Not too long ago, a female patient came to my office complaining of her inability to lose weight, and in fact had gained some weight since she saw me last. To my ignorant eyes she appeared smaller than before but the chart did say she was up five pounds.

I asked all the pertinent questions about diet, water/soda/juice/alcohol intake, exercise habits and supplements/medication but nothing popped out as alarming.

Then I said, “Well you look smaller to me.”

And she said, “I am smaller, I’ve lost almost two pant sizes! But the scale went up. I can’t lose weight.”

I was floored.

It appeared she was basing everything about her lack of "weight loss" on the number of pounds registering on her scale every morning instead of revelling in the fact that she was almost two sizes smaller. I advised her to throw out her scale and get a measuring tape instead.

This led me to the question, do pounds matter in fat loss?

This particular patient decided to really limit her carbohydrates except for some small amounts of brown rice, quinoa or sweet potato. She completely eliminated sugar and fruit and focused on vegetables (lots of them) and protein.

She was also exercising four times per week and drinking a lot of water. I was of the opinion she had lost fat and was building muscle.

Does this eating plan work for everyone? Of course not, but it worked for her.

It takes 3500 calories to make up a pound of fat. Many are of the belief that if they simply cut enough calories, the weight will fall off however the body has a lot of built-in mechanisms making this process difficult.

How many of you starved yourself in the name of weight loss and didn’t lose anything? Your metabolism, hormones, thyroid, energy expenditure, sleep habits, diet, exercise, etc. ... all play a major role in deciding what stays and what goes.

It’s important to note that muscles also burn energy but weigh more, so as you exercise and begin to build stronger muscles, they help with the inches lost but may not cause loss on the numbers of the scale. It’s also good to know your muscles have a type of "memory" meaning if you do the same exercise all the time and aren’t getting where you want -- switch it up.

Vigorous exercise and interval training have been shown to be much more effective at fat loss and metabolic rate while strength training quickly helps to improve glucose/insulin balance in the body better than straight cardio alone.

If you choose to look at the tape measure instead of the scale, the American Heart Association wants men to have a waist under 40 inches and women under 35 inches.

As your inches start to shrink and clothes fit looser, don’t look at the scale. You are losing fat.

References:

1) Better Way to Predict Weight Loss? Web. 22 Feb. 2012
http://www.medscape.com/viewarticle/748668

2) A 45-minute Vigorous Exercise Bout Increases Metabolic Rate for 14 Hours. 22 Feb. 2012.
http://www.medscape.com/viewarticle/750315

3) Strength training improves muscle quality and insulin sensitivity in Hispanic older adults with type 2 diabetes. 22 Feb. 2012
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1752232

4) Body Composition Tests. 22 Feb. 2012.
http://www.heart.org/HEARTORG/GettingHealthy/NutritionCenter/Body-Composition-Tests_UCM_305883_Article.jsp

Reviewed February 23, 2012
by Michele Blacksberg RN
Edited by Jody Smith