Doc’s Talk 05-20-2012

Dr. Scaff talked about weight.

The United States is the most obese nation in the world, …but we are rapidly being overtaken by Mexico, and believe it or not, India.  As we get more money we become more leisurely.  A potbelly is the sign of wealth.  Poor people work in the fields; they are the ones with the flat stomachs.

The bottom line is, we can always eat more than we can exercise.

It is very hard to lose weight
There are nearly 3,500 – 4,000 calories in a pound of fat, that’s enough for 15 or 20 miles of running.

A pat of butter is 90 calories.  If you take 1 extra pat a day, by the end of the year you’ve gained 8 pounds.  And you will notice weight gain doesn’t occur overnight.  Most of us gain 2 – 4 pounds over a period of years, that is because the caloric balance is so fine.

We all know that we should probably be losing weight, but you must remember:  When you lose weight, for every 3 pounds you lose, 2 pounds will be fat, and the other will be bone, blood, and muscle, and that cannot be stopped even when you are exercising.  So losing weight is injurious.

For anyone doing the Honolulu Marathon who is planning to lose weight, you are going to do it now, and then in mid-September or October 1 at the latest, weight loss ceases.  You wake up that morning, look in the mirror and say, “This is my body for 2012.”  You do not get in shape at the last minute, and as a matter of fact, the Honolulu Marathon Clinic will encourage you to gain a couple pounds.

Where weight is makes the difference
The women you see in Africa or Asia who carry the big pots on their heads experience no caloric expenditure at all.  All the weight goes directly through the spinal column and down to the feet.  In fact, when these women are walking you cannot even tell they are carrying weight, and some of these things they carry are 50 to 75 pounds!

We determine caloric expenditure by oxygen uptake.  If you are doing more work you are burning more oxygen.

As weight moves towards the feet, it gets more expensive calorically.

The military, in order to figure out how much recruits can carry in their backpacks, did a very good study: They took soldiers, put them on a treadmill, hooked them up to an oxygen breathing device so they could measure oxygen consumption, and a sergeant stood above them and would drop a brick in the knapsack the soldier had on their back.

Turns out that on your waist or on your back you can carry about 35% of your ideal body weight without changing the workload.  That’s walking.  Running is different.  Running is 3rd dimension, you are going up and down.  So running is always 25% more expensive calorically, or workwise, than walking on the flat.  That explains how a man or woman who walks 1 mile in 15 minutes (4 miles an hour) starts moving up and down (e.g. running) burns 25% more calories (100 calories while walking, roughly 125 calories while exercising).

We cannot always affect how weight is deposited, but weight that is below the hips, on the legs, costs us metabolically 4 times as much as weight above the waist.

Try strapping 2-pound weight belts to both your ankles.  That is only 4 pounds.  See how many times you can make it around the park.  Maybe once.  Put that same weight around your waist and you will hardly know it is there.

So those of us who have thick legs or carry our weight lower and will have a little bit of a handicap.  You will notice the world class runners from Kenya have legs that look like beanpoles.  It also explains how a little 70-year-old potbellied runner with skinny legs goes by you lickity-split in the marathon, because the weight is not costing him that much, it is up above the waist and on his hips.

The key things to remember about weight:
1)  Weight loss causes injuries but it needs to be done.
2)  The way weight is distributed on your body makes a very big difference.
3)  You can always eat more than you can exercise.  (That was survival.  Man would not have gotten out of the Stone Age without being able to do that.)

Shoes and Weight
One thing that IS callorically very expensive is your shoes
.  That is why the lighter shoes seem to be more popular.  People say that they cause injuries, but they don’t if you run properly.  Perhaps that is why the Vibrum Fivefinger shoes are beginning to take off.  They weigh about half what a training shoe does.  Dr. Scaff is not saying that you should go out and get the lightest shoe in the world, just be aware that putting weight on the foot takes a lot more energy than putting weight somewhere else.

Weight and Finish Time
For every pound you lose between now and the marathon, you will finish the marathon 1 minute faster.  That is, if you say you are a 4:10 marathoner, and you wanted to do a 3:50 and you are a little overweight, lose 20 pounds, and with no extra training you will do it.  So, a pound per minute in the marathon.  That is an awfully easy way to improve your time.  Actually it is not so easy, it’s quite hard to quit eating, …but it works.
For more information there are many pages on weight, weight loss, and weight gain in Your First Marathon – The Last Word In Long Distance Running, by Jack H. Scaff Jr., M.D., F.A.C.S.M., available for purchase at the Honolulu Marathon Clinic on Sundays and online at:

For some good reading on nutrition, Dr. Scaff recommends everyone check out the daily postings on Dr. Alan Titchenal’s “Got Nutrients?” web site:

Here is a recent posting:

May 19, 2012
Weight loss may enhance the health and longevity of those with obesity-related health problems. However, weight loss in healthy obese individuals is actually associated with increased mortality. Identifying who needs to lose weight should take this into account.

Consumer Link
The Downside of Weight Loss?

Research Link
Can Fam Physician. 2012 May;58(5):517-23.