# Lesson 3: How to Determine Caloric Intake and Track Progress

### Introduction

From Lessons 1 & 2 I provided (or at least attempted to) an understanding of your TDEE (total daily energy expenditure), how to calculate it, and also how to track calories if desired. In this lesson I will go over how to estimate what your caloric intake should be and how to adjust based on the progress you are making. To do this I first need to discuss how to set a target weight and how quickly you should attempt to gain or lose weight.

### How to set a target weight

In many respects this is largely subjective; if you want to gain weight then go ahead and gain weight, and if you want to lose weight then go ahead and lose weight. You can always set a specific goal (ie, 200 pounds), get there, and then reassess to determine how to move forward. But what does the literature tell us about an ideal weight for optimal health?

Note: These sections regarding a target body weight and rates of weight gain/loss apply to adults only, not children. There are many additional considerations in childhood as children are actively growing and go through puberty at different rates & times. Going back to Lesson 1, for children:

TDEE = RMR + TEF + NEAT + EAT + growth

It’s even debatable if the standard definitions of overweight and obesity used in pediatrics are physiologically appropriate as increased metabolic risk can be seen at lower thresholds than currently used.(Kelly, 2020) While the same concepts in adults will apply to children, it is preferable to ask your child’s medical provider for guidance regarding a target body weight and how quickly to attempt to get there. Alternatively, if children adopt healthier eating and exercise habits they will likely make good progress even without setting any specific goals.

#### Body mass index (“BMI”)

Many people are familiar with the concept of BMI. You take your weight in kilograms and divide by your height in meters squared (kg/m2). Click here for a calculator. This generates a number, and in adults this is classified as:

• BMI < 18.5 = underweight category*
• 18.5 ≤ BMI < 25 = healthy weight category
• 25 ≤ BMI < 30 = overweight category
• 30 ≤ BMI = obesity category
*See the note directly below for a caveat to this.

Note: It seems that there is a subset of people with “constitutional thinness” where they actually have a healthy body fat percentage, low lean body mass (“LBM”), and significant difficulty gaining weight without obvious adverse health consequences (other than poorer bone health).(Bailly, 2020; Bailly, 2021) This is in contrast to people with anorexia nervosa who typically have a considerably lower body fat percentage. As discussed below it is likely beneficial to increase one’s LBM long term; perhaps a key strategy in this situation would be to engage in resistance training and appropriate eating to build skeletal muscle mass. At this time I am unaware of any longitudinal studies indicating if this is a viable strategy.

The research on constitutional thinness is still in its infancy, with no technical diagnostic criteria(Bailly, 2020), and with almost no literature in males, but it is a topic ripe for study as this subset of the population with weight gain resistance may hold clues to treating the obesity epidemic.

Note: Where do these BMI thresholds come from? They are actually somewhat arbitrary(Kuczmarski, 2000; Komaroff, 2016; Solorzano, 2022):

• They initially came from the Metropolitan Life Insurance Company tables back in the 1940s & 1950s.
• In 1985 arbitrary cutoffs for an overweight BMI were set at 27.8 for men & 27.3 for women as these represented the 85th percentile of the BMI distribution for people aged 20-29 in the National Health and Nutrition Examination Survey (NHANES) II. Coincidentally these values correlated with the values representing minimal mortality outcomes.
• When the 2nd edition of the Dietary Guidelines for Americans (DGA) was published (also in 1985) they listed the highest desirable BMI for men at 25-26 and women at 24-25 without proposing a specific rationale.
• In the 3rd edition of the DGA (published in 1990) they adopted the BMI values of 25 for adults age 19-34 years old & 27 if >34 years old from the 1989 National Academy of Sciences report “Diet & Health: Implications for Reducing Chronic Disease Risk.” The reason for a higher BMI at an older age was due to observations that lower mortality was seen with increased body weight as age increases.
• in 1995 the World Health Organization used a newer meta-analysis indicating increased mortality at BMI <18.5 & BMI >30 and set a healthy range of 18.5-25. They acknowledged this was an arbitrary decision.
• The 4th edition of the Dietary Guidelines for Americans (published in 1995) went with this and defined a healthy BMI as 18.5-25, pre-obesity at a BMI of 25-29.9, class I obesity as BMI 30-34.9, class II obesity as BMI 35-39.9, and class III obesity as BMI ≥40.
• In 1998 the NIH defined overweight as BMI of 25-29.9 and obesity as BMI ≥ 30.
• In 2000 the CDC used 5 nationally representative surveys (National Health Examination Surveys II & III in the 1960s, NHANES I & II in the 1970s, and NHANES III from 1988-1994) to make BMI growth curves for children in the US.
• In 2000 The International Obesity Task Force similarly created childhood curves using data from 6 countries and decided to adjust the curves such that they passed through the cutoffs of 25 & 30 for overweight and obesity in adults. The most recent editions of the Dietary Guidelines for Americans moved forward with this and define childhood overweight as a BMI ≥ the 85th percentile and childhood obesity as a BMI ≥ the 95th percentile.

