Monday, June 22, 2009

The Myth of Spot Reduction

Guest blogger: Dr. Karin Anderson

This morning at the gym, I saw a morbidly obese woman, with the unfortunate “apple” distribution of fat around her midsection. She was, predictably, doing situps. My first thought was “well, good for her for doing something.” Making a commitment to exercise and showing up at a gym to do it takes a lot of courage. My second thought was “too bad she’s doing the wrong thing.”

I am going to beat this dead horse one more time, because it’s worth saying again: SPOT REDUCTION IS A MYTH. But for some reason, this belief really persists in people, and they will not give it up, no matter what science says. In order to shrink your midsection (or any body part), you need to lose fat. This is done by achieving a negative calorie balance. Period. Through diet or exercise, or, ideally, both. You have to expend more energy than you consume, and that makes the fat go away. So if this woman finishes her situps and then goes out to Starbucks for a venti something-or-other, it will all have been in vain. Yes, doing situps does burn calories. But she could have burned three times as many on the treadmill.

Many people (and this includes a friend of mine who is a doctor) believe that the body will recruit the fat it burns from the area you’re working. So, they believe, if you work your abs, the body will use abdominal fat for fuel. This is, pardon the expression, a bunch of crap.

Metabolism is very complicated, so this is only a very general description. When the body needs fuel – glucose – and doesn’t have enough in store, it uses fat. The fat is transported from where it is stored to the LIVER (in case you were wondering, the transport molecule for this is HDL cholesterol), where it is converted to glucose. The glucose is then transported to the active muscle. So there is no advantage to using any particular fat store, since it all goes to the liver for processing. Which fat stores does the fat come from? It’s a little bit from everywhere, but more from some areas than others. Where it comes from is determined by genetics and hormones, and is almost ENTIRELY BEYOND OUR CONTROL. Men and post-menopausal women tend to have really stubborn abdominal wall fat. This is hormonal. They can do situps all day long, and their bodies will still pull fat according to its predetermined pattern. If you maintain a negative calorie balance, eventually it will all come off, you just don’t get to control what shrinks first. It’s a little bit like accounting, though: last in, first out – the last place you gained fat is most likely to be the first place from which you lose it.

Yes, it’s frustrating. You start an exercise program. You start eating right. You keep track of your intake and output so that you are sure to have a negative calorie balance. And you want to see your belly shrink. Instead, your boobs disappear and you don’t notice any change in your belly at all. It can really make you want to poke your eyeballs out. But keep at it, and you will see the changes you want.

Now a few words about resistance training. If diet and exercise (when I say “exercise” I mean cardio) are the keys to fat reduction, what is the point to resistance training? Despite what I’ve said above, resistance training and calisthenics are extremely important. They burn calories, especially if you have a pretty vigorous resistance training program, although cardio still gives you more bang for your buck in terms of burning calories. What resistance training does is build muscle. Muscle, being metabolically active tissue, burns calories, even at rest, so it makes the whole process easier. It makes you stronger, so you can do more things. It increases tension on your bones, making your bones stronger. And it just plain looks good: a six-pack really is a beautiful thing.

So back to the woman at the gym this morning: if the situps I was observing were just part of her overall plan that included eating sensibly and a good cardio program, then I am wrong and I apologize for thinking what I did. The combination of all three activities is exactly what she needs to do. If not, then I hope that somehow she is pointed in the right direction. But if even one person learns something from this, then maybe all her situps were not in vain.

Standing by to answer your questions!
Dr. Karin Anderson is an Emergency Room Physician in the Greater Dallas-Ft. Worth area so she definitely knows how to deal with stress. Karin is also a dedicated physical fitness athlete who clearly knows the human body. Teammates, get on board to pick up some great tips from her knowledge of both disciplines.


Unknown said...

Great writing! Now I hope her diet is tight and I am sure that she would see results.

One of my biggest pet peeves I see all the time is the otter junk on the covers of the woman magazines on diet and fitness. Let's face it, Getting into shape is alot harder then just keeping in shape.

My next pet peeve is how many woman think they are fat! I would love to meet the idiot who said it would be a great idea to have almost all sickly skinny woman think the are fat!

I just wish woman would accept themselves for what they are and know that there will always be somebody who loves them for themselves and not for what they might look like!



Unknown said...

Thanks, Max!

