Dr. Vliet’s Health Tip: Stop Chasing “Weight Loss:” Why Visceral Fat Loss Matters More

“Weight loss” has become one of the most sought-after health goals in modern culture. It is a multi-billion-dollar industry in the US alone. “Weight loss” on a scale dominates conversations, advertisements, social media, and even medical discussions. New anti-obesity medications produce substantial “weight loss” but what they don’t tell you in the slick ads is that you lose extensive lean muscle and bone mass you critically need.  All the “fasting” programs and Very-Low-Calorie Diets promise rapid “weight loss,” but don’t tell you the price you pay is loss of lean muscle and bone.

KEY POINT: A lower body WEIGHT does not automatically mean a healthy body COMPOSITION.

You can lose significant weight measured on a scale, but that doesn’t tell you whether what you lost is fat or muscle or bone.  Your friend can lose less weight on the scale, but actually improve health overall by losing visceral fat, preserving (or even increasing) muscle mass, lowering blood sugar, and improving fitness.

I actually went through this exact experience in my late 30s when I was working to get back in shape after the stress of medical school, residency training, moving across country and starting a new faculty position at a medical school.  Over about 9 months of focusing on “get healthy/de-stress,” I significantly increased my exercise with jogging or swimming laps or aerobics classes 4 days a week plus weight training 2 days a week—coupled with major improvements in my meal plans towards a more Mediterranean diet, I was shocked to see that I “only” lost 10 pounds on the scale.  If I had just focused on the scale weight, I would have been profoundly discouraged – and probably returned to my bad habits out of being discouraged at not losing more “weight.”

What REALLY got my attention—and showed the reality of my success with that combined program—was that I lost 5 inches off my waist, 4 inches off my hips and went down 4 dress sizes!  My body fat percentage improved markedly (much lower!), so I clearly had been successful in losing fat and gaining muscle—even though the scale didn’t show many pounds lost over all that time.

I was amazed.  At the time it was a profoundly important lesson for me personally but also profoundly important in helping me as a physician better explain to patients what the goals for healthy body composition need to be and to stop focusing on “weight” on a scale.  That’s why I am still teaching the health goal is not “weight loss.” It is fat loss & muscle preservation.

Body Fat Is NOT All the Same

The amount of fat matters, but where it is located actually matters more in terms of impact on your health risks. The two primary fat compartments are subcutaneous adipose tissue and visceral adipose tissue.

In fact, storing energy under the skin is a safer form of “energy reservoir” than is storing excess fat around the organs of the abdominal cavity. This helps explains why some people with larger body sizes can have healthier metabolic markers (such as fasting glucose, HgbA1C, lipids), while others at lower body weights may develop heart disease, insulin resistance, pre-diabetes, diabetes or fatty liver disease.  It is the body composition and location of excess fat that determines these kinds of health risks.

Visceral fat: the deeper, higher-risk fat depot

Visceral fat sits inside the abdomen and surrounds internal organs. It cannot be measured simply by pinching the abdomen. A larger waistline can be a signal of higher visceral fat accumulation, but waist size does not perfectly measure VAT.

Visceral fat is biologically active. It releases free fatty acids and inflammatory signaling molecules that can affect the liver, blood vessels, pancreas, and other organs. This helps explain why it contributes to insulin resistance, elevated triglycerides, high blood pressure, abnormal cholesterol patterns, type-2 diabetes, and metabolic dysfunction-associated steatosis liver disease (excess fat stored inside liver cells—commonly call “fatty liver”).

The goal is not to eliminate all body fat. The body needs fat for energy storage, hormone signaling, organ protection, and normal physiology. The major goal is to reduce excess fat—especially visceral fat—while preserving muscle and supporting metabolic health.

For example, one person can lose a substantial amount of weight on the scale but also lose too much muscle. The body composition may not have changed or may have even worsened. Another person may see only a modest change in pounds, yet improve insulin sensitivity, waist circumference, fitness, strength, fatty liver markers, and long-term cardiometabolic risk because they lost fat, and gained or preserved lean tissue.