So, based solely on BMI you can determine what your weight needs to be to get to the healthy range. However, this brings up the question if BMI is the most accurate method to determine a healthy body weight (“BW”)?

On one hand, a 2021 umbrella review and meta-analysis of observational and Mendelian randomization studies examining the association of adiposity and cardiovascular outcomes found significant evidence that increased BMI and adiposity contributes to CVD mortality, coronary heart disease and its mortality, hypertension, blood clots, heart failure, and atrial fibrillation, with some evidence of other associations as well.(Kim, 2021) On the other hand, as BMI does not describe the ratio of LBM to body fat (“BF”), and because it does not describe the proportion and location of different types of BF known to confer different health risks(Honecker, 2021) (ie, visceral adipose tissue, abdominal subcutaneous tissue, lower body subcutaneous tissue, etc), BMI as a metric leaves much to be desired.(Bosy-Westphal, 2021)

For example, a popular theory is that our subcutaneous adipose tissue expands with weight gain and acts as a buffer against negative metabolic effects; eventually though the excess adiposity spills over and begins to affect many other organs.(Kessler, 2021) This is summarized in the figure below.(Ross, 2020) When this spillover occurs likely varies between individuals and may depend upon other factors such as extracellular remodelling.(White, 2022) Additionally, the same amount of BF distributed in distinct ways between individuals can have significantly different health implications, and this may further vary by gender.(Bond, 2021)

#### Can you be healthy at an elevated BMI?

A small percentage of people have relatively increased muscle mass, and this can elevate their BMI category. A 2020 analysis found BMI has a specificity of ~95-97% compared to more accurate determinations of body fat % for identifying obesity, implying this may affect 3-5% of people.(Sommer, 2020) To my knowledge there is no evidence that increased muscle mass obtained through healthy means is harmful in any way, though there has been an association seen between higher lean body mass and mortality in middle and older-age; more research is needed to evaluate this.(Sanchez-Lastra, 2023)

However, a much greater percentage of people have increased levels of BF leading to a higher BMI category. This brings up the concept of “metabolically healthy overweight/obesity” (MHO). There is a subset of people with BMIs above the healthy range who do not have any metabolic abnormalities (ie, normal cholesterol, normal blood pressure, etc). However, even these individuals have a higher risk of poor health outcomes than metabolically healthy normal BMI individuals.(Magkos, 2019; Opio, 2020; Tsatsoulis, 2020; Wang, 2022a; Agius, 2023; Kanbay, 2023; Luo, 2023; Iqbal, 2023; Wang, 2023; Tanriover, 2023)

Of note, several of the above-cited reviews cite data showing that when cardiorespiratory fitness is preserved the “harmful” effects of MHO diminish greatly or even completely disappear. Much of this data was summarized in a 2018 systematic review and meta-analysis where it was noted that(Ortega, 2018):

• People with MHO had significantly higher levels of physical activity and cardiorespiratory fitness than  people with metabolically unhealthy obesity.
• When controlling for physical activity levels people with MHO still had higher risks of mortality (32% higher risk but not significant, though this increased to a significant 58% higher risk when omitting one study) and CVD (24% higher risk and only borderline significant) but these were attenuated relative to data where physical activity was not controlled.
• Only 1 study actually directly adjusted for levels of cardiorespiratory fitness and this almost fully attenuated the increased risks of MHO relative to having a healthy-range BMI.

For general health purposes, people with obesity can exercise to increase their cardiorespiratory fitness and obtain significant health benefits even without significant weight loss.(Gaesser, 2021) More research is needed but it is possible that with enough physical activity many of the harmful effects seen with MHO can be mitigated, though this is less likely with a BMI > 40, and it is important to note that many individuals with MHO progress to metabolically unhealthy obesity. It is difficult to state what percentage of people progress to metabolically unhealthy obesity as there are many different definitions of MHO in the literature and the percentage will change over time.

Thus, it seems possible to at least temporarily be healthy at a higher BMI, assuming higher levels of cardiovascular fitness, but it’s not yet clear for how long this will persist and if there is a higher BMI threshold where this no longer holds true.

