Introduction
Over the past 5-6 years, the concept of reverse dieting has gone from a tactic that was less known by the majority of fitness coaches to a very mainstream tactic that gets a lot of people significant results.
However, like any shiny new tactic that people get excited about because of the results it can potentially give, a lack of complete knowledge can result in over-application or being applied in situations where it probably shouldn’t be.
Don’t get me wrong; reverse dieting is an indispensable tool for many applications. Those that are super lean at the end of a dieting phase, those that aren’t so lean but are metabolically adapted and can’t lose weight, or just as part of intelligent long term nutritional periodization.
However, there may be some applications where although it might look to be a good idea to institute a reverse diet based on a significantly lower-than-predicted TDEE, it might not be a good idea in reality.
Let’s dive in and explore 5 situations where reverse dieting might not be a good idea.
1: Metabolic Syndrome, Type 2 Diabetes, or Severe Insulin Resistance from Overeating.
The Problem
Scenario: You’ve just signed on a client thats obese and has a lot of weight to lose. Upon looking over their food logs, you notice that maybe they’re eating fewer calories than you think they should be based on their body weight with mostly bad quality, processed foods.
They also send over the last set of blood work they had done and their fasting glucose and insulin is through the roof, triglycerides are uber high with a low HDL (all markers of insulin resistance; take note!), and they let you know that they struggle with blood pressure issues and are on medication for it.
You feel like you know exactly what to do; their TDEE is lower than expected, so you go for a reverse. This might not be a good idea.
Even though their food logs exhibit lower calories than their projected maintenance, pushing food for individuals with bad insulin resistance/metabolic syndrome could make the situation turn sour pretty fast.
This is especially true if someone has full blown type 2 diabetes. If you increase their macros in a fashion that most coaches have a tendency to when reverse dieting; increasing carbs and protein, and maybe a bit of an increase in fat depending on where their macros were before, this is only going to exacerbate their insulin resistance and metabolic issues.
Individuals with this metabolic profile are probably going to be experiencing leptin resistance along with insulin resistance.
Leptin acts as a satiety signal in the brain, as does insulin. Both of these hormones in healthy people activate a set of neurons in the brain that decrease food intake and increase energy expenditure. However, when the brain can’t see the signal as in leptin/insulin resistance, the result is that their energy expenditure is in all likelihood going to be lower than projected, as well as their appetite higher.
The Solution
Let’s talk about what we actually want to do if someone that’s obese comes to you eating 1800 calories.
First, you have to make sure that their tracking is accurate. They could have switched up their food choices in order to impress you (even if you asked them not to) during their pre-coaching tracking period, and if they’re new to tracking, most people fall prey to the common errors of not tracking cooking oils, not tracking beverages here and there, etc.
Another common error is entering qualitative foods instead of quantitative; i.e. “One medium chicken breast” instead of “250g chicken breast”. Several of these per day can easily add up to 400-700 or more calorie error per day.
If they were truly that low, the next step would be to clean up their diet, including more micronutrients, fiber, and polyphenol/antioxidant density as well as higher protein while keeping their calories similar to what they’d recorded coming into you to see what happens with their weight. Doing this could potentially modulate hormonal responses from food intake giving a more favorable insulin response, and may also help out their tracking game.
Instituting exercise to their current ability is key here as well. Exercise has been shown to improve markers of metabolic syndrome even if someone remains weight neutral. The strategy of sticking to where they were in calories, cleaning up food, and instituting weight training can build muscle, which will improve metabolic health and total energy expenditure, and you’ll probably get some body recomposition as well.
If they can’t exercise or can only do lower intensity walking or similar for whatever reason, consider lowering their carbohydrates. Doesn’t have to be ketogenic levels of carbohydrates (although this is an option), but they may feel better with carbohydrates on the lower end of the spectrum and fats slightly higher given their current metabolic state.
