Seeking diet advice for overweight brother

[JemmyButton]

Jordan,

Thanks for the work you do on this forum, it's easily the best addition to the SS website in recent times.

I'm trying to help out my brother, who is at his wits end on trying to return to health and lose weight. He is 39 years old, 6'4, 270 pounds, and recently diagnosed pre-diabetic (type 2). I don't know his body fat level but if I had to guess I'd say somewhere between 30-40%.

Basically he's had a terrible diet for a long time and is now trying to get his shit together to avoid type 2 diabetes, which is rife in the family. I've encouraged/lectured/ranted at him to move towards a paleo type diet, and whilst he's no where near being 100% paleo he has removed a lot of processed foods from his diet, and reduced carbs, but the scale isn't shifting. And the crazy thing is that I don't think he's actually eating a lot (perhaps his metabolism is shot).

I introduced him to SS and he goes to the gym twice a week and performs the movements, but without a focus on progression. Ie, his squat is around 100 pounds, bench 150, press 125, deadlift 135. He's not in a hurry to move the weights up - and I'm at a loss as to what programming he should adopt given his focus is weight loss and health, and he has been sedentary for so long. Aside from a couple lifting sessions he does some low intensity walking and swimming twice a week.

What would you advise in this situation - any general advice / specific starting macros would be appreciated.

I assume you'd have him start some HIIT? I reckon he would be willing to do some HIIT on the rower and/or swing kettlebells. What would be a good starting point?

Any help much appreciated. Cheers.

[Jordan Feigenbaum]

Thanks for your kind words. PS Jimmy Button is a childhood hero of mine back when I was racing motocross every weekend. Dude ended up breaking his neck and being diagnosed a quadriplegic but walked 2 years later. Sorry for the diversion, your handle reminded me of that...

Anyway, your brother's situation warrants some heart to heart (or maybe a come to Jesus) talk about what he really wants out of life. I can't tell you how many times I've counseled friends/family/ex clients on what they should be doing diet-wise in order to reach their goals and then, at some point, I hear the complaint I'm not losing weight and I'm doing what you said! At first, this really upset me and I thought man, I need to tweak their intake or give them better instructions. So, I'd dig and dig, scouring research and innovative tricks to get people to comply. Sent annotated emails rife with cited literature and personal guidelines and still, nothing happened. Then I realized something, 9/10 times they just weren't doing what I wanted them to do at even an B level. One lady told me she was "pure paleo" but ended up putting down 2-3 jars of almond butter in a week + gluten free treats. A guy tried to reason with me that he thought the chicken wings served at the bar was the best option because, after all, they ARE chicken.

At any rate, I finally figured out that 9/10 of the people who don't get results from changing their dietary habits simply aren't following the protocol. This may be reflective of a protocol that's inappropriate for their current level of commitment or lifestyle or it may just be a knowledge gap for how the darn thing actually should be followed. I will admit, however, about 1/10 of these cases presents with someone who is rigidly following a good plan but has buggered there metabolism so much by starvation, too many competitions without an off season, etc. and these folks require some serious leg work on their coach's end to get them back to where they need to be.

In my opinion, it is highly likely that your brother's version of Paleo is not appropriate for what he needs right now. If it were me setting it up for him, it would be chock full of lean protein sources, fiber-rich vegetables, 1-2 servings of fruit per day, and a limited amount of added fats in the way of cooking oil, salad dressings, etc. I don't believe that having a super big cheat meal 1x a week would do anything positive for him, but perhaps you could get some better initial buy in with him if you advised him on my previous recommendations with the incentive of the following:

1x per week you get to go wild with a few stipulations: 1) This meal has to be eaten away from the home, i.e. go out to eat. 2) You cannot eat this meal solo, but rather you have to be with friends, family, etc. 3) You have 1 hour to eat, from 1st to last bite. and 4) You can't take home any leftovers.

You're also correct on the HIIT recommendation. I'd stick to the rower for him at a 2-3x /week frequency at this point since he's clearly not interested in strength training and the guy needs to do something hard to help his metabolism and drive an adaptation. I'd stick to the rower as well because it'll be a better modality for him to really push the intensity hard versus having to learn a higher skill motor pattern like KB swings or similar.

