Weight Loss Metabolism: Caloric Deficit, and Overcoming the Obesity Set Point

In this must-listen episode of Your Checkup, we dive into three essential facts that can transform your approach to weight loss. Discover which diets have proven success, learn the truth about processed versus unprocessed foods, and find out why the timing of your meals might be just as important as what’s on your plate. Plus, we’ll reveal some surprising numbers about how your metabolism works to keep you at the same weight, and what you can do to counteract it.  If you’re serious about achieving your weight loss goals, this episode is packed with the insights you need to make informed, lasting changes. Plus, if you are a long time listener of the show, we have two updates you wont want to miss 

Takeaways

Consistency is key in any diet plan.
A caloric deficit is essential for weight loss.
Tracking food intake can help identify caloric needs.
Weight maintenance requires significant energy and effort.
Processed foods can lead to weight gain even at equal caloric intake.
Meal timing may influence weight management success.
Eating larger meals earlier in the day can be beneficial.
Understanding the body's metabolic responses to weight loss is crucial.
Personal experiences can provide relatable insights into health topics.
Education on nutrition can empower better health choices.

Keywords

weight loss, nutrition, caloric deficit, processed foods, meal timing, obesity medicine, health podcast, patient education, dog surgery, veterinary care

Transcript

Ed Delesky, MD (00:00)
Hi, welcome back to your checkup. We are the Patient Education Podcast, bringing conversations from the doctor's office to your ears. On this podcast, we try to bring medicine closer to its patients. I'm Ed Delesky family medicine resident in the Philadelphia area.

Nicole Aruffo, RN (00:14)
and I'm Nicole Aruffo. I'm a nurse.

Ed Delesky, MD (00:16)
And

we are so excited that you can join us again today. We certainly do have some updates for everyone. Yeah. Our intern's fine.

Nicole Aruffo, RN (00:24)
Yeah, we do.

Our intern's fine. He just had surgery this weekend.

Ed Delesky, MD (00:32)
He did, turns out that he tore his dog equivalent of his ACL. It was actually really sad.

Nicole Aruffo, RN (00:41)
Yeah, Eddie cried like every day for a week leading up to the surgery.

Ed Delesky, MD (00:45)
Well,

we could probably, hmm, do I tell them that you do this all the time? Where you flip things around and make it seem like it's something I did. Well, we were both really upset. We were scared, but we're really grateful. It was a whole surgery and.

Nicole Aruffo, RN (01:04)
He has a plate in his little nose.

Ed Delesky, MD (01:06)
He does.

He got taken care of like terrifically during this whole process though.

Nicole Aruffo, RN (01:14)
Yeah, they were really great. And honestly, like, out to me.

Ed Delesky, MD (01:20)
Well, yeah, to you. mean, you've given you've given our intern literally every possible thing he could possibly need to succeed. And you got him in to see the people he needed to see as quickly as possible. I just want to take a second and recognize that. But you were going to say.

Nicole Aruffo, RN (01:39)
What was I gonna say? we're two days after surgery. He got surgery Friday today Sunday and we I Mean, we're not like allowed to walk him. We can only take him outside to go to the bathroom But I feel like he's walking better today than he was even before surgery

Ed Delesky, MD (01:56)
Yeah, it's awesome. And he peed and pooped, which was kind of driving us nuts for 24 hours.

Nicole Aruffo, RN (02:03)
or more? Questionably more.

Ed Delesky, MD (02:06)
Questionably more, but he did great.

Nicole Aruffo, RN (02:08)
We did not have to spend our Sunday at the vet emergency.

Ed Delesky, MD (02:12)
Yeah, very happy about that, to not having to do that. But it was a big surgery and we're so lucky that we were able to find people to take care of him. The initial evaluation was really great. I mean, you took him for the consultation and then shortly after he went for the surgery and they did awesome. mean, they were so thoughtful. He was a star.

Nicole Aruffo, RN (02:34)
Yeah, they all love him there.

Ed Delesky, MD (02:36)
Until the end where it seemed like he was getting a little grumpy, but, you know.

Nicole Aruffo, RN (02:40)
He was. Well, he thought his dad would be out of work earlier.

