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LOCALIZED FAT LOSS: a controlled clinical study

LOCALIZED FAT LOSS: a controlled clinical study

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By Paolo Luzi, Massimo Spattini

University of Milan – Interfaculty Agriculture / Medicine and Surgery

Our morphological constitution is the result of all the morphological features which are linked to genetics and epigenetics, that is, the influence of the external environment on the appearance of certain predispositions.

Accordingly, every person can be classified according to a certain morphotype, characterized by his/her hormonal structure, which can be modulated by a diet and physical exercise. Where there is a positive energy balance, each morphotype tends to deposit adipose tissue in specific body areas: the android hyperlypogenetic morphotype in the upper part of the body (abdomen, back, triceps), the gynoid hyperlipolytic in the lower area (perthrocanteric region, glutei, thighs), whereas the mixed type does so uniformly.

AIM: The aim of this study is to evaluate whether, by means of a specifically targeted diet and training sessions, which take into account the hormonal differences of the three different morphotypes, it is possible to achieve localized fat loss.

Method

In the period between 08/03/13 and 15/09/13 a randomized controlled clinical study was carried out in blind parallel groups on a group of subjects  (n = 84) with a mean BMI of 26 (Kg/m2) and mean age of 41.5, according to the criteria of inclusion established beforehand. Each subject was called to a preliminary session in which certain body composition parameters were recorded by means of anthropometric measurements (weight, height, circumference, skinfold) and bioimpedentiometry. A questionnaire was filled out to assess the subject’s physical exercise level and classify his/her respective morphotype. The subjects were randomized by minimization and grouped, according to their morphotype, into 3 pairs of study groups: experimental android (n = 12) vs. control android (n = 12); experimental gynoid (n = 15) vs. control gynoid (n = 15); experimental mixed type (n = 15)  vs. control mixed type (n = 15). Each of these three pairs of groups was assessed independently.

In this summary we have chosen to focus only on the android and gynoid morphotypes since, after a 2-month follow up, the experimental mixed morphotype appeared to adhere less than the mixed control to diet and exercise.

Each subject of each group followed a personalized diet in relation to his/her morphotype.

Android pair (10% higher calorie amount than the calculated basal metabolism value, since the abdominal adipose tissue has greater lipolytic activity mediated by hormone-sensitive lipase): the subjects belonging to the experimental group followed a diet which was divided into the following macronutrients: 40% carbohydrates (C), 30% protein (P), 30% lipids (L). The distribution of Kcal during the day was as follows: 25% breakfast, 30% lunch and 45% dinner. Breakfast  contained a reduced amount of carbohydrates in order not to further raise the already high glycaemia due to the early morning hypercortisolemia.  In fact, high glycaemic peaks in the morning could result in a compensatory insulin response which would favor lipogenesis and the accumulation of triglycerides in the upper part of the body.  Proteins are necessary to counteract protein catabolism induced by cortisol.

Lunch also supplied a low amount of energy, with a reduced percentage of carbohydrates to support exhaustion of the supply of hepatic glycogen.

Dinner was the most substantial meal, bringing 45% of the total Kcalories and 65% of the total daily  carbohydrates, mainly supplying low glycaemic index carbohydrates. These carbohydrates were necessary to restore the hepatic glycogen supplies, which were reduced due to the high-protein lunch, without stimulating lipogenesis.

Consumption of carbohydrates in the evening in this morphotype increases compliance, as it increases the cerebral serotonin synthesis which contributes to greater relaxation. Besides this, it also causes an increase in leptin secretion (anorexiant) and reduces ghrelin secretion (orexiant), thus helping to limit cortisol secretion. Moreover, in the evening, cortisolemia is low and therefore hyperglycaemia does not set in with the consequent hyperinsulinemia induced by consuming carbohydrates. This morphotype should eat only limited proteins in the evening, as phenylalanine and tyrosine are precursors of adrenalin, which would contribute towards “stressing” the subject and increasing cortisolemia further.

Gynoid pair (a 10% lower calorie amount than the assessed basal metabolism value because the adipose tissue of glutei and thighs shows lower lipolytic activity mediated by hormone-sensitive-lipase and because  this morphotype generally has a slow metabolism): the subjects belonging to this experimental group were subjected to a diet divided into the following macronutrients: 55% C, 20% P, 25% L. The daily Kcal distribution was as follows: 30% breakfast, 45% lunch and 25% dinner. Proteins were given in reduced amount, in order to limit a drop in pH which can result in a drop in calcium crystals in an acid environment, favoring the creation of cellulitis nodules.

Breakfast mainly contained carbohydrates in order to stimulate thyroid metabolism, favoring the conversion of T4 into T3. Proteins, instead, have the aim of contrasting protein catabolism promoted by cortisol.

Lunch was the main meal and mostly provided carbohydrates to stimulate the thyroid,  keeping the glycemic index under control to avoid insulin peaks after lunch and consequent lipogenesis. Proteins and lipids were necessary to lower IG of the meal.

Dinner was the smallest meal and provided only 25% of the daily calories. Carbohydrates were reduced as hyperglycaemia blocks GH secretion during  the first hours of the night. Proteins were the main macronutrient of this meal as they are necessary to stimulate GH production. This has a synergic effect combined with evening exercise to support GH peak. Lipids, in particular monounsaturated fatty acids, support the hepato-biliary functions, contributing to estrogen elimination.

The distribution of macronutrients in each meal was different in the two experimental groups.