Finally, I believe preparation is the name of the game in this situation. Making double servings of lean proteins each time he cooks, i.e. if he's eating chicken make two or if he's making eggs, make double for later. A whey protein supplement might be a good option too so he's never "stranded" without good choices. Finally, he'd likely get some benefit out of r-ALA and chromium picolonate supplementation. Hope this helped.

[danradin]

Jordan's advice is pretty spot-on. As somebody who's been nearly a foot shorter at 15 pounds heavier, here are my recommendations:

1. The best thing your brother can do for his weight, healthy, and longevity is learning to cook foods that fit his dietary goals, that he enjoys eating.
2. Keep it simple. Eat meals on a schedule, don't miss meals, and don't snack. Most meals should be basically a large amount of a protein and some vegetables. He's a large, grown man and needs more calories than he probably thinks. But again, keep it simple and focus on quality: real food that comes from an animal or the ground, and not a factory or lab. Don't eat because you're bored. Don't eat because you're annoyed. Don't eat because you're depressed.
3. This has to be a change for the rest of his life. Not until he reaches his "goal weight" or fits into his old jeans size. All the weight is statistically almost guaranteed to come back, and more, if he goes back to "eating normally".
4. I agree with Jordan's diet setup and also agree that cheating isn't necessary, but certainly understand the food-as-comfort issues many of us have.

Wishing him the best of luck,
Dan

[afatgoat]

It might be an adjustment, but tell him to hit a vegetarian site like post punk kitchen (theppk.com) for a month or two. They're relatively balanced nutritionally, well thought out meals that taste great. You might need to put a bit more effort into them, but none of them are rockets. Substitute quinoa for rice where you see fit. In my experience, I havn't come across too many fat vegetarians.
I'm not a fan of structured ready made diets but if he's desperate and half assed disciplined throw him on that p90x diet. It's pretty much soup, salad and fish, focusing on portion control, carbloading in the morning and minimizing them at night.
Someone will heckle the shit out of me for this, but look at jenny craig, i've seen a couple 300+ sedintary oil patch lifestyle guys lose a fair amount of weight. Some people need that discipline accountability and black and white terms.
I definitely agree with Dan about learning to cook the meals he loves from scratch, right from the sauce. Quit using items out of a can. It takes 5 minutes longer and end up cutting out so much excess sugar and salt from your diet.
Is he interested in playing racquetball or squash? beer league slowpitch (lay off the beer)? Hell, even bowling is better then sitting at home scratching your sac. Take the dog out more. Volunteer at the spca if he doesn't have one. Volunteer to coach at your kids game or for a youth organization. Nothing will turn him into a 200lb brick shitting weight smashing monster, but it will allow him to relearn some active habits, and he'll improve the lives of those around him as well as his own.

[JemmyButton]

Thanks gents.

Jordan, you've hit the nail on the head with the "leading a horse to water" aspect. I have however had a chat with him and agreed step number one is getting a baseline of what he is actually consuming over a week so we can see where he's going wrong.

A couple quick questions: 1) what is r-ALA ? and 2) What do you consider to be non lean protein sources? e.g, is lamb a non lean protein source? Salmon? Just trying to understand if you mean he has to stick to chicken breast and white fish only.

Thanks again.

[Jordan Feigenbaum]

It might be an adjustment, but tell him to hit a vegetarian site like post punk kitchen (theppk.com) for a month or two. They're relatively balanced nutritionally, well thought out meals that taste great. You might need to put a bit more effort into them, but none of them are rockets. Substitute quinoa for rice where you see fit. In my experience, I havn't come across too many fat vegetarians.
I'm not a fan of structured ready made diets but if he's desperate and half assed disciplined throw him on that p90x diet. It's pretty much soup, salad and fish, focusing on portion control, carbloading in the morning and minimizing them at night.
Someone will heckle the shit out of me for this, but look at jenny craig, i've seen a couple 300+ sedintary oil patch lifestyle guys lose a fair amount of weight. Some people need that discipline accountability and black and white terms.
I definitely agree with Dan about learning to cook the meals he loves from scratch, right from the sauce. Quit using items out of a can. It takes 5 minutes longer and end up cutting out so much excess sugar and salt from your diet.
Is he interested in playing racquetball or squash? beer league slowpitch (lay off the beer)? Hell, even bowling is better then sitting at home scratching your sac. Take the dog out more. Volunteer at the spca if he doesn't have one. Volunteer to coach at your kids game or for a youth organization. Nothing will turn him into a 200lb brick shitting weight smashing monster, but it will allow him to relearn some active habits, and he'll improve the lives of those around him as well as his own.