In adults aged ≥65 years, an “obesity paradox” has been observed in many studies where individuals with BMI in the overweight or even the obesity category live longer than those with BMI in the healthy weight category.(Dramé, 2023) This extends to various functions of daily living in elderly individuals.(Kıskaç, 2022) This may effectively shift the threshold for defining overweight to a higher BMI.(Javed, 2022) There have been many studies showing this, with various explanations proposed.(Javed, 2020; Fonseca, 2022)

• One possible explanation is that a person may lose weight with illness before death and then be classified in a lower BMI category than they had been in for most of their adult life.(Sorkin, 1999; Berry, 2022)
• A second is that as we age our height decreases so our BMI is artificially elevated, potentially by up to ~2 points.(Holt, 2023)
• A third is that both smoking status and preexisting conditions may lead to individuals with a “normal” BMI having higher mortality rates as these conditions that drive increased mortality can also prevent excess weight gain.(Garcia, 2021)
• A fourth is that extra BF is actually helpful in older age as a source of energy for the body to help stave off negative effects of decreased caloric consumption. There is also evidence that extra adipose tissue can be beneficial in people who have already been diagnosed with a variety of conditions such as cancer, certain types of cardiovascular disease, chronic kidney disease, diabetes, and osteoporosis.(Ohori, 2021; Lee, 2022; Pan, 2022)
• A fifth, as shown in a recent cohort, is that individuals with overweight and obesity may be diagnosed with cardiovascular disease earlier in life, and it’s possible this leads to healthy lifestyle changes and treatment earlier in life that helps extend their lifespan for a greater duration.(Fekri,2020)

However, several recent analyses point to a separate cause; elderly individuals with higher BMI also have more skeletal muscle, and this is what may be contributing to improved health.

• In one cohort followed for >30 years increased longevity and quality of life correlated with increased skeletal muscle & decreased body fat percentage (“BF%”).(Jyväkorpi, 2020)
• In an analysis of NHANES data, separating BF% from appendicular skeletal muscle index (ASMI, total lean mass of the 4 extremities summed & divided by height squared) showed that in the elderly population higher skeletal muscle mass was the principal reason for increased survival in individuals with BMI in the overweight and obesity category relative to the normal weight category.(Abramowitz, 2018) When normalizing for the ASMI there was actually similar survival in the normal & overweight BMI categories with a non-statistically significant advantage for normal weight.
• In a separate analysis of NHANES data, increasing levels of LBM were associated with lower risk of mortality while increasing levels of BF were associated with increased risk of mortality.(Liu, 2022)
• A 2021 pooled analysis of 7 prospective cohorts yielded similar findings; in fact when looking at individuals ≥ 65 years old(Sedlmeier, 2021):
• there was a linearly positive increased risk of mortality with increasing fat mass
• there was a linearly inverse risk of mortality with increasing fat-free mass
• A 2022 systematic review and meta-analysis found that in the elderly relatively low appendicular skeletal muscle mass associated with earlier death.(de Santana, 2022)
• A 2023 study found that people with central obesity and low muscle mass have higher risks of cardiovascular death even if they are metabolically healthy.(Kim, 2023)

Thus, it seems likely that higher skeletal muscle is driving the better health outcomes at higher BW as opposed to higher BF. The protective effect of higher LBM also seems to extend to children when looking at various health markers.(Xiao, 2021) While there may be a benefit to having elevated body weight in some settings as indicated above, for most people it seems that losing excess body fat will be helpful. As this may come at the expense of lean body mass, particularly in elderly individuals who otherwise have difficulty obtaining and maintaining their lean body mass, it may be best to only encourage weight loss in this setting if it is expected to improve their health-related quality of life and medical comorbidities, while utilizing appropriate dietary and exercising habits.(Buch, 2021; Nowicki, 2022)

If you are curious, I have made a YouTube video discussing this in more detail, which I have included below.

#### Does a healthy BMI guarantee healthy body composition?

As BMI itself does not describe the ratio of LBM to BF, one consideration is if it’s possible to have high BF levels while also having a healthy range BMI. It turns out this is indeed possible. In the fitness world this is commonly referred to as “skinny fat”. In the literature this has been termed several things, including “overfat”, and it’s estimated that >20% of individuals with a normal BMI have an elevated BF%, both in adult populations and pediatric populations.(Javed, 2015; Maffetone, 2020). Per one analysis this may apply to 40-50% of adults with a healthy range BMI.(Sommer, 2020) In a cross-sectional study this extended to elderly adults (mean age 80) where ~18% of the individuals with a healthy BMI had an elevated waist-to-height ratio.(Assumpção, 2021) This means that just because someone has a BMI classified as healthy does not mean their body composition is healthy. While this is in part due to having too much BF, it can also be attributed in part due to a lack of LBM.