Ed Delesky, MD (02:43)
If

you could hear he still made an appearance now he's got this bigger crate

Nicole Aruffo, RN (02:47)
Yeah, we have a whole like first floor set up for him. So he has a brand new crate. It's like his apartment downstairs. I have a brand new memory foam bed. There's his blanket over top. It's like his little den.

Ed Delesky, MD (03:01)
He's got an airplane travel pillow to prevent him from gnawing at the incision.

Nicole Aruffo, RN (03:07)
except I came down last night I guess like early this morning at like 4 a.m. and his cone was off

Don't tell a

Ed Delesky, MD (03:16)
it. Right. So now he's going to go back to the cone of cone of shame nightly. But I guess the hot take this week is that the T.P.L.O. might be a good surgery.

Nicole Aruffo, RN (03:27)
That's good surgery. Well, and now we like, I've never heard of this or like thought I didn't know anyone whose dog has ever had this surgery. And then like our neighbors had it. Two of my coworkers dogs have had it. seems like more common than like the surgeon that we took him to said it's the most common surgery she does. So.

Ed Delesky, MD (03:47)
I felt a lot better about that once we were walking him around. So he also has a stroller now.

Nicole Aruffo, RN (03:52)
yeah, we got him the stroller pre-surgery for about a week and a half, two weeks. He loves that. I can't wait to put him back in.

Ed Delesky, MD (04:00)
He's parading around Center City. He's not like aggressive towards other dogs anymore.

Nicole Aruffo, RN (04:04)
because he's better than everyone.

Ed Delesky, MD (04:06)
And

he's just riding around going to Washington Square Park and then he's just parading around there.

Nicole Aruffo, RN (04:12)
Stroller

honestly like you would think we had like a newborn in this house Do we have a newborn or did our dog just have surgery?

Ed Delesky, MD (04:20)
But

he's got lots of meds too and he's sleepy. He does.

Nicole Aruffo, RN (04:24)
He loves the trazodone.

Ed Delesky, MD (04:27)
human-grade medication. It's awesome. All right, so we're going to

Nicole Aruffo, RN (04:34)
wait

no, we have another announcement. What's that? That's probably bigger than Ollie. I'm just kidding, nothing's better than Ollie. But we got me a boom arm.

Ed Delesky, MD (04:45)
yeah. I don't know if we're going to save it till the end, we finally got Nikki a boom arm. No thanks to any of from donations. It's all private equity. But we finally got her a boom arm, so now her neck will stop having issues at night when she wakes up craning from recording all day every day. So that's awesome. got the boom arm. So two big updates for you.

Nicole Aruffo, RN (04:48)
I'll be here on Wednesday.

Yeah, no, thanks to you guys. But again, it's all for free.

Ed Delesky, MD (05:11)
And as life has it, you know, it was a big week last week with taking care of Ali and, know, I've gone back into the hospital for longer shifts. So it was a little tricky to come up with an episode this week, but we definitely didn't want to leave any loyal listeners hanging on Monday.

Nicole Aruffo, RN (05:27)
Getting a little ditty today.

Ed Delesky, MD (05:28)
So we're getting a little ditty today. It's still in the theme of the weight loss and nutrition and eating plans. But in thinking about our other episodes, there were just a couple things that we wanted to add. And I've also been doing some extra learning.

Nicole Aruffo, RN (05:43)
yeah, Eddie's getting, what is it?

Ed Delesky, MD (05:45)
I'm turning on a board certification in obesity medicine.

Nicole Aruffo, RN (05:50)
Yeah, so he's been studying, watching all these lectures. They actually seem pretty interesting, like what you told me.

Ed Delesky, MD (05:56)
They are. They really are.

Yeah. I'll like text Nikki as soon as I'm done with it. And I'm like, my God, I had no idea. Turns out a lot of this stuff is in the brain. And maybe as the years come and I learn more about it, then we'll be able to share more. But some of these tidbits are from these early lectures. And things that we wanted to highlight that we've discussed already, but maybe didn't feel like we put to the forefront. So what's the first point that we want to discuss today, Nikki?

Nicole Aruffo, RN (06:23)
So in our previous episode, I think it was the last one or the one before that, we talked about different diets or eating plans, ways of eating. And the most important thing to highlight during any kind of way of eating is that it doesn't matter what diet it is. It doesn't matter if it's low carb, higher carb, whatever kind of diet is out there. It just matters that you are consistent and sticking with it and ultimately at a caloric deficit.

