Where does weight go?

Cape Breton Post - - Obituaries/Advice/Games - Keith Roach Email ques­tions to ToYourGoodHealth@ med.cor­nell.edu (c) 2017 North Amer­ica Syn­di­cate Inc.

DEAR DR. ROACH: When you lose weight through diet and ex­er­cise, where does the weight go? -- L.A.J.

AN­SWER: Weight gain and weight loss in the very short term can be re­lated to body fluid, but I think you are re­ally talk­ing about peo­ple who have made a long-term loss of, say, 10 pounds. Those 10 pounds can be fat or mus­cle. In peo­ple who are eat­ing very few calo­ries and not ex­er­cis­ing, it will be a com­bi­na­tion of both of th­ese body com­po­nents. Un­for­tu­nately, los­ing mus­cle is un­healthy, which is why it’s best to ex­er­cise in com­bi­na­tion with chang­ing the diet, so that the weight loss is all fat. I’ve had pa­tients who have lost fat and gained mus­cle, who can be frus­trated that their weight isn’t go­ing down, but in re­al­ity they are much, much health­ier.

From a physics stand­point, a pound of fat rep­re­sents about 3,500 calo­ries. Eat­ing 3,500 more calo­ries than you ex­pend means a pound of fat gain, while the re­verse means a pound of weight loss. In weight loss, the fat is used to pro­vide en­ergy for the body’s meta­bolic pro­cesses and is (al­most lit­er­ally) burned away into car­bon diox­ide.

How­ever, the physics doesn’t prop­erly ad­dress the com­plex­ity of weight gain and loss in hu­mans. Sim­ply eat­ing less and ex­er­cis­ing more doesn’t lead to the ex­pected weight loss, as the body has ways of adapt­ing to lower food intake. Also, as peo­ple lose weight, their en­ergy needs de­crease fur­ther, and the “3,500 calo­ries per pound” rule be­comes a very poor ap­prox­i­ma­tion. In some peo­ple, the body uses ev­ery trick it can, in­clud­ing over­pow­er­ing hunger, to stay at the same weight. For th­ese rea­sons, I don’t find sim­ply telling peo­ple to eat less and move more to al­ways be an ef­fec­tive ther­apy.

DEAR DR. ROACH: I have prostate can­cer. He has given me two op­tions: One is to have ra­dioac­tive seeds im­planted, and the other is to freeze the can­cer. Which of th­ese has the lower chance of erec­tile dif­fi­culty? -- H.K.E.

AN­SWER: Ra­di­a­tion seed im­plants (called brachyther­apy) and freez­ing (cryother­apy) are con­sid­ered rea­son­able op­tions for some men with lo­cal­ized prostate can­cer. There prob­a­bly are dif­fer­ences in ef­fec­tive­ness and in other side ef­fects, which may make you con­sider how th­ese treat­ments af­fect you and the can­cer.

How­ever, in terms of sex­ual, my un­der­stand­ing of the lit­er­a­ture sug­gests that brachyther­apy has less risk of poor func­tion.

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