Nutrition and Weight Management Condensed Course

Introduction

The full Nutrition and Weight Management Course is rather lengthy, and that is by design as I made it evidence-based and it takes time to discuss large amounts of evidence. However, I realize many people will not have a desire to read through the full course. Thus, I have made this shortened version. If you do not have time (or the desire) to read the full course, or if you have read it once and want a quick recap, or if you are trying to determine which portions to read in more detail, consider reading through this shorter version. Then you can refer to the full course at any point in time for clarification and further discussion of any key concepts as well as additional insights that are provided.

  • Calorie (kcal) intake and caloric expenditure are the primary considerations regarding body weight outcomes:
    • calories in > calories out -> gain weight
    • calories in < calories out -> lose weight
    • calories in = calories out -> maintain weight
  • Total daily energy expenditure (TDEE) = the number of calories your body expends on a daily basis.
    • The primary components are your resting metabolic rate (RMR), thermic effect of feeding (TEF), exercise activity thermogenesis (EAT), and non-exercise activity thermogenesis (NEAT).
    • TDEE = RMR + TEF + EAT + NEAT
  • RMR:
    • This is the number of calories your body utilizes at rest on a daily basis. This is primarily based on your lean body mass, including your vital organs (ie, your heart, brain, kidneys, and liver). More muscle and fat will increase your RMR by ~6 kcal/kg/day and ~2 kcal/kg/day, respectively.
    • When in a caloric deficit your RMR may decrease significantly (called “adaptive thermogenesis”) but this will revert to essentially normal when you are no longer in a deficit.
    • In general, the RMR and the change in RMR with dieting can vary significantly between individuals; this is one reason some people have more difficulty than others when attempting to gain or lose weight.
  • TEF:
    • These are the calories you burn to digest and absorb the nutrients you consume.
    • This is generally ~10% of your daily caloric intake.
    • Contributions to the TEF are based on food composition (protein > carbohydrate > fat). This is not significant enough to justify major dietary changes.
      • TIP: The TEF is not considered when creating nutrition labels. It is usually best to ignore your TEF and simply trust the calorie counts provided on nutrition labels (though in the USA they can be legally off by 20%).
  • EAT:
    • This represents calories you burn with planned physical activity and as your body “returns to normal” after an exercise session (termed “EPOC” – this is usually a minor contribution)
      • TIP: most exercise machines will overestimate the calories you burn while using them. EAT also tends to decrease as you get in better shape and are in a caloric deficit. Thus, it is hard to track this accurately, and it is best to avoid relying on precise measurements of EAT.
  • NEAT:
    • This represents the calories you expend with non-planned physical activity (ie, rolling over in bed).
    • This can vary considerably between people and is one reason why some people have more difficulty losing or gaining weight than others.
    • This can also decrease with weight loss and when in a caloric deficit.
      • TIP: setting and achieving a daily step goal can help ensure this does not decrease too much when dieting.
  • Constrained model of TDEE:
    • There is some evidence that as you increase your physical activity further, other aspects of your TDEE will decrease such that your TDEE reaches a plateau.
    • This is less likely to occur for people who were previously sedentary and now increasing to a moderate level of activity.
    • TIP: Increasing physical activity should help increase your TDEE to some degree, but most of your focus for losing or gaining weight should come from your nutritional choices.
  • There are different online calculators to estimate your TDEE:
  • You can alternatively estimate your TDEE by tracking your caloric intake:
    • This theoretically works if your weight has been stable for several weeks; in this case you are on average consuming a total number of calories similar to your TDEE each day.
    • You will need to write down or in some way record everything you consume (you can write things down/text yourself/take pictures with a phone and then look up nutrition labels later (this website will work, as will others)) or directly enter things into an app such as MyFitnessPal.
    • TIP: It is helpful to weigh out foods with a kitchen scale rather than measure by volume (which is more prone to inaccuracy).
    • TIP: Nutrition labels can legally be off by 20% so accept the fact that it will be impossible to do this perfectly.
  • You may be able to eat healthily and achieve a healthy body weight without ever estimating your TDEE or tracking any calories. If so, that is great, and there is no need to do this (though you can if interested).