Ed Delesky, MD (06:52)
Yep. And there's a lot of weight behind that.

Nicole Aruffo, RN (06:56)
Which that's also like a large umbrella statement, I feel like. There's a lot that goes into it.

Ed Delesky, MD (07:02)
There's a lot of research, a lot of dieticians will come out and say this and I just co-sign that what you said there. Kind of transitioning into the next point that we wanted to highlight is that that caloric deficit. So we talked about one strategy of coming up with about 500 calories of a deficit in the course of a day and doing that for seven days to come up with a caloric pound, which we said 500 times seven.

would be 3,500 calories, which is the caloric pound.

Nicole Aruffo, RN (07:37)
And if you're kind of having, I guess, trouble gauging where to start for that, because maybe you're like, OK, how do I know if I'm eating 500 less calories? Maybe start tracking what you're eating just like normally throughout the day without kind of giving much thought to it to kind of see where you are. And then from there, then you can work on taking away however many calories.

Ed Delesky, MD (08:02)
Absolutely. That's a great place to start. I think some people may change their behavior once they start to do that. And it works for some people. It doesn't. It kind of goes in the same vein as like weighing yourself every day, which I think for the right person can be a strategy. But for the wrong person, I think it's kind of detrimental. So we're talking about this calorie deficit and

That's all well and good, but something that was really interesting that I learned, which kind of pays homage to the obesity set point episode, or some people call this the weight equilibrium. Just a reminder is that your body wants you to stay the same weight. But this lecture was really cool because it gave numbers to how things work.

Nicole Aruffo, RN (08:50)
And what are those numbers? This was actually really cool. And kind of like infuriating at the same time.

Ed Delesky, MD (08:54)
Yeah.

So before we enter into this concept, I'd like you to think about the basal metabolic rate. Seeing that your body is burning calories from quite literally just sitting there. So think about that and also think about your body has a certain drive of how much food that it wants to survive. So what they did in this study was they used statistical models and they determined that for every kilogram of weight that you lose,

your basal metabolic rate slows down 25 calories. And then for every kilogram that you lose, you actually get about 95 calories hungrier, all in the body's effort to keep you at the same weight.

Nicole Aruffo, RN (09:45)
And for those of us not on the metric system, one kilogram is 2.2 pounds. So every 2.2 pounds that you lose, are, so for every 2.2 pounds that you lose, the amount of calories that you are burning at rest slows down.

Ed Delesky, MD (10:02)
And then every 2.2 that you lose, your body makes you 95 calories hungry.

Nicole Aruffo, RN (10:03)
just so.

because it's trying to like get back to where it was.

Ed Delesky, MD (10:15)
So what do you think about this?

Nicole Aruffo, RN (10:17)
Oh my god, it's so annoying. I'm like, two pounds is not a lot. So like, that's so annoying.

Ed Delesky, MD (10:25)
But I think it goes to like, it takes a look at why weight gain is so high. when, because there's weight loss and then there's weight maintenance and it's so, there's so much energy that goes into even maintaining a weight. So I think this is a great commentary on that. think hopefully it normalizes the whole process, right? I mean, like it's hard, but now there's like some numbers that are backing it up. I thought this was like a fascinating little tidbit of information to learn.

In our next episode, we're not done yet, but in our next episode, we're going to talk about what the medications might do to either one of those numbers there.

So I know earlier we said that there's no structure of a diet that will actually give benefit, like whether it's high carb, low carb, low fat, high fat, high protein, it's all so confusing and maybe each of them has their own individual components, but when compared against each other, those didn't result in any weight change. But there were studies that showed two things when they were compared against each other. One group gained weight and one group didn't.

What were those two groups?

Nicole Aruffo, RN (11:38)
The two groups were, one group was eating a diet that consisted processed foods and then the other group had a diet that had no processed foods. And this study showed, I don't know if there were like specific numbers in this study when you were reading this, but at the end of the day, the group that was eating the processed foods gained weight. And the group that did not gain weight.

Ed Delesky, MD (12:05)
Yeah, and they tried to make everything as equal as possible. Like they didn't.

Nicole Aruffo, RN (12:09)
Like equal calories, equal everything.