Importantly, this “normal weight obesity” phenotype is associated with increased health risks in both adolescents and adults, including a variety of different cardiometabolic risk factors (such as metabolic syndrome, hypertension, various glycemia and insulin metrics, and dyslipidemia) as well as non-alcoholic fatty liver disease.(Cota, 2021; Mainous, 2022; Rakhmat, 2022)

As an aside to body composition, it is possible to have a healthy BMI but be metabolically unhealthy, as determined by some combination of dyslipiemia, hypertension, or insulin resistance.(Seo, 2023) A 2022 MA found that individuals with normal weight who are metabolically unhealthy have significantly increased risks of death and major adverse cardiovascular events compared to individuals with obesity who are metabolically healthy.(Putra, 2022)

TIP: For individuals with a healthy BMI but elevated BF%, there are two primary options:

• You can diet to lose the excess BF; this is likely more warranted if your waist-to-height ratio is elevated (see below).
• You can attempt to maintain your current BW while undergoing a resistance training program and adopting healthier eating patterns. This will allow you to build skeletal muscle and lose BF at the same time (frequently termed “body recomposition” in the fitness world).

If your primary goal is to improve health then I generally do not recommend gaining weight if you already have significantly elevated BF levels.

#### How to determine if your body fat percentage (BF%) is elevated

Upper limits of healthy BF% are typically considered 25% for men and 32% for women(Jayawardena, 2020), though there is no true standard definition. This is in part due to the fact that different people carry BF in different places with different health implications.(Haczeyni, 2018; Luong, 2019) In one analysis that associated BF% with all-cause mortality, J-shaped curves were evident where the lowest risk was seen at 22% in males and 35% in females; the risk increased more significant once the BF% reached 27% in males and 44% in females.(Jayedi, 2022)

There are several ways to estimate your BF%; unfortunately the practical methods all have flaws as detailed in this series of articles:

• Of the various anthropometric options (these are the ones that don’t require special equipment or cost money), a recent study in adults indicates the best may be the Department of Defense formula.(Tinsley, 2020) It should be noted that just because this was considered the best does not mean it is very accurate; it had an individual margin of error >5% (at times it was up to 10% off) and thus cannot be relied upon to provide accurate information. There are several other anthropometric measures that have been evaluated and show promise, but the overall body of literature at this time is sparse and do not indicate any of them provide significantly greater accuracy.(Jayawardena, 2020; Cicone, 2021)
• Another common and popular option is bioelectrical impedance analysis (BIA); scales can be purchased at a relatively low cost and then this can be used to track weight and estimate BF%. These should not be used by people with electronic implants and it’s not clear that it is safe to use while pregnant. Unfortunately, these also tend to not be super accurate and the single-frequency type (the type one would purchase cheaply) has margins of error of ~5%.
• Cheap body fat calipers can also be purchased but can lead to widely inaccurate results with inexperienced users; that said if you can use them consistently and simply compare the actual skinfold measurements directly you can track progress with them without even having to calculate BF%. The idea here is that the calipers will pinch the skin and subcutaneous fat; as you lose subcutaneous fat the measurement will decrease.
• If you wish to do this, make sure to check the same location each time and to compress the skin with the same degree of firmness each time; the harder you compress the skin the more the skin and fat will pinch together and this will make the measurement smaller, thus you should try to be consistent.
• While the above studies cater to adults, a recent review shows similar accuracy problems in children.(Orsso, 2020)
• More accurate options, such as a DEXA scan, cost more money and may still be off multiple percentage points.

Thus, there is no good, practical method to easily estimate your BF%. However, as described below, as different people carry BF in different places one’s actual BF% is less meaningful for health prognostic purposes than the distribution of one’s BF. Thus, there is no need to stress about attempting to accurately quantify your BF%.

#### Using your waist circumference as a proxy for your body fat distribution

Two people can have the same BF% but carry the BF in different places. It turns out that this can confer significantly different health risks(Gowri, 2021), as indicated in the tables below (reproduced from a systematic review and dose-response meta-analysis of 72 prospective cohort studies)(Jayedi, 2020). The top table indicates risk of mortality for different standard measurements, while the bottom table indicates risk of mortality for a shift of 1 standard deviation of each measure. Thus, the bottom table gives a better indication of the comparative value of each measure.

In general a larger waist circumference is found to be harmful while larger hip and thigh circumferences are found to be beneficial. Additionally, waist-to-height ratio (with increasing risk when this ratio is >0.5) seems to have more prognostic value than waist circumference alone. Only waist-to-thigh ratio seems to have more prognostic value than waist-to-height ratio, but as the former measurement was only considered in two studies it’s unclear if this is a robust finding (notice the large 95% confidence interval of [1.01-1.62] for the waist-to-thigh ratio, as this almost crosses 1.00 this is barely statistically significant – simplistically this implies there is a 95% chance the true value is in the range of 1.01-1.62 though the technical definition is a bit more complicated).