  • If you do have trouble losing or gaining weight as desired and making dietary/exercise changes that seem logical do not prove helpful, then you can track calories for 1-7 days as a troubleshooting tool to pinpoint what changes you should make. You can then continue tracking calories if desired or just resume doing so whenever needed for troubleshooting purposes.
  • CAUTION: Some people will find that tracking calories may lead to disordered eating or other mental health concerns related to eating. If this applies to you then I strongly suggest that you do not track calories and instead consider discussing more viable approaches to healthy eating with your healthcare provider and/or a mental health professional if you feel this will prove beneficial.
  • The information in this lesson does not apply to children.
  • You can arbitrarily set any body weight target and adjust your caloric intake to reach this.
  • From a health perspective when attempting to determine a target body weight, considerations include:
    • You can aim to obtain a body weight so your BMI is in the “healthy” range (between 18.5-24.9 for adults)
    • Elevated BMI:
      • Some people with an elevated BMI will seem metabolically healthy from various health biomarkers, but generally long-term health risks are still increased unless you maintain a relatively high level of cardiorespiratory fitness.
      • In elderly populations there is an “obesity paradox” where people with an elevated BMI seem to have lower rates of mortality, but this seems to be due to increased levels of lean body mass as opposed to the increase in body fat.
    • Normal BMI:
      • Some people with a health range BMI will still have increased levels of body fat (generally around the abdomen) and increased health risks.
    • Thus, you can instead consider your waist circumference; if this is less than half of your height (such that your waist-to-height ratio is <0.5) this indicates lower health risks long-term. Consider losing weight if your waist-to-height ratio is above this threshold.
  • After you determine a goal weight, or at least a general desire to increase or decrease your weight, you can then consider what rate of weight gain or loss you would like to experience.
    • To gain weight:
      • You may want to aim to gain 0.25-0.50% of your body weight weekly if you are a beginner to resistance training and no more than 0.25% of your body weight weekly if you are more advanced. This will help ensure the weight gained is lean body mass rather than body fat.
        • This may correspond to a 500-1,000 kcal increase per day if it is difficult for you to gain weight, otherwise increasing by 250-500 kcal per day may be a more reasonable starting point.
    • To lose weight:
      • In general you can lose up to 1% of your body weight weekly if you are consuming sufficient protein and engaging in resistance training without having to fear significant losses of skeletal muscle.
      • If you are already fairly lean I would aim to lose closer to 0.5% of your body weight weekly.
  • Over time as you start to gain or lose weight you’ll want to track progress to make indicated adjustments:
    • Keep a 7-day rolling average of your body weight.
      • Take your average weight Monday-Sunday, then the following Monday remove last Monday’s weight and calculate your new average. Repeat this daily.
      • If your weight is increasing or decreasing too quickly, adjust accordingly.
    • Measure your waist circumference once weekly.
      • If your 7-day rolling average is not decreasing as quickly as you desire but your waist circumference is decreasing, then you may be experiencing changes in water weight and should not overreact to the scale alone. Alternatively, if you are gaining weight and your waist circumference is increasing noticeably quickly then you are liking gaining excessive amounts of body fat.
    • Take pictures once every 2-4 weeks to see progress in the mirror as this can be motivating.
    • Track your exercise numbers; if you start losing strength with the weight loss and are not already lean then you may be losing weight too quickly, consuming insufficient protein, or engaging in a suboptimal resistance training program.
  • Higher protein intake can aid weight loss as it stimulates muscle protein synthesis (improving lean body mass retention while you lose body fat), is more satiating than carbohydrate and fat, and has a small beneficial impact on the thermic effect of feeding which can increase your TDEE slightly.
  • Protein intake recommendations include:
    • From the 2020-2025 Dietary Guidelines for Americans:
      • 2-3 years old: 5-20% of one’s calories should come from protein
      • 4-18 years old: 10-30% of one’s calories should come from protein
      • ≥19 years old: 10-35% of one’s calories should come from protein
    • The recommended dietary allowance (RDA) is 0.8 grams/kg body weight/day (g/kg/d).
    • Some evidence indicates aiming for 1.2 g/kg/d is more advantageous in the elderly.