BOTTOM LINE: Do not focus on weight loss at any cost.  Focus on improving health risk.

Why BMI is Not Really a Helpful Measure of Health

Unfortunately, most consumers and most doctors just rely on scale weight and body mass index, or BMI (a notoriously poor indicator of whether you carry excess visceral fat or just have exceptionally dense muscle mass for your height. BMI seems to be one of those rigid “guidelines” of “health” that insurance protocols and doctors today use without thinking, and without considering all of the limitations of BMI OR taking into account individual differences in muscle and bone mass relative to height.

BMI is just a calculated number based only on weight and height, and then puts people into standard categories imposed on us as a measure of “health.”   BMI tells us nothing about lean muscle mass, or amount of visceral vs subcutaneous fat.  This distinction matters more than ever in an era of aggressive calorie restriction and powerful weight-loss medications.

BMI really only has value as a population-level screening tool. It is easy to calculate, inexpensive, and useful for identifying people who may benefit from further metabolic-risk assessment. But BMI has critical limitations when used as an individual measure of health.  BMI should not be considered a final health marker for all individuals as it has become.

BMI does not distinguish between:

• Body fat and skeletal muscle
• Visceral fat and subcutaneous fat
• Bone mass and soft tissue
• Water retention and fat gain
• A physically active person with substantial muscle mass and someone with high body fat
• A person with a “normal” BMI who carries excess visceral fat and has metabolic dysfunction

Two people can have the same BMI and dramatically different health profiles. For example, consider two adults with a BMI of 27:

• One person strength trains regularly, has above-average muscle mass, normal blood pressure, normal triglycerides, healthy blood sugar, and relatively low visceral fat.
• The other person has low muscle mass, a larger waist circumference, elevated triglycerides, insulin resistance, fatty liver risk, and higher visceral fat.

BMI labels both individuals “overweight,” but it does not reveal the difference in their body composition or metabolic risk of serious disease like diabetes or heart disease.

The opposite can also occur. A person with a BMI in the “normal” range may have relatively low muscle mass and excess abdominal or visceral fat. This pattern is sometimes called “skinny fat” or normal-weight obesity, and is a metabolically unhealthy normal weight.

The scale and BMI may appear reassuring, while the underlying metabolic picture is not.  BMI should therefore be viewed as a starting point to do a more detailed assessment of body composition and your actual health risks.  BMI should not be used as the sole indicator of a diagnosis of “normal” or “overweight” or “obese.”  BMI should not be the primary target of treatment plans.

Shift Your Focus from Scale Weight and BMI to Body Composition

Body composition describes the relative amounts of components the scale measures, and includes:

• Fat mass
• Lean soft tissue, including skeletal muscle, organs, and connective tissue
• Body water
• Bone mineral content
• Total body fat and distribution in the body
• Visceral adipose tissue can be determined with state-of-the-art testing methods, such as DEXA Body Composition.

• How much total body fat do you carry?
• Where is that fat stored?
• Is visceral fat decreasing?
• Is lean mass being preserved during fat loss?
• Is strength improving or declining?
• Is abdominal fat decreasing even if scale weight isn’t changing or is changing slowly?
• Are blood sugar, blood pressure, triglycerides, liver fat, and fitness improving?

You may lose only five pounds but gain strength, reduce waist circumference by two inches, lower visceral-fat estimates, improve fasting insulin, and preserve lean mass. That outcome is more meaningful than losing 15 pounds quickly through severe calorie restriction and in the process, losing a substantial amount of lean muscle!

The Scale Does Not Tell the Whole Story

The scale only reflects total body weight made up of muscle and other lean tissue, fat mass, bone, water, glycogen (the stored form of carbohydrate in muscle and liver), food and fluid in the GI tract and fluid throughout the body.

A rapid drop in scale weight is misleading. Early weight loss is loss of fluid and changes in glycogen reserves, especially if someone sharply reduces carbohydrates or calories. Over time, aggressive calorie deficits can also lead to loss of lean muscle and bone mass.  This loss of muscle and bone is devasting to our health and independence as we get older, and in people over 40, much harder to build back after losing.