If their weight doesn’t budge after all that, then you may have to lower calories further. Remember that they have a depressed energy expenditure due to their current metabolic profile, so they simply may just need lower calories. Of course once you do this, pay attention to their SHREDS biofeedback to ensure that all of their biofeedback is improving with weight loss instead of getting worse.
You can still institute diet breaks back to maintenance for certain periods of time if they’re experiencing mental diet fatigue or after 3-6 month time chunks of straight dieting since they’re probably going to be needing to diet for quite some time to lose the weight they need to lose. Once they’ve reversed their insulin resistance/metabolic syndrome/T2DM and get on the leaner side of things, then this would be a situation for a proper reverse diet along with resistance training.
2: High-stress and Low-Sleep Cortisol-induced Insulin Resistance
The Problem
This one’s in a similar vein as number one, but with some key differences. Chronically elevated cortisol itself can induce insulin resistance and contribute to metabolic syndrome even if someone isn’t obese and does not have a lot of weight to lose.
We see a lot of the same effects on physiology by cortisol-induced insulin resistance that we do with overconsumption-induced insulin resistance. Chronically high cortisol can affect those same neurons in the brain we were talking about earlier, drive gluconeogenesis and triglyceride formation even after meals because of liver insulin resistance, drive muscular insulin resistance, and probably most importantly – drives fat deposition into visceral fat as well as sensitizing all fat tissue to insulin for greater storage.
As a result of these effects, if you pushed the calories of an individual in this situation they’d have very poor nutrient partitioning; meaning that the nutrients that they’re consuming are going to be shunted more towards fat storage instead of glycogen storage or muscle building, further exacerbating the insulin resistance.
This might be tough to parse out and probably necessitates seeing some labs. It might be an individual that has some weight to lose, but they’re not obese. They may appear to have a high stress lifestyle, but to truly see if it’s affecting their insulin sensitivity, checking things like fasting insulin, trig/HDL ratio, fasting BG, A1C, SHBG would be a good idea.
If all of those things look good, reverse dieting may still be an option. However, if they don’t look so great, you may need to address the real issue first – the stress.
The Solution
To address this, I wouldn’t do much on the calorie side; perhaps stick with the amount of calories they showed on their tracking logs while looking to see where you can improve food quality. Adjusting macros to a typical profile conducive to weight loss would be good, meaning higher protein, and setting carbs/fat based on activity and preference, but I wouldn’t consciously set them in a surplus or deficit just yet. Address the core of the issue first, which is the stress and/or the poor sleep.
There are numerous ways to manage stress. Meditation, art, walks, music, nature, time with loved ones, breathwork, and encouraging fun activities can be good stress-reduction techniques. The name of the game is getting them out of rumination mode and into enjoying the present, and all of the above activities can do this.
You could also ask probing questions about sources of stress that they might not see as well. Do they have toxic relationships? Do they feel supported? If it’s financial stress, do they budget well or are they impulse buying things all the time? Do they constantly have mainstream news on their TV?
These are all valid questions to ask to see if you can help. In the vein of improving sleep and circadian rhythm regulation, some tips here include a cold, dark room, cutting off electronics after a certain hour, blue light blockers, not eating too heavy within a few hours of bed, and as much sun exposure as possible in the morning.
The caveat here is if someone is extremely low body fat and undereating to stay that way as well as having high stress levels. Their current metabolic state is contributing to that stress, so you probably still need to increase calories slowly, particularly carbohydrates, while working on stress and sleep as the primary variables.
If the stress and sleep gets controlled, they may start experiencing body recomp or weight loss when their macros and calories have stayed static. If they don’t, and you know that their insulin resistance is resolved based on labs, then this might be an instance where you can start a reverse or lower calories based on how much they were already eating.
3: Severe Gut Issues; Dysbiosis or Increased Intestinal Permeability (Leaky Gut)
The Problem
Someone comes to you with a bit of weight to lose, eating on the lower calorie side compared to their projected maintenance, but they also get severe bloating and stomach distension after nearly everything they eat that’s also accompanied with gas and alternating bouts of diarrhea and constipation. Maybe they also get acid reflux here and there a few times a week. You get the point; their digestion and gut health is not in a good place.