A separate more recent meta-analysis also found that using a waist-to-height ratio of >0.5 as a threshold is more informative of cardiovascular disease risk than using waist circumference or waist-to-hip ratio.(Xue, 2021)

The (Jayedi, 2020) analysis also shows that adjusting one’s waist circumference for their BMI provides even more useful prognostic information. In a recent consensus statement by the International Atherosclerosis Society (IAS) & International Chair on Cardiometabolic Risk (ICCR) Working Group on Visceral Obesity, the authors advocate doing this.(Ross, 2020) They provide the following table:

This table indicates waist circumference thresholds for increased health risk stratified by BMI for white adults. This clearly does not encompass all ethnic groups and much more research is needed to be able to stratify waist circumference by BMI in people of various ethnic backgrounds.

So how can you measure your waist circumference? You can take your waist measurement as described on pages 52-53 here or as shown in the videos here. You can then compare it and your BMI to the table to the left, knowing there are limitations regarding the data that has comprised this table, or you can simply calculate your waist-to-height ratio. If your waist circumference is greater than half of your height then this implies you are carrying excess abdominal BF. While not perfect, if this is the case it suggests losing weight may be beneficial since an elevated waist-to-height ratio is associated with negative health conditions.(Ashwell, 2020)

For completeness, the World Health Organization recommends a different measurement site for waist circumference. There are also several other locations where you can take a waist circumference, and it’s not yet clear which one may be optimal in any given situation.(Repp, 2022) At this point most of the literature uses the above two noted methods so I would stick with those, but realistically if you are going to track progress over time it makes the most sense to use whichever method you feel you can reproduce most accurately.

Tip: If you have BF on a specific area of your body and you want to get rid of it, the only non-surgical method to do this is to lose overall BF. A 2021 systematic review & meta-analysis evaluated 13 studies where only 1 limb was exercised regularly and compared subcutaneous fat loss over that limb compared to the contralateral limb.(Ramirez-Campillo, 2021) The authors found there was no difference in fat loss between the two sides of the body. This implies that specifically training a muscle group will not allow you to preferentially lose fat overlying that muscle group.

Thus, “spot reduction” is a myth. You’ll likely be better off training your entire body for general health and lean body mass gain/retention purposes while you eat in a caloric deficit to lose the body fat.

#### Recommendations

It should be clear from a health perspective there is no one perfect BW for any given person, rather there is a range across which similar health outcomes can be seen. Thus, I do not actually advise targeting a specific body weight. In general I advise individuals with excess BF, principally determined by their waist circumference, to lose the BF while also following a resistance training program to help maintain (or even build) their overall muscle mass. Most people in the obesity category by BMI, and many people in the overweight category and with a waist-to-height ratio >0.5, will have excess BF, and losing this will likely benefit their physical health. Beyond that it is really up to personal preference.

### Alternative to setting a target weight

An alternative mindset is to not set a target weight or even aim to decrease your waist-to-height ratio below 0.5. Instead, simply adopt healthier habits and see where this takes you while aiming to lose 10-15% of your current weight.

• 10-15% weight loss has been shown to elicit greater health improvements than the often recommended 5-10% weight loss, as summarized in the discussion here.
• There is also data indicating 10-15% weight loss is more beneficial than 5-10% in people with a BMI in the overweight category (distinct from the obesity category).(Wang, 2022b)
• A recent study found very significant health benefits in a cohort of individuals who lost a median of 13% of their BW.(Haase, 2021) This would equate to losing 39 pounds for someone who weighs 300 pounds. I have reproduced a figure from this publication here that demonstrates the decrease in risk of several conditions when losing 13% of their BW from several different starting BMI values:
• A 2022 review discusses implications of losing 5, 10, and 15% of starting weight, summarizing their findings in the figure below(Horn, 2022):

Thus, simply developing healthier habits and seeing how much weight loss this provides can go a long way towards better health (assuming this leads to >5% weight loss, and preferably 10-15%), even if your BF% remains elevated or your waist-to-height ratio remains >0.5. Eventually when weight loss plateaus you can consider adopting new strategies to further improve your health, but you can be confident that even a relatively small amount of weight loss can go a long way.

### Rate of weight gain or loss

If you want to gain or lose weight it is helpful to know how quickly you can do this safely and effectively, as well as the risks of changing your BW too rapidly.

Note: Some basic terminology:

• maintenance: consuming a number of calories equal to your TDEE, thus generally maintaining your current bodyweight
• surplus: consuming more calories than your TDEE, leading to weight gain over time
• deficit: consuming fewer calories than your TDEE, leading to weight loss over time

#### For people who want to gain weight

Note: This advice does not apply to people who are medically underweight (body mass index < 18.5 and not constitutionally thin) . If medically underweight I recommend discussing goals of weight gain with your medical provider; in general the desired rate of weight gain will be faster than what I discuss below.