Muscle matters. Skeletal muscle helps regulate glucose, supports physical function, protects mobility, contributes to balance and fall prevention, and helps people remain independent with age. Muscle also gives the body a metabolically active place to store glucose after meals.

When people lose muscle during dieting, they may become lighter without becoming proportionally healthier. They may also experience reduced strength, lower exercise capacity, fatigue, and more difficulty maintaining weight loss over time.

The question should not be, “How much weight did I lose?”

The more useful questions are: “How much fat did I lose, how much muscle did I preserve, and did my metabolic health improve?”

Weight Loss at Any Cost Can Seriously Backfire & Jeopardize Health

Rapid weight loss in a medically supervised program can be appropriate in selected circumstances, especially when obesity contributes to type 2 diabetes, obstructive sleep apnea, fatty liver disease, severe mobility limitations, or cardiovascular risk. New medications and structured dietary interventions can provide meaningful benefits.  But rapid weight loss must have a plan to protect muscle.

Very-low-calorie diets should not be confused with a balanced moderate calorie deficit specifically for weight loss. A balanced moderate caloric deficit is a meal plan with adequate protein, vegetables, fiber, essential fats, vitamins, minerals, and food volume to support staying with it AND preserve physical function and improve long term health, the goals that matter.

Very-low-calorie diets: severe calorie restriction affects more than body weight

A very-low-calorie diet generally provides fewer than 800 calories daily. These programs can produce fast weight loss and may be used for specific medical purposes under professional supervision. They are not a routine long-term strategy and can be difficult to sustain. They also increase the risk that weight loss will cause loss of lean muscle mass and bone mass if protein intake, nutrient adequacy, resistance training, and medical monitoring are insufficient.

Very-low-calorie diets can change body weight quickly, but the body does not interpret severe calorie restriction as a neutral event. When energy intake falls dramatically—especially below about 800 calories per day—the body adapts to protect essential functions.

Adaptations to severe calorie deficit include changes in thyroid hormones (altering ratio of T4 to T3, percentage of thyroid hormones in free vs bound state, etc.), resting metabolic rate, reproductive hormones, adrenal hormone production, bone turnover, mood, exercise recovery, and lean tissue preservation. These are some of the reasons that “faster” weight loss is not always better weight loss.

Research in very-low-calorie diet settings has found reductions in active thyroid hormone T3, increases in reverse T3 in some studies, and reductions in resting metabolic rate. In one small trial using a 400-calorie-per-day diet, T3 fell by as much as 66 percent while reverse T3 rose. Other studies similarly found declines in T3 and resting metabolic rate during severe calorie restriction.

This is sometimes called “sick euthyroid syndrome.”  It means TSH remains normal, free T3 is low (a protective response to caloric starvation), free T4 may be low also.  The thyroid gland IS still working properly to protect the body from damage in the setting of severe caloric (and energy) deficit.  The protective response is to reduce liver and thyroid gland conversion of T4 to the more metabolically active hormone T3.  The reduction in free T3 helps the body’s energy-conservation response. Lower T3, loss of lean mass, and reduced activity levels can all contribute to a lower daily energy expenditure during and after aggressive dieting.

The thyroid changes that occur with adaption to severe calorie deficit cause symptoms mistaken for “hypothyroidism” – fatigue, feeling cold, “foggy brain,” reduced exercise tolerance, sleep disruption, irritability, low mood, poor concentration, and oftentimes, a frustrating weight-loss plateau.

These symptoms should NOT lead to a self-diagnosis of hypothyroidism. They are a reason to evaluate whether the calorie deficit is too severe, whether protein and micronutrient intake are adequate, whether recovery is sufficient.  A health care professional should assess the necessary steps to take to overcome the adverse effects of thyroid changes to very-low-calorie diets.

