Hi there, I apologise if this is the wrong forum. I’m a coach that specialises mostly with fat loss clients. I’d be keen to hear your thoughts on long term success and outcomes for managing obesity with training for the following points:
My experience as a coach has been a mixed bag. Whilst many of my clients, friends and gym goers do make permanent changes, a good portion of them gain a lot of weight back and struggle, despite their best efforts with maintaining a healthy bodyweight. I understand that this is very common and a reason why GLP-1 drugs are so popular.
The regain seems to still occur despite a lot of activity, high adherence to resistance training and long periods of dieting. Some people have reported an overwhelming desire to overeat which they just cannot ignore indefinitely, and the prolonged willpower battle leads to a prolonged period of excess where they gain weight back. I sympathise a lot and wish I could do more. Am I to assume that obesity permanently impacts satiety and signalling? Can this be reversed?
Additionally what I’ve noticed is many formerly obese people I know really, really struggle to make the kind of physique or performance gains that non-obese counterparts do. Their weight loss leaves them with mild, but non-trivial pockets of sub-cutaneous fat concentrated around their torso, some will have surgery, but many can’t afford it and this prevents them from weight cycling. They seem to stall earlier for muscle gain as they cannot do a dedicated caloric surplus for sustained periods. This naturally impacts longer term strength acquisition and physique goals they may have.
Anecdotally, some end up on steroid and PED cycles to overcome this situation. Can anything be done short of surgery or pharmaceuticals to manage this impact of weight loss beyond chronic dieting?
Thanks for all you guys do,
Best wishes
Winston
I think adding some information about what causes obesity makes it easier to understand your observations, as well as help with management.
Obesity is principally caused by a mismatch between an individual’s genetics and their environment. In this case, it’s mostly the food environment that has been contributory (vs changing activity levels). Because neither of these things can be changed -at least in this lifetime- most people will not be able to achieve and sustain weight loss long term. Some individuals have more favorable genetics and do not experience this.
Anabolics, particularly testosterone and its derivatives, drive fat loss via the increased estrogen signaling, as well as a dose-response level of muscle gain at supratherapeutic levels.
Whether people should or shouldn’t gain weight for strength/physique goals is an individual decision as you know. I’ll reserve that conversation for another time.
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Thank you Jordan for your reply.
About that conversation, well now I’m curious! 
Perhaps we could have it?
I agree fully it’s a personal choice, but from your perspective as both a doctor and powerlifter, what are the trade offs? There is always a need for fat loss, but is there ever a need for weight gain, even if that individual a healthy size?
What are the trade offs (if any) for not gaining weight with regards to training?
Thanks
Winston
I’ll turn the question to you. For health purposes, and assuming someone doesn’t have low energy availability (LEA), disordered eating, and so on, what are the predicted health benefits for gaining weight in order to improve strength performance?
Oh, that’s interesting.
Well the obvious one is strength is directly correlated to lower all-cause mortality. Older people do better when they strength train, and younger people tend to have less health problems that can cause problems later on by strength training.
To what end? I don’t know.
Unless somebody is pretty underweight like <18 BMI (I know, it’s a poor measure, but most people are going to be underweight at this size) then I really don’t think there is any blocker to gaining what I would imagine is a pretty modest amount of strength (for the aforementioned health benefits)
So unless somebody wants to be like powerlifting or strongman strong… Or they want to gain significantly more muscle than is needed to maximise health benefits, then I don’t suppose it’s necessary outside of being underweight (<18 BMI and maybe trouble with performing basic movements at bodyweight or the tiniest amount of added resistance?)
That’s possibly how I’d frame it, there is also some consideration that needs to be given to the fact that even without weight gain, people will gain muscle and lose fat over time, provided they are training.
Winston
While I agree that stronger people (to a point) have lower mortality and increased physiological reserve, I do not think weight gain is needed for most individuals to achieve the max benefit from strength with respect to health. I think most signals in the data hinting towards this relationship are focused more on muscle mass, which does correlate well with strength, though the causal link between muscle mass and strength performance is tightest (over time) when people are far past this threshold.
I agree with the rest of the post generally speaking. With that in mind, I don’t think gaining weight really benefits health for most people.