Tons of things could be happening here that would preclude pushing food higher. They could have enzymatic insufficiency or low stomach acid; this would mess up their protein and fat digestion. They could also have overgrowths of opportunistic, deleterious bacteria which could be contributing to systemic inflammation through increased intestinal permeability, which could result in worse nutrient partitioning. Pushing food here could potentially induce other sensitivities as well as further damage the gut lining.
The Solution
The clear thing to do here would be to shift the focus from body composition or weight loss to addressing the gut issues. I can tell you from personal experience that many clients take a good amount of weight off just from doing this; perhaps its water retention from inflammation, but either way its a win.
Keep their calories static with a macro profile similar to what we’d spoken about earlier while adjusting food choice. If they came to you eating a standard American diet, then the first thing to do would be to improve food quality. Advise more micronutrient and fiber-dense whole foods, increase hydration, increase protein, consumption, etc.
If they’re still experiencing the same amount of gut issues after they’ve been consistently eating “cleaner” for at least a couple months, then you might have to look to elimination or a full gut protocol. Going into detail about a full 4R/5R would be beyond the scope of this post, but a few worthy approaches to try would be low FODMAPs, classic paleo which eliminates grains, dairy, soy, etc (which I view as more of an elimination diet strategy than a permanent way of life) and if unresponsive to that, something like an AIP might be necessary if things are very severe.
After the individual’s gut health is back in a good place, then you can consider instituting a reverse if still needed.
Once again, the caveat here is if someone is extremely lean and undereating and experiencing gut issues. Just the fact that they’re underfed and malnourished could be contributing to excess sympathetic nervous system and HPA activation, potentially causing worse digestion.
In this case, I would experiment with increasing food first, particularly carbohydrates, to see if it helps alleviate the digestive issues along with making the food choices ones that are more easy on the gut; perhaps lower cruciferous vegetables and whole grains.
4: Hormonal Downregulation due to Inflammation or Oxidative stress
The Problem
If someone has down-regulated thyroid hormone and sex hormones like testosterone, estrogen, or progesterone due to the fact that they’re very lean, then a reverse diet is a given.
However, there’s many other sources of hormonal downregulation; excessive inflammation and oxidative stress from a high cortisol lifestyle, obesity, environmental toxins/heavy metal exposure, or another source.
If they’re hypothyroid, have low testosterone, and/or imbalanced estrogen/progesterone, this is also going to severely affect nutrient partitioning here, shunting more of the calories consumed towards fat storage.
The Solution
The thing to do here is keep their calories static where they’re maintaining and find the source of inflammation and hormonal downregulation. This is going to require some detective work on your part, but first look at the obvious suspects: Stress, sleep, training volume, and food quality. There are many podcasts in my feed (Sam Miller Science) on these topics, so please look there for more details.
A simplified protocol here would be getting them on a better macronutrient profile and increasing food quality in all of the ways previously discussed, getting them sleeping a solid 8 hours per night, and reducing stress.
Sex hormone axis issues could also exist coming off of birth control. In this case you’d really want to work on balancing the three main sex hormones before really pushing calories higher. Again, please look to my podcast feed, there will be numerous episodes speaking to post-birth control syndrome.
If we’re dealing with Hashimoto’s hypothyroidism instead of just thyroid downregulation, then we’d need to get stress down and go on a gluten and dairy free diet while looking out for other potential sensitivities.
Once hormones are in a good place, then we consider a reverse diet if it’s still necessary. It may not be, however, since improving hormonal status can increase TDEE on its own.
5: Improper Tracking
I hinted at this on the first point, but improper tracking is easily the most common issue that can honestly be tough to mitigate.
Your client gives you their pre-coaching food logs which say they’re eating 1400 calories. If you don’t question their accuracy and automatically go into a reverse, you could potentially be making a big mistake. Definitely check their tracking accuracy first.