The general goal is typically to gain LBM while minimizing BF gain. The rate at which you can gain new skeletal muscle and LBM is limited; if you gain beyond this rate the excess weight will accumulate as BF.

There are various recommendations for rate of weight gain. In many respects it depends on your current level of musculature; people with less muscle tend to be able to gain muscle more quickly as they are further from their genetic potential. One generic recommendation(Iraki, 2019) (written for bodybuilders in the off-season but applicable to anyone trying to build muscle) is to limit weight gain to:

• no more than 0.25-0.50% of your BW weekly if you are a beginner to resistance training
• no more than 0.25% of your BW weekly if you are more advanced

Another recommendation is to limit the caloric surplus to(Aragon, 2020):

• at most 20-40% of your TDEE, or 500-1,000 calories daily for beginners to resistance training, particularly if you typically have difficulty gaining weight (presumably due to a significant increase in non-exercise activity thermogenesis)
• at most 10-20% of your TDEE, or 250-500 calories daily for non-beginners
• while not stated in their recommendations, this would likely also apply to people who put on excess BF easily

Tip: My recommendation is to eat as few calories as necessary to get stronger with resistance training over time, as strength gains correlate with skeletal muscle hypertrophy.(Taber, 2019) Only a small surplus of a few hundred calories daily(Slater, 2019) is likely needed to maximize skeletal muscle hypertrophy. Thus, if you focus on gaining strength without gaining too much BF then skeletal muscle hypertrophy will accrue over time. When strength gains stop then you can generally either change your resistance training program or increase your caloric intake by 100-200 kcal/day.

Anecdotally, many people will “bulk” (gain weight) quickly and think they are gaining a lot of muscle. Then when they eventually “cut” (lose weight), they look similar to how they did prior to bulking. This is because a lot of the weight they gained that they thought was muscle was actually water/glycogen/BF. Beyond the beginner stage (which can last several months to 1-2 years when training consistently) it takes time to build appreciable muscle; you are unlikely to see changes on a weekly basis (or even a monthly basis if you are more advanced).

So how do you tie this in to calculating your TDEE and tracking calories? You can calculate your TDEE, aim to eat this daily (knowing there is some margin of error), and increase your target by 100-200 kcal/day if progress with resistance training stalls. Alternatively, you can follow a good resistance training program while eating sufficient protein (discussed in Lesson 4) without tracking calories. If you stop making progress with the resistance training you can consider if you are not eating enough calories and increase food intake accordingly. If you are gaining weight too quickly (beyond the guideline above, or if you can tell your BF% is increasing) you can take certain things out of your diet or temporarily track calories to get back on course.

#### For people who want to lose weight

The general goal is typically to lose BF while maintaining (or even gaining) LBM.

If you lose weight too rapidly then you put yourself at risk of medical complications (ie, developing gallstones). Additionally, faster weight loss increases the risk of losing LBM, which likely makes it harder to keep the weight off long-term.(Dulloo, 2018) It is harder to maintain a faster rate of weight loss as the body undergoes compensatory mechanisms to fight this. These changes include decreases in leptin/thyroid/insulin/satiety hormones, increases in cortisol/ghrelin hormones, and alterations in sympathetic nervous system activity. Collectively this increases adaptive thermogenesis & hunger, making dieting more difficult.(MacLean, 2017; Müller, 2013)

Note: Technically not all of adipose tissue is actually fat. When you lose fat you lose some of the non-fat mass associated with the adipose tissue. It’s unclear how variable this is between individuals but it’s estimated that ~15% of adipose tissue is actually not fat.(Abe, 2019) While this fact may be of interest for individuals who are losing large amounts of weight and attempting to track changes in LBM via sophisticated means (ie, a DEXA scan), practically speaking this is not an important thing to consider.

So how quickly should you lose weight?

