD: Lippincott Williams & Wilkins; 2014.[↩]
154. Simopoulos AP. The importance of the omega-6/omega-3 fatty acid ratio in cardiovascular disease and other chronic diseases. Exp Biol Med (Maywood). 2008 Jun;233(6):674-88. doi: 10.3181/0711-MR-311[↩]
155. Wang C, Chung M, Lichtenstein A, Balk E, Kupelnick B, DeVine D, et al. Effects of omega-3 fatty acids on cardiovascular disease. Summary, evidence report/technology assessment no. 94. https://archive.ahrq.gov/downloads/pub/evidence/pdf/o3cardio/o3cardio.pdf[↩]
156. Stanley JC, Elsom RL, Calder PC, Griffin BA, Harris WS, Jebb SA, Lovegrove JA, Moore CS, Riemersma RA, Sanders TA. UK Food Standards Agency Workshop Report: the effects of the dietary n-6:n-3 fatty acid ratio on cardiovascular health. Br J Nutr. 2007 Dec;98(6):1305-10. doi: 10.1017/S000711450784284X[↩]
157. Harris WS, Davidson MH. RE: Plasma phospholipid fatty acids and prostate cancer risk in the SELECT trial. J Natl Cancer Inst. 2014 Apr;106(4):dju019. doi: 10.1093/jnci/dju019[↩]
158. Fritsche KL. Too much linoleic acid promotes inflammation-doesn’t it? Prostaglandins Leukot Essent Fatty Acids. 2008 Sep-Nov;79(3-5):173-5. doi: 10.1016/j.plefa.2008.09.019[↩]
159. Very Low-Calorie Diets. https://www.govinfo.gov/content/pkg/GOVPUB-HE20-PURL-LPS78142/pdf/GOVPUB-HE20-PURL-LPS78142.pdf[↩]
160. Pritikin M, McGrady PM. The Pritikin Program for Diet and Exercise. New York: Bantum Books, 1980.[↩]
161. Ornish D. Can lifestyle changes reverse coronary heart disease? World Rev Nutr Diet. 1993;72:38-48. doi: 10.1159/000422326[↩][↩][↩]
162. Hand B and Romine S. The Spark Solution. HarperOne, 2014.[↩]
163. Gaesser GA, Tucker WJ, Jarrett CL, Angadi SS. Fitness versus Fatness: Which Influences Health and Mortality Risk the Most? Curr Sports Med Rep. 2015 Jul-Aug;14(4):327-32. doi: 10.1249/JSR.0000000000000170[↩][↩]
164. Masters RK, Reither EN, Powers DA, et al. The impact of obesity on US mortality levels: the importance of age and cohort factors in population estimates. Am. J. Public Health. 2013; 103: 1895–901.[↩]
165. Kramer CK, Zinman B, Retnakaran R. Are metabolically healthy overweight and obesity benign conditions?: A systematic review and meta-analysis. Ann Intern Med. 2013 Dec 3;159(11):758-69. doi: 10.7326/0003-4819-159-11-201312030-00008[↩]
166. U.S. Department of Health and Human Services. Physical Activity Guidelines for Americans, 2nd edition. Washington, DC: U.S. Department of Health and Human Services; 2018. https://odphp.health.gov/sites/default/files/2019-09/Physical_Activity_Guidelines_2nd_edition.pdf[↩][↩][↩]
167. The Physical Activity Guidelines for Americans. https://odphp.health.gov/our-work/nutrition-physical-activity/physical-activity-guidelines/current-guidelines[↩]
168. Barry VW, Baruth M, Beets MW, Durstine JL, Liu J, Blair SN. Fitness vs. fatness on all-cause mortality: a meta-analysis. Prog Cardiovasc Dis. 2014 Jan-Feb;56(4):382-90. doi: 10.1016/j.pcad.2013.09.002[↩]
169. Wildman REC, Miller BS. Sports and Fitness Nutrition. Australia: Thomson/Wadsworth, 2004.[↩]
170. 2008 Physical Activity Guidelines for Americans. https://odphp.health.gov/sites/default/files/2019-09/paguide.pdf[↩]
171. Melanson KJ. CE Test: Food Intake Regulation in Body Weight Management: A Primer. Nutrition Today 2004; 39(5).[↩][↩]
172. Cava E., Yeat N. C., Mittendorfer B. Preserving healthy muscle during weight loss. Advances in Nutrition: An International Review Journal . 2017;8(3):511–519. doi: 10.3945/an.116.014506[↩]
173. Westcott W. L. Resistance training is medicine. Current Sports Medicine Reports . 2012;11(4):209–216. doi: 10.1249/JSR.0b013e31825dabb8[↩]
174. Gomes G. K., Franco C. M., Nunes P. R. P., Orsatti F. L. High-frequency resistance training is not more effective than low-frequency resistance training in increasing muscle mass and strength in well-trained men. The Journal of Strength & Conditioning Research . 2019;33(1):S130–S139. doi: 10.1519/JSC.0000000000002559[↩]
175. Sabag A., Najafi A., Michael S., Esgin T., Halaki M., Hackett D. The compatibility of concurrent high intensity interval training and resistance training for muscular strength and hypertrophy: a systematic review and meta-analysis. Journal of Sports Sciences . 2018;36(21):2472–2483. doi: 10.1080/02640414.2018.1464636[↩]
176. Defining Muscular Hypertrophy & Growth Training Best Practices. https://blog.nasm.org/sports-performance/defining-muscular-hypertrophy-and-training-growth-best-practices[↩]
177. Jakicic JM, Winters C, Lang W, Wing RR. Effects of intermittent exercise and use of home exercise equipment on adherence, weight loss, and fitness in overweight women: a randomized trial. JAMA. 1999 Oct 27;282(16):1554-60. doi: 10.1001/jama.282.16.1554[↩][↩]
178. Jakicic JM, Marcus BH, Gallagher KI, Napolitano M, Lang W. Effect of exercise duration and intensity on weight loss in overweight, sedentary women: a randomized trial. JAMA. 2003 Sep 10;290(10):1323-30. doi: 10.1001/jama.290.10.1323[↩]
179. Andersen RE, Wadden TA, Bartlett SJ, Zemel B, Verde TJ, Franckowiak SC. Effects of lifestyle activity vs structured aerobic exercise in obese women: a randomized trial. JAMA. 1999 Jan 27;281(4):335-40. doi: 10.1001/jama.281.4.335[↩]