Ed Delesky, MD (12:12)
And then everyone ate to being satisfied. They all rated the same when they were asked about all these things. But the people who had the processed food just ate more and had more calories, which is like kind of like not rocket science, but it just really gets at the fact that if it comes in a bag or if it's wrapped up, maybe you think twice about it. This can get a little tricky though, because I think there are a lot of like processed foods that are labeled as healthy too.

Nicole Aruffo, RN (12:41)
Uh, yeah, it's all marketing.

Ed Delesky, MD (12:45)
It is a lot of marketing. But I thought that that was an interesting thing because they compared keto, they compared Atkins and they said all of these different diets and none of them mattered. But when it came to people who only ate unprocessed food or minimally processed food, really did well and especially in the weight loss category. So that was another thing. There was another set of

lectures that we talked about or that I was learning about that actually shows that maybe when you eat the majority of your food might matter.

Nicole Aruffo, RN (13:21)
yeah, this was also cool. And that was the one where if you ate the majority of your food, like in the morning or with breakfast, had like a bigger meal, medium sized meal for lunch and then smaller meal for dinner. Yeah.

Ed Delesky, MD (13:34)
And like one calorie breakdown of that that they offered was like 700 calories for breakfast, maybe 500 for lunch and 200 for dinner. And I feel like a lot of people probably think about like not eating after eight o'clock and like that's a common way to try to get yourself to eat less. But it was trying to link it up with your circadian rhythm and when you're most active throughout the day using your food as energy.

And I thought that was really interesting. mean, we looked at this and like even in our own diets and we tried to see what that would be like.

Nicole Aruffo, RN (14:06)
Yeah, because we definitely, I mean, I think we probably eat the most at dinner.

Ed Delesky, MD (14:12)
yeah. Right. And I was like chatting like.

Nicole Aruffo, RN (14:15)
guess depending on when, because today we both had huge bagel sandwiches for breakfast.

Ed Delesky, MD (14:22)
But during the week even, sometimes we'll have two eggs and a wrap.

Nicole Aruffo, RN (14:27)
sometimes

like yeah a slice of toast or a wrap or something.

Ed Delesky, MD (14:31)
Yeah, and that's it ends up probably being about half of that model But especially when you flip over to dinner thinking 200 calories at dinner dinner is like such a social and cultural experience Like you're sitting with your family maybe or like I don't know it just it's on our society that dinner is supposed to be more bigger grander and There were some studies and this lecture I was watching

studying for the obesity medicine boards that maybe that isn't all it's cracked up to be. Maybe it should be flipped. So I thought that was really interesting. So on this episode, we talked about different tidbits to think about as you continue to approach your weight. And we'll probably do another episode or two on this topic before we add back in some variety. We talked about processed and unprocessed foods. We talked about how your metabolism and in your body change when you lose weight.

and how that can relate to the obesity or metabolic set point that your body has. We talked about how it doesn't quite matter exactly what diet you choose, but as long as it's in a calorie deficit, that you're probably going to lose some weight. And we talked about how when eating most of your calories might impact losing weight, with most people having success from eating food earlier in the day and less in the evening.

So thanks for bearing with us on this little ditty of an episode. We're so happy that you were able to come back and join us again today. Please feel free to reach out. You can email us. Please find us on Instagram. Take a look at our website. Share us with a friend. But more importantly, hopefully today you learn something for yourself, a loved one or. And hopefully you're able to come back next time. Stay healthy, my friends. I'm Ed Delesky Thank you and goodbye.

Nicole Aruffo, RN (16:17)
neighbor.

Bye, gotta

make all the dinner.

Ed Delesky, MD (16:40)
This information may provide a brief overview of diagnosis, treatment, and medications. It's not exhaustive and is a tool to help you understand potential options about your health. It doesn't cover all details about conditions, treatments, or medications for a specific person. This is not medical advice or an attempt to substitute medical advice. You should contact a healthcare provider for personalized guidance based on your unique circumstances. We explicitly disclaim any liability relating to the information given or its use.

This content doesn't endorse any treatments or medications for a specific patient. Always talk to your healthcare provider for complete information tailored to you. In short, I'm not your doctor. And make sure you go get your own checkup with your own personal doctor.

Nicole Aruffo, RN (17:17)
I am not your nurse.