Muscle Is Medicine in “Gain to Lose” Approach

Kevin Fontaine, Ph.D., has an idea for a better way to lose weight, and the professor in UAB’s Department of Health Behavior already has a catchy title: Gain to Lose. He also has some seed funds to develop his idea thanks to the Back of the Envelope Awards, a program in the UAB School of Public Health that acts like a venture capital fund for innovative research proposals.

The conventional approach to losing weight is to “restrict how much you eat and exercise more,” Fontaine says. The problem with that, he notes, “is you tend to get indiscriminate weight loss—you lose muscle and other lean tissue along with the fat.”

Losing lean tissue compromises metabolism. That could be one reason why many people who do lose weight can’t seem to keep off the pounds in the long term. “The question we’re trying to answer with Gain to Lose is, can you produce discriminated weight loss?” says Fontaine. “We want to focus on losing body fat, not just weight.”

Gain to Lose doesn’t start with diet, but with increasing muscle mass. “Muscle is medicine,” Fontaine says. “It burns calories, stokes metabolism, and enhances overall physical functioning.”

The initial stages of Gain to Lose will “focus on exercise to promote a mild increase in muscle and lean tissue,” Fontaine says. This muscle will act like a bank account for when the dieting begins. “You’re trying to increase savings so that when you start withdrawing, you will be ahead of the game,” he explains.

Just any old exercise won’t do. “Aerobic exercise, like running or walking, certainly has its place, but I want to focus on the particular types of exercise that promote or enhance muscle,” Fontaine says. That includes things like weight training, he notes. “But I’d like to eventually develop a protocol where people wouldn’t need to go to a gym—they could do the exercises using their own body weight,” such as sit-ups, chin-ups, or pull-ups.

In the diet phase of his plan, Fontaine will focus on restricting carbohydrates such as sugary snacks, bread, and pasta. “These create an increase in insulin, which promotes fat storage,” he says. “We’ll have people gradually decrease carbs, which should produce fat loss but preserve or at least slow muscle loss at the same time.”

The first step will be to hold small trials to “flesh out the protocol” in preparation for a large, randomly controlled study in the future, says Fontaine. His goal is to keep the plan slim and trim, emphasizing things people can do on their own. “I’m in public health,” he says. “I always want to think about how we can make interventions simple so that they can be available to and used by as many people as possible.”