    • Aiming for 1.3-1.6 g/kg/d in adults who are engaging in resistance training regularly may be additionally beneficial to aid lean body mass acquisition.
    • Alternatively, aiming for 20-40 grams of higher quality protein in each of 3-4 meals daily should likely come close to maximizing muscle protein synthesis.
      • Aiming closer to 40 grams may be more useful for people with severe obesity and in particular after a full body workout.
  • A higher level of protein intake (up to the 1.6 g/kg/d threshold) seems safe for people with healthy kidneys at baseline, assuming they perform resistance training while obtaining a healthy body weight and consuming sufficient calcium & vitamin D, though it is unclear if there may be increased risk of chronic kidney disease long-term.
  • TIP: If you are concerned about the long-term potential of worsening kidney damage from higher protein diets, consider only increasing protein intake while actively losing weight and then lowering your protein intake when maintaining a healthier body weight.
  • EXAMPLE: If you weigh 80 kilograms (~176 pounds) and consume 2,500 kcals/day, then 0.8 g/kg = 64 grams daily. 10-35% of 2,500 kcals = 250-875 kcals from protein, and considering 4 kcal/g of protein on average this comes to 62-219 grams of protein daily. 1.3-1.6 g/kg/d = 114-128 grams daily. Thus, even this higher level of protein intake is still considerably lower than the upper threshold of the dietary guidelines.
  • Protein quality considerations:
    • Leucine seems to be the most important amino acid for skeletal muscle building purposes; this is more prominent in animal-based foods and can be supplemented directly if desired (potentially more useful in the elderly who may want to consume lower amounts of protein due to chronic kidney disease or who eat less in general).
    • The speed of digestion is not very important in the context of consuming food in mixed meals.
    • The bioavailability of amino acids from different food sources is also not very important in the context of consuming food in mixed meals.
    • Plant-based protein sources are generally associated with healthier outcomes than animal-based protein sources.
  • Protein distribution:
    • It may be helpful to split up significant amounts of protein intake into at least 2 and preferably 3 or even 4 meals daily as this may further increase muscle protein synthesis for muscle building purposes.
    • However, it seems that the total daily protein intake is considerably more important than the distribution of protein intake throughout the day.
  • Fat intake recommendations include:
    • From the 2020-2025 Dietary Guidelines for Americans:
      • 2-3 years old: 30-40% of one’s calories should come from fat
      • 4-18 years old: 25-35% of one’s calories should come from fat
      • ≥19 years old: 20-35% of one’s calories should come from fat
  •  There are no meaningful differences in weight loss outcomes when comparing low-fat and high-fat diets assuming protein and total calories are matched.
  • Lower fat diets may aid total and low-density lipoprotein cholesterol while higher fat diets may aid high-density lipoprotein cholesterol and triglyceride levels.
  • TIP: You can likely consume less than the recommended minimums for short periods of time without significant risk of harm, but fat intake does aid the absorption of vitamins A, D, E, and K, as well as with hormonal production, and healthy fat sources have beneficial properties, so I would not go lower than the minimum amounts for extended periods of time.
  • Types of dietary fats:
    • Saturated fats: It is recommended to keep these at less than 10% of your total daily calories, though there is controversy about the health impact of elevated saturated fat intake.
    • Monounsaturated fats: These are likely more neutral for health as a whole, but plant sources seem healthier than animal sources.
    • Polyunsaturated fats: These are generally considered health-promoting, though there is some controversy due to their potential peroxidation and oxidation (more likely when prepared with higher temperatures, air exposure, and light exposure).
      • Regarding omega-3 fatty acids, there is debate about the benefit of supplementing these directly but for most individuals if you consume low-mercury, fatty fish (such as salmon) a couple times weekly there likely will not be a significant benefit from supplementation.
    • Trans fatty acids: These are generally considered harmful for health, particularly the industrial type. Ruminant trans fats, produced naturally by some animal species, seem less harmful.
    • EXAMPLE: If you want to eat within the guidelines, then if you consume 2,000 kcal daily, 20-35% would be 400-700 kcal daily, and at an average of 9 kcal per gram of fat this equals 44-78 grams of fat daily. Regarding saturated fat, 10% of 2,000 = 200, and thus saturated fat intake should be <23 grams daily.