• A 2019 review indicated no significant differences in outcomes of body composition with weight loss rates up to almost 1% BW weekly in dietary interventions without exercise components.(Turicchi, 2019)
• A 2020 systematic review and meta-analysis evaluating the impact of different rates of weight loss via dietary interventions (there is no mention of exercise interventions being employed) found more gradual weight loss led to slight improvements in BF loss and BF percentage loss (-1 kg and -0.83%, respectively).(Ashtary-Larky, 2020) Of note, the rate of weight loss was variable in these studies (0.2-1 kg/week in the slower weight loss group, 0.5-1.8 kg/week in the faster weight loss group).
• A 2022 narrative review including 13 studies with no mention of exercise interventions found that the faster weight loss group lost 0.5-3.2 kg/week, while the slower groups lost 0.2-2.3 kg/wk.(Fogarasi, 2022)
• In general, faster weight loss led to greater loss of LBM and slower loss of BF in several (but not all) studies, but the differences became less apparent after 1 month of weight stabilization in 2 studies that assessed for this.
• Of the 12 studies that assessed body composition changes, the faster weight loss group on average lost 1.0 kg more LBM than the slower weight loss group while losing 1.46% of their body weight per week..
• In the 2 studies that did further assessments after 1 month of weight stabilization, 1 study found the rebound gain in LBM was ~1.0 kg greater in the fast weight loss group than the slow weight loss group, and the other study found that the difference between the two groups regarding LBM loss decreased from 1.0 kg to 0.6 kg.
• The rate of weight loss did not seem to have a very meaningful impact on BF distribution or cardiometabolic risk factors in the studies that assessed for this.
• There was also no influence on hunger & appetite levels at the end of the weight loss period or on subsequent weight regain in the studies that assessed for this.

A 2021 meta-analysis evaluating the impact of an energy deficit on changes in LBM with resistance training found that at a deficit of 500 kcal daily there were no changes in LBM; this would approximate ~1 pound per week weight loss without losing LBM.(Murphy, 2021) Of note, the authors did not find an influence of study duration on LBM outcomes, which indicates the methodologies to assess LBM changes may have been inaccurate or the resistance training interventions were suboptimal as one would typically expect more LBM gain with longer intervention duration. Additionally, there was no consideration of dietary protein intake in this analysis.

Overall, the literature is sparse regarding interventions in large groups of people with effective exercise and dietary components testing the impact of variable rates of weight loss on outcomes. As following a proper resistance training program will further aid in maintaining or gaining LBM while losing BF, I feel aiming for up to 1% BW loss weekly is a safe and effective metric to shoot for while you have a BMI in the obesity range.

Tip: According to a 2022 review, in young adults it is potentially helpful to maintain (or even increase) your typical resistance training volume while you are in a caloric deficit (as opposed to decreasing it) to help maintain (or potentially gain) LBM.(Roth, 2022) I think decreasing training volume will be important if you are having difficulty recovering adequately from your workouts, but otherwise I do not see any reason to decrease your training volume when eating in a caloric deficit.

Example: Let’s see how we can attempt to lose weight keeping in mind all of the above. A 200 pound person with a TDEE of 2,500 kcal/day wants to lose 1% BW weekly. 1% of 200 is 2 pounds, requiring a 7,000 kcal weekly deficit, or 1,000 kcal/day. Thus, they aim to eat 1,500 kcal/day, which is 1,000 kcal/day below their TDEE. Knowing their BMR, TEF, and NEAT will decrease as discussed in Lesson 1, they estimate these to cumulatively decrease 300 kcal/day. Therefore, they start exercising enough to burn an estimated 300 kcal/day to make up for this difference. This maintains their TDEE at 2,500 kcal/day with a 1,000 kcal/day deficit. Part of their exercise is resistance training to attempt to maintain their LBM and have the weight loss come from BF.

Over the first few days they lose 4 pounds of water/salt/glycogen (see tip below). Over the next 4 weeks they lose 7-8 pounds, meeting the 1% body weight loss per week goal. Now that their new body weight is less (~188 pounds), there is more adaptive thermogenesis, so their TDEE decreases further. As this continues to occur at some point they will no longer be losing 1% of their body weight weekly. They can proceed with a slower rate of weight loss or choose a combination of eating fewer calories and increasing exercise to maintain the needed deficit for 1% loss per week. As a minimum amount of nutrition (via macronutrients and food groups, all discussed later in this course) is needed for good health at some point calories cannot safely be reduced further and any increase in the deficit should come from increased exercise.

However, keep in mind that as described in Lesson 1 our TDEE can only increase so much from increased physical activity (unless we really crank up physical activity to unrealistically high levels for most people). Thus, there will come a point where there is not a safe and effective way to continue losing weight at the same rate. In some ways this can be a good thing; I’d rather have someone follow sustainable, positive lifestyle practices and make progress more gradually then perform a crash diet or other unhealthy methods to lose weight too quickly. This slowdown in weight loss is not going to be overly significant for people with obesity attempting to reach a healthy body weight; it will become more significant for people who are already relatively lean and attempting to drop down to very low BF levels (ie, physique competitors).

Ok, so the desired rate of weight loss seems straightforward, but what if you have a lot of water weight fluctuations so it’s hard to know how quickly you are losing weight? What if you don’t want to track calories and thus cannot easily adjust the total amount you are consuming? First I will go over how to track weight changes and monitor progress, and then I will go over a strategy to do this without tracking calories.