I agree totally -- women's magazines, not just fashion but the so-called fitness rags as well, lead to totally unrealistic expectations. Both in terms of what we should look like (airbrushed starving 17 year-olds, apparently), and how easy it is to look like that (just do 10 minutes of cardio and 20 crunches, three days a week!).

I am incredibly grateful to Jamal, my trainer, who somehow showed me (and I can't figure out how he got me to get past all the magazine images and really internalize it -- he's a philosopher as well as a trainer) that muscles in women -- that shape and definition -- are beautiful.

I have a friend who believes that the maximum ideal body weight for a woman is less than 110 pounds, and he will only date frail, breakable women. Whatever. His problem!

Thanks for your input. I hope every woman has a man like you (or Jamal) in her life to keep her focused and to remind her that, no matter what, she is beautiful.

Karin Anderson, MD

Joe G. said...

Excellent article. Truer words have never been written on this site, and I've heard plenty of BS from healthcare "professionals" throughout my career.

Karin Anderson, MD said...

Hello, B.J. -

I think you can send a friend request through this site, and send a private message that way.

I do need to say upfront, though, and this is to everyone, I can not legally or ethically give any medical advice or answer any specific or personal medical questions. To do so requires a detailed history, physical exam, and documentation, none of which can be done to my satisfaction over the internet. So, unfortunately, my answer to specific or personal medical questions will always be something along the lines of "see your personal physician." The most I may be able to help with is figuring out what types of questions or concerns you should discuss with your doctor.

I am happy to answer any general questions that have to do with nutrition/metabolism or exercise physiology.

Karin Anderson, MD

Karin Anderson, MD said...

Joe G. -- Thanks for the feedback: it really made me feel great. I, too, have heard a lot of nonsense from doctors (?) who misuse their title to mine the system for cash. I can assure you that I'm a real person, I work real night shifts in a real ER seeing real patients for real problems. I also live this lifestyle, and I'm doing this blogging thing (which I'm very new at) solely because I'm interested in learning and helping others learn about these topics.

Karin Anderson, MD

Alden Mills said...

BJ -- Dr. Karin is a member of our Perfect Fitness community site -- if you join up there, you can send her a private message.


Angel Junior, Orion and Sammy said...

So if a person is at an ideal weight, and they are doing lots of cardio, what will that do to muscle?

Anonymous said...

Doctor, are there any ways to help metabolize protein better in order for it to not get stored as fat?
Thanks, B.J.

Karin Anderson, MD said...

Junior and Orion --

Good question. The answer (and you knew this was coming) is IT DEPENDS. In terms of weight and fat, it depends entirely on your calorie intake. If they are balanced, then that is maintaining your ideal weight. Cardio does develop muscle, and which muscle it develops depends on the cardio you do. If you look at distance runners, they are all lean but for the most part do not have particularly large muscles. This has a lot to do with recruitment of different muscle types during different types of exercise. Cardio, such as distance running, tends to recruit more type I (slow-twitch) muscle, whereas resistance training tends to recruit more type II (fast-twitch) muscle.

Karin Anderson, MD

Karin Anderson, MD said...

B.J. -- No.

Anything that you consume that you do not burn is stored as fat. This is basic physics: matter (and energy) cannot be created or destroyed, only changed from one form to another. You don't get to eat 10,000 calories, followed by some Acai berries, and have those calories vanish into thin air. Don't buy into that stuff.

There is no magic when it comes to this. No secret trick that renders the laws of physics invalid. It all boils down to using energy to perform work. I wish there were an easier answer.

Karin Anderson, MD

Anonymous said...

Thanks, Dr. Can I ask some more questions? If so, here they are: What exercises could you do in addition to leg lifts (besides situps and crunches-I need a mat) to get muscle in the upper abs? Would doing the "crunch" motion standing up work? Also, if you do leg lifts instead of certain types of crunches, can you get all of the same muscle as you would doing crunches? It's a stupid question but I'm switching from crunches to leg lifts and don't have the same results as crunches but I was doing hundreds of crunches and can hardly do nearly as many leg lifts, yet!
Thank you, B.J.
P.S.-I'll be back with more questions

Grass Oil said...

hi karin - great stuff. i've been a "no such thing as spot reduction" disciple for years. my "problem" is that i do lots of cardio and i have the options (treadmill, rower and elliptical), a lot of know-how (been reading about this stuff for years) which i think creates a lot of confusion!

i also have a hard time buying into the whole resistance training thing when i bust my fanny on my rower for 5 miles at high intensity interval training (about 45 mins/session).

my (warped?) thinking is that if i don't sweat a ton, then it's not "work."

help! are there others out there who have a hard time accepting/doing all three (cardio, ST and flex)? sometimes i feel like i'm wasting my time... and the thing is: i KNOW better... i know it's important to do all three... talk me into it! gimme a "prescription" to do the work (and oddly, if it comes from a doctor... i will)!

or is HIIT on the rower the perfect (or purdy durn close to perfect) combo? i'm secretly hoping you'll tell me to round out my routine to avoid boredom, muscle overuse injuries and plateaus... btw, i love yoga.

thanks so much!