  • Increased carbohydrate intake may aid your ability to exercise well. It is worth experimenting with the quantity and timing of carbohydrate intake to help optimize any exercise you perform.
  • The RDA for carbohydrate intake is 130 grams daily, while the recommended macronutrient percentage is 45-65% of your daily calories, but many people do well consuming less than this. There is technically no minimum requirement of dietary carbohydrates.
  • It is recommended to keep added sugar at <10% of your daily calories. This is less important if you are exercising regularly and have a healthy body composition, while this is more beneficial for health if you have insulin resistance.
  • Artificial sweeteners seem to aid weight loss efforts (when used in place of sugar) without any obvious risks of harm (when consumed in moderation), but more research is needed.
  • The glycemic index and glycemic load do not seem overly influential, particularly for people with a healthy body composition who are exercising regularly. For people with insulin resistance it is likely healthiest to avoid consuming foods high in glycemic index and glycemic load in isolation.
  • Dietary fiber essentially describes carbohydrate compounds that are not digested and absorbed well.
  • The minimum recommended amount is 14 grams per 1,000 kcal intake, though going higher may have additional health benefits.
  • Different types of fiber have different properties:
    • Soluble, viscous, gel-forming fiber can increase satiety, decrease the rate of blood glucose absorption, and decrease cholesterol levels.
      • Due to the increase in satiety, increased fiber intake may aid weight loss.
    • Fermentable fibers generate short-chain fatty acids (when fermented by the gut microbiome, particularly in the colon) that have beneficial health properties.
    • Non-fermentable fiber can aid with loose stools or constipation.
  • TIP: Do not worry about obtaining different types of dietary fiber from different food sources. Only consider the structure-function properties of fiber if you are purchasing specific fiber supplements.
  • Standard recommendations include that people who currently do not drink alcohol should not begin to drink alcohol for the hope of achieving health benefits.
  • Other recommendations include:
    • Females should not average >1 alcoholic drink daily and should not consume >3 drinks in ~2 hours.
    • Males should not average >2 alcohol drinks daily and should not consume >4 drinks in ~2 hours.
    • Pregnant individuals and people who are underage should not consume alcohol.
  • Alcohol intake within these guidelines does not seem to impede dieting and resistance training progress, though some people who are prone to overeating when consuming alcohol may specifically find it beneficial to decrease alcohol intake.
  • There is controversy regarding if alcohol consumption within the above guidelines provides a cardiovascular benefit.
  • Alcohol intake at any level seems to increase the risk of cancer.
  • Of the various alcoholic beverages, the healthier options seem to be red wine, white wine, and beer, potentially in that order, though associated lifestyle considerations may explain the relative health benefits of one type compared to another.
  • Micronutrients are the compounds in foods in milligram or less quantities, such as vitamins, minerals, and other phytonutrients.
  • You can use cronometer.com to assess your micronutrient intake. This works well for most micronutrients (one exception is iodine, which is not included).
  • Multivitamin/multimineral supplements are generally not necessary, but if low-dose variations are chosen they may be beneficial for people consuming a caloric deficit who are eating relatively low amounts of foods and/or people who are exercising regularly.
  • Micronutrients of concern:
    • Sodium: It is generally recommended to keep daily sodium intake at <2,300 milligrams (mg), though there is some controversy regarding this.
    • Potassium: New recommendations as of 2019 suggest:
      • Adult males should aim for 3,400 mg daily.
      • Adult non-pregnant/non-lactating females should aim for 2,600 mg daily.
    • Vitamin D: This likely is not as helpful as many hope, but if you have any concerns you can generally take 2,000 international units (IUs) daily without risk of harm.
    • Calcium: High levels of supplementation may increase the risk of cardiovascular harm so I only suggest supplementing to meet the RDA (generally 1,000-1,300 mg daily for anyone ≥4 years old) if you are not meeting this with food intake.
    • Iron: This is more likely to be low in children, in women who are experiencing menstrual cycles, and in endurance athletes. Consider supplementing your iron intake if Cronometer indicates your iron intake is low.
  • Grains:
    • Consuming at least 3 and up to 7 servings of whole grains daily can yield increasing health benefits.