### How to track progress

• Use a scale. I recommend weighing yourself every morning after using the bathroom and calculating a 7-day rolling average:
• Weigh yourself Monday – Sunday and calculate the average.
• Then next Monday replace the prior Monday’s weight with your new weight and calculate the new average.
• Continue to repeat this process with each successive day.
• Track how this changes over time. I recommend this strategy because water weight can fluctuate daily depending on physical activity and what you eat; using a 7-day rolling average helps to smooth out these differences. Of note, as women go through their menstrual cycle water weight can fluctuate a lot. Thus, depending on how big of an issue this is, women may need to compare 7-day averages from cycle to cycle (ie, the 7-day average on the 3rd day of this cycle compared to the 7-day average of the 3rd day of the last cycle) to confidently track progress. Libra (android) and Happy Scale (iPhone) are apps that can be used for this. An example done in Excel is shown below.

7-Day Rolling Average Example

• Body part measurements. A change in weight on the scale won’t tell you if you are gaining or losing LBM or BF. Measurements help you do this. I recommend measuring once a week (ie, every Sunday), in the morning after using the bathroom. For males measuring the waist is useful. For females measuring the waist and additionally at the widest portion of the hips is useful. You can measure additional spots (ie, neck, arms, thighs) if desired. In general, BF decreases or increases when waist/hip measurements decrease or increase, respectively. This is very helpful to help determine if the weight being gained or lost is due to LBM vs BF. Additionally, for women with water retention issues due to the menstrual cycle, if the scale is moving in the wrong direction but your measurements are going in the right direction, you can be confident you are doing well even if the scale is not showing it acutely.

TIP: Of note, it is crucial you perform measurements the same way each time. A protocol for measuring your waist circumference was linked to above. It doesn’t matter too much how you do it (or any other measurement) as long as you are consistent over time. Consistency is key. Pick whatever method you think will be easiest to stick to and stay consistent.

Additionally, for those attempting to gain muscle measuring arm and thigh circumferences can be helpful. Beware though that if you lose fat and gain muscle at the same time the measurements will capture both of these processes so they should not be relied upon in isolation. A combination of metrics to track progress is most insightful.

• Pictures. I recommend taking pictures when you start dieting (to gain or lose weight) and periodically take new ones with the same poses and lighting. This can help motivate you and provide another method to track progress. I would take pictures no more frequently than every 2 weeks. Every 4 weeks is probably better for being able to see significant changes, especially when it comes to muscle gain.
• Exercise numbers. In general, maintaining strength while losing weight indicates LBM is being maintained. If you gain weight without gaining strength, that’s a sign you are probably gaining excess BF. If you are losing weight and start to lose strength this would be a good time to reevaluate if you need to slow down the rate of weight loss (by increasing calories), increase protein intake (discussed in Lesson 4), or alter your resistance training program (discussed in the general exercise course).

TIP: The first week of dieting can yield water weight changes of several pounds. This is because when you decrease calories and increase exercise you use up glycogen (a molecule the body uses to store glucose), and 1 gram of glycogen is stored in the body with at least ~3 grams of water.(Murray, 2018) Changes in sodium intake also impact water retention especially in the first few days of dietary changes. Therefore, weight fluctuations the first week do not indicate actual changes in BF.

After the first week I recommend tracking your weight daily for 2 weeks and taking measurements each week. If after these 2 weeks (not including the first week) you are gaining or losing weight at the appropriate pace and the measurements are good, keep doing what you are doing. If your weight is not changing at the desired rate, adjust accordingly. As examples, if you want to lose 1.5 pounds per week and are only losing 0.5 pounds per week, then decrease your calories by 500 kcal/day (or increase activity accordingly). If you want to lose 1.5 pounds per week but lost 2 pounds the last week, increase your calories by 250 per day. Then adjust further after another 2 weeks of measurements.

For those who do not wish to track calories, you can still track your overall progress as described above and adjust accordingly. If you’re not losing weight quickly enough, try to eat smaller portions of the same foods, cut out a food item that has a significant number of calories, do more physical activity, or adjust in some other way that makes sense to you. Then get right back to tracking your progress and make further adjustments as necessary. If these strategies do not work you can always temporarily track calories to troubleshoot the issue.

### Conclusion

After these first three lessons you should now have a basic understanding of the interplay between TDEE & caloric intake, how to estimate your TDEE, how to use this estimate to start the dieting process, how to set a healthy goal BW, and how to track progress and adjust caloric intake over time as indicated. As long as you are objectively and consistently tracking progress you can attempt almost any dieting or lifestyle strategy that suits you and adjust as needed.

With this general understanding of calories, it is time to start discussing where these calories come from. In the following 3 lessons I will go over the 3 basic macronutrients: protein, carbohydrate, and fat.

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