A couple of things:

Nobody is downplaying the importance of exercise and no one is being irresponsible. A little back and forth about the muscle building abilitiy of post-ops in no way, shape or form implies that endurance, decreases in BF% and strength are not important. I believe my response deals specifically with the issue of gaining muscle tissue after WLS. There are countless benefits of exercise that have nothing to do with weight loss and/or building muscle; health issues are not really the focus of this post however. The initial post included some general talk about the difficulties of maintaining muscle tissue after WLS.

You are right, it is not impossible to gain muscle 6 months out but for the majority of individuals out there who are still losing considerable amounts of weight 6 months post op, it is going to be very difficult. In order to gain significant amounts of lean tissue, you must create an anabolic environment. Caloric restriction is catabolic and not only causes the mobilization of protein and fat but muscle glycogen stores decrease as well. It is pretty difficult to gain muscle tissue under these cir****tances. 

Again, as caloric intake rises after WLS, muscle building potential increases. For some who are fortunate enought to be near their goal weight 6 months out and can start increasing caloric intake to match or keep up with caloric needs (RMR and activity needs), you may be able to see some pretty significant gains in muscle tissue. While there is no research that nails down the specific cut off for caloric intake that allows you to gain muscle tissue, if you are chronically 500 or more calories below your total calorc expenditure for the day (combined RMR, exercise, and lifestyle), it is going to be difficult to gain muscle tissue, especially long term. Most individuals 6 months post op are still calorically restricted far more than 500 cals/day.

As far as protein, protein is necessary but carbohydrate intake should be higher than protein to maximize lean tissue gains; again, we are specifically talking lean tissue gains.

Get on Google Scholar or PubMed and dig around for studies where people under significant caloric restriction were able to gain muscle tissue. 

I believe the Counselor was being irresponsible by inferring that exercise wasn't important and by misquoting you to support his claim.

Obviously, carbs are the fuel for our body but for most of the WLSers who don't exercise "big-time", it's best to keep a lid on total carb intake and follow the WLS credo......protein first. I realize that good carbs (fruits & veggies) are critical as well but if required to pick one over the other (a reality given our limited capacity), it's a no brainer.

Boner 

If the Counselor is Batwingsman then his quote is partially correct. The study performed at Pacific Laparoscopy on DS patients did not show any major differences between body weight 18 months post op between exercisers and non-exercisers. The body weight measurements in that study were ok but their body composition measures had some serious issues. It is an interesting study nonetheless.

I did however present a couple of other studies that looked at changes in lean body mass.

Yes, the Counselor is Batwingsman and I would be interested in reading the study. Can you send me a link or the study itself if it's not on the web?

Here's why I'm so impassioned about this entire topic. Why is the world getting fat? Easy ....poor eating habits (lots of bad carbs) and a lack of exercise. That's exactly how I got morbidly obese. As a former fat man, I can tell you that if you give me any excuse to go back to my bad habits, I'm there baby.

So, when I read there's no weight loss difference between WLSers who exercise and those who don't.....well, that flies right in the face of all published research which I've seen. In other words, I'm highly skeptical since it doesn't make sense. Quite frankly, it's also dangerous since it gives me an excuse not to exercise.

Same can be said about those who promote increasing carbs in order to stoke ones exercise fuel. Truth be told, most people don't exercise at a level that requires much more than water before the workout and a balanced meal after the workout.  

I go crazy over the marketing hype spewed over all these so-called "energy bars" which are no more than glorified candy bars or "sports drinks" which are not much more than glorified soda. Because of this frickin hype, I believe many, many people actually eat more calories preparing for exercise than they burn up via the exercise. 

No need to exercise to maximize weight loss? Increase carbs if your workouts aren't big-time aerobic? Those dogs don't hunt in my book.
 
Boner




 

Well it is getting late here but I always love a good debate. So, if exercise does contribute to weight loss while on a very low calorie diet or after weight loss surgery, I would love to see the publsihed research you have seen. I would also like to see the research that says you should not increase carbs unless after aerobic exercise. There are numerous studies that address the issue of carbohydrates specifically and I will certainly have plenty for you to look at tomorrow.

Be careful when reading research in regards to weight loss. There are specific adaptations that someone eating 2000 calories a day can make that post-ops simply can't.

You said....