    • Refined grains are not inherently unhealthy as long as consuming them does not lead to excessive caloric consumption. It is suggested to make at most half of your grain intake be refined grains.
    • There is no benefit to avoiding gluten unless you have a gluten allergy, Celiac disease, or if you have reproducible symptoms with gluten intake.
  • Fruits and Vegetables:
    • Consuming at least 5 servings (400 grams) and up to 10 servings daily provides increasing health benefits.
    • 100% fruit juice has health properties and is a viable option assuming that consuming this does not lead to excess caloric consumption.
    • Canned and frozen fruits and vegetables are generally as healthy as fresh fruits and vegetables.
  • Nuts:
    • 0.5-1 serving daily (14-28 grams) provides health benefits.
    • Other than Brazil nuts (you should probably not consume more than 1-3 daily), there does not seem to be harm when consuming high levels of nuts.
  • Oils:
    • Two servings each day are recommended in the guidelines for individuals consuming 2,000 kcal daily. Olive oil, particularly extra virgin, seems to be one of the healthiest types when not cooking with it at high temperatures.
    • When cooking at high temperatures avocado oil is a good option as it has a healthy fatty acid profile and higher smoke point.
    • TIP: Try to cook at relatively low temperatures to help prevent the formation of various oxidation byproducts.
  • Dairy:
    • Dairy intake is associated with several potential health benefits in children and adults.
    • In children, 2-3 servings of dairy intake can aid bone development if the children are not consuming sufficient calcium and vitamin D otherwise. Excess dairy intake in children may decrease iron absorption and increase the risk of acne.
    • In adults there seems to be a small increased risk of Parkinson’s disease and an increased risk of prostate cancer with elevated dairy consumption.
    • There do not seem to be many substantial differences between whole-fat and reduced-fat dairy intake.
    • Fermented dairy products such as yogurt and cheese may have additional health properties. People with lactose intolerance can still usually consume yogurt without much difficulty.
  • Eggs:
    • Egg intake will generally increase cholesterol levels; this will impact “hyperresponders” more than “nonresponders”. You can get your cholesterol checked before and 4 weeks after making significant dietary changes to see if this impacts you significantly.
    • Consuming up to 1 egg daily does not seem to have negative health effects and can provide some health benefits. Consuming >1 egg daily may not have detrimental health effects if your cholesterol does not increase significantly but more research is needed.
  • Meats:
    • Consuming fish rich in omega-3 fatty acids (but low in mercury) 2-3 times weekly is recommended.
    • Meat otherwise is not associated with many health benefits, though unprocessed poultry is generally considered neutral for health outcomes.
    • Unprocessed red meat seems potentially harmful when consumed regularly though occasional consumption should is likely not overly detrimental.
    • Processed meats should generally be avoided.
  • Intermittent energy restriction (IER), where you eat at a caloric deficit some days or weeks but then eat at maintenance calories intermittently, generally does not improve or detract from weight loss outcomes relative to continuous energy restriction (CER). Thus, taking breaks from dieting and eating at maintenance is a viable strategy to aid long-term adherence, but it will prolong the dieting process.
  • Intermittent fasting (IF) in the research world refers to significant caloric restriction for ≥1 day per week and generally does not show any health benefits or dieting benefits in human studies.
    • As eating more regularly, particularly with protein, may help promote lean body mass retention as you lose body fat, I generally recommend against prolonged fasting.
  • Meal frequency (the number of meals consumed daily) does not seem very influential for dieting or health outcomes.
  • In general, eating meals at similar times each day seems beneficial, and preferentially consuming calories earlier in the day seems health-promoting.
    • Of note, the studies that show this do not evaluate exercise in the evenings; it is possible that eating more calories in the evening will prove more beneficial when performing evening exercise sessions.
  • Time-restricted eating, generally entailing consuming all of your calories in a 4-10 hour window (what the general public refers to as intermittent fasting) seems to naturally lead to a reduction in caloric intake and has shown some promise regarding health benefits (particularly when making your eating window earlier in the day), but more research is needed to fully evaluate this strategy.
  • There are many different diets you can choose from if desired.