In the control groups, the amount of calories was calculated according to morphotype group. The distribution of macronutrients, which was the same for the 2 control groups, was as follows: 55% C, 15% P, 30% L. The daily Kcal distribution was as follows: 25% breakfast, 5% snack, 35% lunch, 5% afternoon snack and 30% dinner, therefore energy distribution was uniform in the three main daily meals.

In the 2 control groups, the distribution of macronutrients for each meal was the same.

The two experimental groups underwent a program of specific training sessions according to their morphotype, following the principles of spot reduction; the rationale of the relationship between training and localized weight loss is that muscle contraction favors an increase in the temperature of the muscle involved in the exercise and this increases the temperature of the subcutaneous adipose tissue  (SCAT) over the muscle, causing an increased blood flux in the SCAT.

This increased blood flux boosts the concentration of catecholamines in the adipose tissue. Catecholamines promote lipolysis and therefore increase the mobilization of free fatty acids, while at the same time the esterification of fatty acids decreases and this allows triglycerides to form and be deposited in the subcutaneous adipose tissue. This should make localized lipolysis possible.

The aim of the training sessions in the experimental android group was to increase blood flow in abdominal adipose tissue in order to increase localized lipolysis. Physical exercise performed in the late afternoon, when the hepatic glycogen reserves are limited due to the mainly protein lunch, allows a quicker activation of oxidative metabolism of fats.

The training sessions for the experimental gynoid group included exercises involving the lower limbs and glutei, allowing an increased blood flow in the adipose tissue of the perthrocanteric region and the hips, in order to support  venous return and localized lipolysis. Physical exercise in the late afternoon, combined with a dinner mainly based on proteins, will enhance a GH peak in the first hours of the night.

The training sessions for the 2 control groups were the same; compared with the training programs of the experimental groups, training did not involve a specific muscle district, but full body aerobic training was implemented in order to stimulate aerobic metabolism, hence overall lipolysis.

All three types of training sessions had the same volume and took place three times a week.

At the end of a two-month follow up period of, those who had remained in the study until the end (n = 80), were called again and their body composition was measured by means of anthropometry and bioimpedentiometry. The following statistical analysis of the results included only the subjects who followed the diet and physical exercise (n = 70).

Results

In the experimental android group there was a significant reduction (compared with the control group) of under scapular, abdominal and waist circumference folds. In both groups there was a significant reduction of fat mass (FM) compared with the baseline, but there was no difference between the experimental and control group.

The fat free mass (FFM) did not show any change in either group compared with the baseline.

In the experimental gynoid group there was a statistically significant mean reduction of over-iliac folds, thigh folds, waist circumference and thigh adipose area. Moreover, there was a meaningful mean percentage increase of the thigh muscular area.

The thigh circumference in both groups saw a small but significant reduction compared with the baseline, but there was no difference between the experimental and control group.

It is possible to conclude that, although there was not a significantly higher decrease of thigh circumference in the experimental group, this group achieved an increase in the ratio of thigh muscle area/ thigh adipose area compared with the control group. The results of the gynoid morphotype could be interpreted differently; it is possible that after the follow up period, the experimental group underwent greater absorption-drainage of interstitial fluids of the lower limbs, compared with the control group. Therefore, according to this interpretation of the results, there was no modification of the muscle-adipose areas in the experimental group, but there was greater reduction of extracellular water. In order to confirm or refute this hypothesis, a baseline and a post-follow up measurement by means of DEXA would be necessary.

Experimental and control treatment in this morphotype produced a lower FM reduction compared with the android morphotype, but also a higher reduction in FFM and in all the parameters connected to it.

Conclusions

In the subjects studied it was demonstrated that proper diet and training sessions which take into account the morphological constitution of the subject can produce localized fat loss in android and gynoid morphotypes.

 

Training program

GYNOID  HYPOLIPOLYTIC  –   FCmax 60-65%
5’ runner

5’ stretching

Circuit x 3 cycles*:

Squat x 25

Bench press x 10

Leg extension x 25

3’ recumbent gym bike or 5% uphill treadmill walking

Lat machine x 10

Push up x 10

Leg curl x 25

3’ recumbent gym bike or 5% uphill treadmill walking

Curl barbell x 10

Calf x 25

Pull down biceps x 10

3’ recumbent gym bike or 5% uphill treadmill walking

 

* NO REST BETWEEN EXERCISES

 

ANDROID  HYPERLIPOGENETIC  –  FCmax  70-75%
5’ runner

5’ stretching

Circuit x 3 cycles*:

Bench press x 10

Standard Crunch x 15-20

Reverse Crunch  x 15-20

Horizontal press x 10

3’ recumbent gym bike with torsion, pulling instead of pushing **

Leg curl x 10

Oblique Crunch x 15-20

Abdomen side pulling x 15-20

Shoulders: push up x 10

3’ recumbent gym bike with torsion, pulling instead of pushing

Lat machine forward x 10

Twist (abdomen) x 40’’

Hyperextensions x 15

Curl barbell x 10

3’ recumbent gym bike with torsion, pulling instead of pushing

 

  * NO REST BETWEEN EXERCISES

** It means you have to pulley instead to push the pedal (as the racing

    cyclists do) bringing  the left elbow to the right  knee at the same time   

 

 

 

Control training

5’ runner

5’ stretching

Repeat the whole circuit x 3 cycles*:

Side lift x 10

Curl barbell x 10

Triceps ropes x 10

Bench press x 10

Lat machine forward x 10

Standard Crunch  x 15

Reverse Crunch  x 15

Oblique Crunch x 15

Squat/press x 12

At the end of all the 3 cycles:  25’ runner/gym bike

 

* NO REST BETWEEN EXERCISES

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