"So, when I read there's no weight loss difference between WLSers who exercise and those who don't.....well, that flies right in the face of all published research which I've seen. In other words, I'm highly skeptical since it doesn't make sense. Quite frankly, it's also dangerous since it gives me an excuse not to exercise."

This is the way I see it.....

The current research points to the fact that exercise does not really contribute to total weight loss in the morbidly obese. If this is so, why would I want you to focus on weight loss through exercise? In every talk I give I present numerous benefits of exercise that have nothing to do with weight loss.

Cholesterol, BP, diabtetes, CV disease, strength, endurance, and weight loss maintenance are all benefits and goals that achievable and are independent of weight loss. I feel that when focusing on weight loss through exercise, you are only creating roadblocks to success. I would much rather you understand that exericse may not help with weight loss so you can focus on the benefites mentioned above, instead of failing because you set a goal for exercise that is not realistic.

I have seen far too many times that whether it is getting over a plateau, losing the last 20 pounds, losing weight preoperatively, or numerous other situations, if people set weight loss goals through exercise, the majority do not accomplish these goals and the chances of them successfully participating in an exercise program in the future are dramatically decreased. I can show you that without a doubt, you can get stronger. I can show you that without a doubt you can increase cardiovascular endurance. I can show you without a doubt that you can decrease your risk of death and/or developing cardiovacular disease.   

So, saying that exercise may not contribute to total weight loss is not providing an excuse not to exercise. It is helping people readjust their focus so they are not setting themselves up for failure and instead setting realistic goals that are achievable and will promote long term exercise adherence.

I will look forward to providing you with the DS study and more.

Not to get overly simple here but here's all the research I need with regards to the impact of exercise on weight loss ------ calories burned > calories in = weight loss. End of debate unless there is some magic research study which you can provide which proves this to be  empirically not true. 

Oh' by the way, my apologies to you Counselor since I guess you didn't misinterpret Jeremy's comments after all. My bad.

Boner 

If that is all there is to it then I guess there is no reason to review the literature.

I would like to see your DS research for sure. In my opinion, the physics of weight loss is quite simple when it's broken down to the caloric formula (i.e. calories burned > calories in = weight loss). The formula doesn't discrimate be you 500 pounds or 100 pounds, had WLS or not, female or male.....

On the other hand, the RATE of weight loss can certainly be impacted by an endless number of variables.

Boner

Was this what you were trying to say? If so, I agree....two ways to lose weight, cut the calories consumed or increase the calories burned. Back to the old weight loss equation which never fails imo.

Boner

Weight loss: Better to cut calories or exercise more?

Q.	Which is better for losing weight: cutting calories or increasing exercise? I recently read that if you have to choose, diet is better.

A.

 

You may be referring to a study published in the Journal of Clinical Endocrinology & Metabolism. This six-month study examined the effects of diet alone (25 percent fewer calories consumed) versus diet plus exercise (12.5 percent fewer calories consumed and 12.5 percent more calories burned) in overweight but otherwise healthy adults. Researchers hypothesized that the diet plus exercise group would lose more body fat, but results showed equal amounts of weight and fat lost in both groups. This confirms that weight loss is all about calories: If you burn more calories than you eat, you'll lose weight. It doesn't mean exercise isn't important. Exercise has many health benefits. Plus, it can be tough to create a calorie deficit by diet alone.

---

By Mayo Clinic Staff
June 8, 2007

Kind of but not completely. You are correct in saying that it is calories in,calories out, but again there is more to the story.

In the study you presented above, the subject's caloric deficit was matched. Depending on what you are looking at, that type of study has it's advantages. However, there are numerous studies that not only had people on the same (calorie for calorie) low calorie or very low calorie diet, but also had exercise and non exercise groups. So, caloric deficit was not equal among groups. In the end, the exercise group lost no more than non exercise groups. 

I am not only looking at studies where they matched caloric deficit, but studies that also created a higher caloric deficit through exercise.

Take for instance the following study:

This study looked at 109 obese women and placed them on a very low calorie diet of 520 cal/day (not unlike the number of calories you would eat shortly after WLS). Great study here because they divided them into several different exercise groups.

http://www.jacn.org/cgi/content/abstract/11/2/152

There are plenty more like this.

One more thing to mention here is that throughout most of these studies, they conclude that regualr physical activity enhances long term weight loss maintenance. But, weight maintenance is much different than initial weight loss.