Insulin normally decreases when carbohydrate intake drops and calorie intake falls, which leads to improved insulin sensitivity as fat mass decreases. Clearly this is a desired goal for people with insulin resistance or type 2 diabetes. Keep in mind, however: The metabolic benefit of lower insulin does not eliminate the risks of prolonged severe calorie deficit that leads to under-fueling the body, inadequate protein intake or loss of lean muscle and bone.

BOTTOM LINE: fat loss should create a manageable energy deficit, not a chronic starvation signal.

• Special Considerations for Women.  Very-low-calorie dieting can be problematic at any age, but the dominant risks differ across life stages.
• Premenopausal, reproductive age women:  severe calorie restriction—especially when paired with strenuous exercise—suppresses the hypothalamic-pituitary-ovarian hormone axis. The medical term for this is hypothalamic hypogonadism, and it leads to suppression of menstrual periods, irregular periods, absent or scant menses, low energy, impaired ovulation, reduced fertility, and loss of optimal estradiol, progesterone, testosterone and DHEA production. A missed menstrual period is not evidence that a diet is “working.” If a person who previously menstruated regularly has no period for three months, develops persistent cycle irregularity, or has signs of restrictive eating or compulsive exercise, she should seek clinical evaluation and proper adjustments to the diet and exercise plan.
• The Female Athlete Trial: This clinical syndrome occurs in both younger and perimenopausal women due to loss of estradiol and testosterone (as described above) along with low vitamin D, and inadequate caloric intake for energy that causes loss of bone mass and increases the risk of bone stress injuries. This is where body-composition assessment, adequate protein, resistance exercise, balance training, and bone-health evaluation become especially important.
• Menopausal women: the immediate concern is to avoid very low calorie diets and overtraining that can cause loss of muscle and bone, leading to loss of strength and risks of falls and fractures. Estradiol has already declined and increased risks for osteopenia, osteoporosis, falls, frailty, and loss of independence due to hip and spine fractures. A severe calorie deficit accelerating these risks by causing lean-mass loss, lowering protein and micronutrient intake, and reducing mechanical loading on bone.
• A special note about Progesterone: During pregnancy, progesterone’s effect to decrease insulin sensitivity and increase fat storage is adaptive to serve the energy needs of the developing baby.  In menopausal women taking estradiol, progesterone-induced reduction of insulin sensitivity (increased insulin resistance) has potentially negative effects when trying to lose excess body fat, which is already higher in menopausal women.   So in patients I am treating, I use the least amount possible to achieve therapeutic goals, and adjust diet and exercise during progesterone phase of HRT to help reduce the increase in insulin resistance progesterone causes.

  Menopausal women with a uterus who take estradiol DO need progesterone to prevent excess buildup of the endometrial lining and later malignant change with unopposed estrogen.  Options are a daily low dose (100 mg) or cyclic short 12 days cycles at the higher 200 mg dose every 6-12 weeks (frequency depends on bleeding pattern).

  Menopausal women taking estradiol who have had a hysterectomy do not need progesterone for menopause therapy.  I have written extensively on this in my books, available the Truth for Health website. Profits from my book sales benefit the Foundation.

GLP-1 and related weight-loss medications

GLP-1 receptor agonists and newer incretin-based medications can be transformative for many people, but they have serious adverse effects you need to take into consideration. They do reduce hunger, support blood sugar control, and lead to meaningful weight loss in severe obesity and diabetes. In these patients, these drugs may reduce overall health risks and improve quality of life.

These medications do somewhat reduce visceral fat as total fat mass declines. That is a meaningful benefit. But the serious risk of the GLP-1 and related medicines is that they cause significant loss of lean muscle and also as part of the loss in lean mass, they cause loss of bone. They DO NOT exclusively cause just fat loss.  You can minimize the loss of lean body mass by adequate protein intake, resistance training, and adequate balanced overall nutrition—but sadly most people taking these drugs are not given this guidance or do not put in the time and effort to follow it.