  • There is not much literature comparing them for various weight and health outcomes.
  • The options with the greatest amount of research supporting their health benefits include the Mediterranean diet and the DASH diet, but several others show benefits as well.
  • TIP: If you want to follow a named diet you should likely pick whichever one will aid your adherence assuming it follows the general nutritional principals stated elsewhere in this course.
  • More diets are listed in the lesson, but some of the more popular that I discuss include:
    • Atkins diet: This starts with very low carbohydrates so you will lose several pounds in the first couple of days due to a decreased in glycogen and associated water content. Otherwise by limiting carbohydrate options several healthy food options are not available, so I do not recommend this diet.
    • DASH diet: This essentially follows the recommendations of the 2020-2025 Dietary Guidelines for Americans.
    • Ketogenic diet: Being in ketosis has appetite-decreasing properties, which can be beneficial when working on losing weight. However, this also eliminates several healthy food options. Thus, I would not follow a ketogenic diet for an extended period of time.
    • Mediterranean diet: This likely has more supportive evidence than any other named diet for general health benefits.
    • Vegetarian diet: This can be done in a very healthy fashion if you make appropriate food choices. A vegan diet will require supplementation for general health purposes.
  • Tips regarding cost savings include:
    • Purchase canned or frozen fruits and vegetables instead of fresh.
    • Buy bags of dry beans instead of canned beans.
    • Buy whatever type of nuts are cheapest as there are not major differences between different types (other than too many Brazil nuts being dangerous).
    • Oatmeal, whole grain pasta, brown rice, and certain types of cereal can be cost-effective healthy grain options.
    • Choose the cheapest type of fish (fresh, frozen, or canned). You can choose fattier cuts of meat and prepare them in such a way as to remove most of the fat.
    • Do not purchase eggs with extra ingredients if this costs more; regular eggs alone have significant nutritious content.
    • Cheese may be cheaper to purchase in bulk; if doing this then make sure to wrap it tightly in plastic to avoid air exposure in the refrigerator after opening it.
    • Always look for sales and coupons.
    • Purchase plain foods and use various flavoring options (such as spices or cinnamon (preferably Ceylon cinnamon if you are going to use large amounts)).
    • I include relatively cheap healthy food choices from various stores in this article.
  • Tips regarding time constraints:
    • Meal prep is very helpful, where you prepare large amounts of food at once and store it for the future. Purchasing a deep freezer and plenty of Pyrex if possible can prove very beneficial.
    • Meat: you can prepare and store lots of meat at one time, then take it out and put it in the microwave when you are ready to eat it.
    • Potatoes: you can bake many potatoes, divide them into portions, and freeze them.
    • Beans: you can prepare many servings and freeze them.
    • Fruits and vegetables: you can purchase these frozen or canned and take out enough for a few days at a time.
    • Oatmeal: you can store several servings at a time.
  • In general with enough planning you can find ways to afford relatively healthy eating and to fit this into your lifestyle. It helps to focus on what you can do rather than what you cannot do.
  • There are many differences between people with and without obesity in regards to hunger levels, appetite preferences, taste sensitivity, and all of these factors can make it more difficult for people with obesity to lose weight.
  • There is a large genetic influence on the heritability of obesity, both in regards to appetite and energy intake preferences as well as energy expenditure, making achieving a healthy body weight considerably more challenging for some individuals than others.
  • TIP: One of the contributors to the obesity epidemic is the easy access to highly palatable and energy-dense food in various fast food and grocery stores. You can control your local food environment where you live by getting all of the junk and snack food out of your home. This will make it easier to maintain healthy eating practices as you will not be constantly tempted to consume these foods.
  • Feelings of stigma, guilt, and shame are commonly experienced by those with obesity and generally make weight loss more difficult due to increasing general stress levels. Thus, shaming people with the hope that this will help spur them to work harder to lose weight generally does not work and can make things worse.
  • Long-term habits that have been shown to aid weight loss maintenance include goal-setting, monitoring (ie, weigh yourself weekly), having social support to help increase accountability while also putting you in a position to succeed, engaging in regular physical activity, and finding ways to maintain motivation.

Conclusion

I hope this was informative! Please refer to the full course for further information if desired.

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