Is fitness more important than weight loss?

Should physicians focus on helping overweight or obese patients lose weight, or on encouraging them to become more physically fit?

That’s the question Dr. Bret Scher, MD, Medical Director of Diet Doctor, explores in a recent DD News video.

Dr. Scher analyzes the findings of a new paper that examines research and suggests treatment should not focus on weight loss, but rather on improving obese patients’ physical activity and fitness.

The paper, which Dr. Scher calls “fascinating” but “superficial,” was published in the September issue of iScience. It is a meta-analysis of existing research on the topic. Dr. Scher notes that the researchers “convincingly support their claim,” but they don’t explore “healthy weight loss” — such as the role of low-carb, higher protein diets in improving metabolic health.

The lead author of the paper is Glenn A. Gaesser, PhD, a professor of exercise physiology at the College of Health Solutions at Arizona State University. He’ll be an upcoming guest on the Diet Doctor podcast, scheduled to air on November 16, 2021.

iScience: Obesity treatment: Weight loss versus increasing fitness and physical activity for reducing health risks

“Their point is physical activity is better for reducing all-cause mortality than weight loss alone,” says Dr. Scher.

But Dr. Scher digs deeper. He explores how physical activity impacts health markers and health risk, and how research shows “unhealthy” weight loss, in particular yo-yo dieting, does not improve health markers.

Dr. Scher notes the cycle of weight loss followed by weight regain is indeed bad for health because individuals tend to reduce their metabolic rate, lose lean muscle mass, and add weight back as fat — not muscle — further increasing their body fat percentage.

This, however, is different from “healthy weight loss,” which preserves muscle mass, reduces body fat percentage, and does not depress resting metabolic rate. The researchers did not specifically look at this form of healthy weight loss.

“[To me] it’s the combination of a low-carb, adequate- to high-protein diet combined with physical activity [with cardio-respiratory fitness and resistance training, that] is likely the best approach for healthy weight loss. That’s going to allow you to lose weight in a way that’s going to improve your cardiometabolic risk factors and likely decrease your long-term risk of premature mortality,” said Dr. Scher. “That’s where I’d like to see this paper go to take that next step.”

Watch the video for more details and discussion.

Each week, Dr. Scher takes a scientific study in the fields of nutrition, exercise, health, or disease and carefully analyzes the researchers’ methods and findings. In doing so, he helps you better understand how to judge the quality of various research papers and make informed decisions about your own health and wellness.

You can find more of Dr. Scher’s news videos on the Diet Doctor Youtube Channel. Subscribe to the feed so that you don’t miss any.