If you are taking a GLP-1–based medication for appropriate medical indications needs to ALSO pair the medicine with a muscle-preservation plan following these priorities:

• Include protein early in meals, when appetite is often best.
• Eat enough protein, even if appetite is reduced.
• Use nutrient-dense foods rather than relying on very small amounts of low-protein snack foods.
• Resistance train at least two to three times per week when medically appropriate.
• Continue regular walking, cycling, swimming, or other aerobic activity.
• Monitor strength, energy, exercise tolerance, waist circumference, and body composition—not only scale weight.
• Work with the prescribing physician if nausea, vomiting, severe constipation, or early fullness prevents adequate food and protein intake.

Medication can make fat loss more achievable. It cannot replace the nutrition and strength-training behaviors required to preserve muscle, bone and overall lean mass.

Dr. Vliet’s Recommended Supplements to Support Fat Loss

Fiber: the most practical starting point

Fiber is one of the most useful nutrition tools for fat loss. Fiber supports fullness, bowel regularity, blood-sugar control, cholesterol metabolism, and a healthier gut microbiome. Consider a supplement when food intake remains consistently low in fiber.

TruFiber Lean™ – contains a glucomannan-derived soluble fiber that supports healthy glucose metabolism, cholesterol metabolism, bowel regularity, digestive health, and weight management. It also acts as a prebiotic substrate for intestinal bacteria.  I recommend to my patients that they start slowly and increase gradually. Fiber supplements can cause bloating, gas, or abdominal discomfort if introduced too quickly. Take them with adequate fluid and separate them from medications when appropriate because fiber can affect medication absorption.

Probiotics and prebiotics: supportive, not primary therapy for visceral fat

The microbiome influences appetite regulation, inflammation, gut-barrier function, and metabolic signaling. Evidence for probiotics as a direct visceral-fat treatment, however, remains mixed and strain-specific.  I recommend my patients try our TruProbiotic Lean™ which contains the probiotic strain Bifidobacterium animalis subsp. lactis B420.

I consider TruProbiotic Lean™ as a complementary tool for my patients who want to support gut health and a sustainable fat-loss plan but not necessarily a direct visceral-fat-burning product. B420 has been studied in the context of weight management, with benefit being modest support for body-fat reduction and reduced central adiposity over time rather through beneficial effects on gut-barrier integrity, low-grade inflammation, metabolic signaling, and energy handling. A healthier intestinal barrier can reduce bacterial components that can contribute to chronic low-grade inflammation—a process associated with insulin resistance and adipose-tissue dysfunction.

Berberine: a metabolic-support option

Berberine is a plant-derived alkaloid that may support glucose and lipid metabolism. Research suggests it can produce modest improvements in body weight, waist circumference, blood sugar regulation, insulin resistance, triglycerides, and other cardiometabolic markers.   These two products in our weight loss support bundle are ones I recommend for my patients:

• TruBerberine™ 5X: contains dihydroberberine, a form that produces higher circulating berberine exposure than standard berberine and supports glucose and lipid metabolism, which complement a fat-loss program for people with insulin resistance or metabolic syndrome. OR,
• TruCardioMetabolic Protect™: A combination of alpha-lipoic acid, berberine, and biotin formulated to support glucose metabolism, insulin sensitivity, lipid metabolism, and as well as antioxidant status.

Note: Berberine can interact with prescription medications and may lower blood glucose. People taking insulin, sulfonylureas, metformin, antihypertensive medication, blood thinners, immunosuppressants, or multiple medications should consult a pharmacist or prescribing clinician before using it. It is generally avoided during pregnancy and breastfeeding unless specifically recommended by a qualified clinician.

Alpha-lipoic acid: modest support, not a primary strategy

Alpha-lipoic acid, or ALA, is an antioxidant compound involved in cellular energy metabolism. It has been studied for insulin sensitivity, oxidative stress, body weight, and metabolic health.  Both of our products contain ALA, which is most useful when addressing insulin resistance, glucose control, oxidative stress, or cardiometabolic risk as part of a broader integrated treatment plan: TruAlpha-Lipoic SR™ (sustained release) or TruCardioMetabolic Protect™
Note: ALA may lower blood glucose and should be used cautiously by people taking diabetes medications.