I literally can't stop chuckling at this post, which is the only reason I approved it.

Thanks gents.

Jordan, you've hit the nail on the head with the "leading a horse to water" aspect. I have however had a chat with him and agreed step number one is getting a baseline of what he is actually consuming over a week so we can see where he's going wrong.

A couple quick questions: 1) what is r-ALA ? and 2) What do you consider to be non lean protein sources? e.g, is lamb a non lean protein source? Salmon? Just trying to understand if you mean he has to stick to chicken breast and white fish only.

Thanks again.

r-ALA is alpha lipoic acid, in R Form. Seems to help with insulin sensitivity/glucose disposal and chromium picolinate does some of the same things in diabetics/prediabetics.

Per the lean meat- I consider anything with single digit levels of fat/serving lean meat, i.e. chicken, turkey, 96/4-93/7 beef, eggs/egg whites, center cut bacon, beef bacon, various fishes, protein powder, fat free/low fat greek yogurt, etc.

[strideknight]

Just want to throw my 0.02 in as someone who who started at 395 and is down to 320 now... A great way to track the food you've eaten is using www.myfitnesspal.com, and they also have a wicked helpful mobile app.

2. Keep it simple. Eat meals on a schedule, don't miss meals, and don't snack.

Keep in mind, this worked for Dan, but this style of rigidness destroyed my motivation. It was far too much structure and work. I know Jordan isn't a huge fan of it for the reasons everyone touts, but Intermittent Fasting has helped me, more with compliance than anything else. You eat everything for the day in an 8-10hour window, so it automatically cuts out snacking at other times of the day and when you are eating, you're focused on what you've logged. And it makes for some fun meals (~1500-2000 calories in a sitting).

[Jordan Feigenbaum]

I agree that it helps with compliance for sure and that's the name of the game in this arena. On the other hand, it doesn't fix the main problem nor is it optimal for anything UNLESS it's the only way you can comply. If anyone prefers it, I support them in their endeavor 100% although I'd rarely ever recommend it.

[afatgoat]

I literally can't stop chuckling at this post, which is the only reason I approved it.

I want to clarify that post. I was trying to impart that he needs some lifestyle changes as much as cleaning up his diet. Challenge him to eat alternatively and give him a means to do so. Eating vegetarian isn't going to magically solve his weight issues. It will make him have to re-evaluate what he's putting into his face. On a personal level, I think cookie cutter corporate diets are bullshit. Some people identify with them. Depending where his commitment levels, health issues, weight goals are at, they may or may not be viable.

I'm assuming a couple things when I hear "near 300 pounder with type 2 diabetes" - crap food and lack of physical activities over a long period of time, he's picked up undesirable behaviors that he needs to unlearn - probably feels like a sack of shit going to the gym, being sore, and watching his brother outlift him. He's showing a commitment to change by showing up at the gym. If he's not interested in progressing in weightlifting, introduce him to other activities that he can find a passion for, and hopefully stick to. He's not going to lose 40 pounds overnight walking a dog at the spca, but he might find he likes it, giving him a reason to go out and be active because he wants to, not because it's a chore in the grand scheme of losing weight.

I'm not the nutritionist. I don't have a masterplan. Your brother has options. Good luck.

[danradin]

Just want to throw my 0.02 in as someone who who started at 395 and is down to 320 now...

Congrats. That's awesome progress!

My comment about eating on a schedule was not to say "everyone must eat breakfast"; rather I strongly believe setting mealtimes rather than "eating when hungry" is the way to go for substantial weight loss and post-weight loss period (the rest of your life if done successfully). Listen, you're reprogramming your body, brain, and hormones –– you can't go by feel because that's how you got fat.

I personally do follow Leangains and have found it to be a great approach for managing calories, as somebody who loves to eat. I eat at 1:30ish post-workout, 4-5ish, and 8:30-9:30ish. You could eat every two hours. Every three. Two meals. Nine meals. Standard breakfast, lunch, and dinner, with or without scheduled snacks. Whatever approach you find works, eating on a schedule is likely to be much more successful than eating when hungry. If you fail to plan, you plan to fail.