Karin Anderson, MD said...

Hi, Molly!

Thanks for your comments. It took me a long time to get on board with the resistance stuff too, so you're not alone. Like you, I figured I was only going to spend so much time in a day working out, and I wanted spend that time exerting myself as much as possible. Resistance training seemed, well, sort of useless. And like a "guy thing."

Then I started doing it. And it has really made a huge difference. I have shape. It makes me a better runner. My resting metabolic rate is higher. I know; none of that would've convinced me, either. So try this one: I saw one of my (male) coworkers a few days after a wedding we both went to. He told me that, at the wedding, his wife pointed at me, and told him "I want my arms to look like THAT."

You don't need to do all that much resistance training. I only do 3 hours a week, with a trainer, then cardio (on my own). If you can, I really recommend doing your resistance stuff with a trainer, a mentor, or a friend who knows what he or she is doing. This is the one area where technique really makes a huge difference. Start with 2 or 3 days a week, and don't sacrifice your sweat-work (try to dig up three extra hours somewhere). Once you start to see results, you won't stop.

As far as the cardio goes, I believe that efficiency is the enemy of fitness. The minute your cardio becomes comfortable or easy for you, it's not doing you any good. But as long as you're, well, fairly miserable doing it, then you're okay.

Karin Anderson, MD

Joe G. said...

Karin, thanks again for this thread. It's so refreshing to see a physician walking the walk.

Anonymous said...

What happens in terms of fat loss when a person does long, nonstop cardio intervals (for instance, 30 minutes or an hour) and when they do 5 minutes of cardio throughout the day but the total adds up to either of those times? Which type is more effective for fat loss?
Also, in your opinion, what would be some downsides to using an ab belt exercising device?

Karin Anderson, MD said...

Hi, there!

I'm going to address two different questions in one post.

1) B.J. - These are great questions, but I am by no means the best person to answer them. I am not a trainer, and I think you would get the best answers from somebody who is. The good news is, there are plenty of them -- plenty of people who REALLY know what they're talking about in this area -- on this site. For the specifics of how to do an activity to achieve a specific result, I just do what my trainer, Jamal, tells me to. So that's my advice to you -- do what someone who knows what he/she is talking about tells you to.

2) Ashley -- great question. I had to look this up, because it's very complicated. The answer is that the jury is still out on this. Technically, there should be no difference: energy in, energy out, and if you burn 300 calories at once or 50 calories 6 times, it's the same. So that's my answer as far as fat loss is concerned. That said, there are some benefits to doing it all at once. It takes a little while for your heart rate to get up to where it should be. So doing it all at once gives you a little more time at your target heart rate range. I'm not sure how much of a difference it makes. Certainly, if your schedule only permits 5-minute bursts of activity, then do that.

There is a lot of research going into when you start burning fat vs. glycogen, at what intensity do you burn what, etc. This stuff is often misinterpreted by the media. Keep in mind, the body is always doing things metabolically. It is always in a state of flux and reequilibration. If glycogen stores get low, fat is metabolized and turned into glycogen to maintain homeostasis -- where things should be. The fat-vs-glycogen thing is important for endurance athletes. When you're running a marathon, for example, you want to be burning fat for most of the run, leaving your glycogen stores intact for when you need a burst of energy to, say, get up a hill. For the average person, though, who is exercising for fitness and not running 26.2 miles, these differences are less important, because the body always reequilibrates (I wish everything else in life did that).

As for the question about the weight belt -- see my reply to B.J. about that: there are much more qualified people than I to answer that.

Karin Anderson, MD

Karin Anderson, MD said...

Ashley --

An addendum to your question. Check out this article in the New York Times. It doesn't really address fat loss, it covers endurance more, but maybe you'll find it interesting:

Karin Anderson, MD