There exists numerous studies on the topic of how rampant under-reporting actually is, even amongst people who know what they’re doing (accidental under-reporting).
One study found that people, on average, under-reported about 800 calories per day. Another study found some individuals under-reporting by as much as 2000 calories per day. Yet another compared obese twins to their non-obese counterpart and found that the obese twins under-reported by an average of 764 calories. Yet another found that people under-report calories even when their caloric intake can be verified. Putting the nail in the coffin; in one particular study testing dietitians accuracy, even they under-reported by an average of 225 calories, and they teach people this stuff. We can clearly see this is a huge issue.
Educating around basic tracking; weighing and measuring everything and consistently tracking everything that goes into their mouth, since folks do have a habit of grabbing a small handful of nuts here, a square or two of chocolate there that may go untracked.
Educating around the common pitfalls as I mentioned earlier; not tracking cooking oils, not tracking condiments, not tracking liquid calories, and using poor choice of entry into their tracking app – I.e. choosing “1 medium apple” instead of “250g apple”.
If you use tracking as part of your approach, you should have some sort of document and/or screen-share video that educates your clients that they can use for reference to ensure accurate tracking.
If they start tracking accurately and their actual calories were 2700 instead of 1400, then there we go, problem solved. However, if they truly were eating 1400 and don’t suffer from any of the other things we talked about before, then they’re definitely safe to go into a reverse diet.
Conclusion
Reverse dieting can certainly be an amazing tool for many people, but please cross reference this list with your current clients or new clients before making the decision to start pushing food.
I’ve seen it many times; someone gets their client from 1800 to 2300 calories over 3 months, and their issues either get worse, or they gain too much weight, and their TDEE doesn’t actually raise and they still can’t lose weight going back down to 1800 calories. You can save you and your clients several months of frustrating and defeat by implementing the strategies above based if they line up with your client profile.
References
Champagne CM, Bray GA, Kurtz AA, Monteiro JB, Tucker E, Volaufova J, Delany JP. Energy intake and energy expenditure: a controlled study comparing dietitians and non-dietitians. J Am Diet Assoc. 2002 Oct;102(10):1428-32. doi: 10.1016/s0002-8223(02)90316-0. PMID: 12396160.
Muhlheim LS, Allison DB, Heshka S, Heymsfield SB. Do unsuccessful dieters intentionally underreport food intake? Int J Eat Disord. 1998 Nov;24(3):259-66. doi: 10.1002/(sici)1098-108x(199811)24:3<259::aid-eat3>3.0.co;2-l. PMID: 9741036.
Buhl KM, Gallagher D, Hoy K, Matthews DE, Heymsfield SB. Unexplained disturbance in body weight regulation: diagnostic outcome assessed by doubly labeled water and body composition analyses in obese patients reporting low energy intakes. J Am Diet Assoc. 1995 Dec;95(12):1393-400; quiz 1401-2. doi: 10.1016/S0002-8223(95)00367-3. PMID: 7594141.
Pietiläinen KH, Korkeila M, Bogl LH, Westerterp KR, Yki-Järvinen H, Kaprio J, Rissanen A. Inaccuracies in food and physical activity diaries of obese subjects: complementary evidence from doubly labeled water and co-twin assessments. Int J Obes (Lond). 2010 Mar;34(3):437-45. doi: 10.1038/ijo.2009.251. Epub 2009 Dec 15. PMID: 20010905.
Yanetz R, Kipnis V, Carroll RJ, Dodd KW, Subar AF, Schatzkin A, Freedman LS. Using biomarker data to adjust estimates of the distribution of usual intakes for misreporting: application to energy intake in the US population. J Am Diet Assoc. 2008 Mar;108(3):455-64; discussion 464. doi: 10.1016/j.jada.2007.12.004. Erratum in: J Am Diet Assoc. 2008 May;108(5):890. Kipnis, Victor [added]. PMID: 18313427.