Leptin Modulation to support fat loss: TruLeptin Modulator™

Leptin is a fat-cell-derived hormone involved in hunger and energy balance, and leptin resistance is common in obesity. TruLeptin Modulator™ contains vitamin C and ORALVISC®, a proprietary glycosaminoglycan complex that supports healthy leptin activity and helps to help manage appetite.
These I just mentioned supplements provide complementary support for safe and effective fat loss (especially visceral fat) when added to your efforts that also include balanced adequate nutrition, resistance training, aerobic activity, good quality sleep,

What Success Should Look Like

A successful fat-loss program should improve more than body weight or BMI. It should aim for:

• Lower fat mass, especially reduced abdominal and visceral fat
• Preserved or improved lean mass and strength
• A smaller waist circumference
• Improved blood sugar, triglycerides, blood pressure, and liver-health markers
• Better energy, mobility, exercise tolerance, and confidence
• An eating pattern that can be maintained for years rather than weeks
• Less reliance on extreme restriction or repeated cycles of weight loss and regain

THE BOTTOM LINE:

My suggestion: throw out your bathroom scale and BMI – I consider them misleading at best and useless as measures of actual health risks. Focus on body measurements (waist, hip, thigh, etc), how your clothes fit, changes in actual body composition and lab markers to show progress.
Instead of asking, “How many pounds did I lose?”

Ask: “Have I lost inches around my waist? Have I lost fat? Have I gained or at least preserved muscle? Have I improved my lab markers of health?”
Avoid the mindset “eat as little as possible and exercise as much as possible.”

Instead:

• Use a moderate, sustainable calorie deficit.
• Prioritize protein at each meal.
• Build meals around vegetables, legumes, high-fiber carbohydrates, and measured healthy fats.
• Perform resistance training at least twice weekly.
• Include regular moderate aerobic activity.
• Match exercise volume to food intake and recovery capacity.
• Supplement to support dietary changes and healthy weight loss.  Check out our Weight Loss group of supplements at www.TruthforHealth.org/Store
• Treat menstrual changes, persistent fatigue, declining strength, recurrent injury, and loss of function as warning signs that something is amiss—not badges of discipline.
• Use DEXA Body Composition testing to establish a baseline and to verify fat loss and lean-mass preservation.

Strategies to Measure What Matters: Body Composition

Waist circumference: a simple and practical estimate

Waist circumference offers more useful information than BMI because it reflects central fat distribution. Measuring at the same anatomical site over time can help track meaningful change.  A shrinking waist often indicates improvement in abdominal fat, even when body weight changes slowly. Still, waist circumference can indicate but not separate visceral fat from subcutaneous abdominal fat, so it remains an indirect measure.

DEXA, state-of-the-art Body Composition Scan

DEXA, or dual-energy X-ray absorptiometry, is one of the most useful clinical tools originally developed for accurate assessments of bone mineral density.  The technology has been refined and expanded to include assessments of full body composition giving measures of bone density, body fat, lean mass, and current generation scanners can also measure visceral body fat. For a person beginning a fat-loss program, a baseline DEXA scan can establish fat mass, lean mass, bone measures, and regional fat distribution. Repeating the scan after 9-12 months helps determine whether the program is improving body composition rather than just loss of pounds.

CT and MRI are the most direct reference methods for measuring visceral fat because they visualize abdominal tissues and can anatomically distinguish visceral fat from subcutaneous fat.

DEXA does not directly “see” visceral fat in the same way CT or MRI does. Instead, modern DEXA systems use validated algorithms to estimate visceral adipose tissue in a defined abdominal region. DEXA-derived VAT estimates correlate strongly with MRI-derived visceral fat measures and offers a practical, lower-radiation, more accessible option for repeated body-composition tracking.

DEXA is especially valuable because it provides whole-body information at the same time. A CT scan may give a more direct measurement of visceral fat, but it is more expensive and does not routinely provide the same practical assessment of total fat mass, regional lean mass, and bone density in a standard body-composition setting.

NOTE: Use the same DEXA facility, scanner, software version, and pre-scan routine whenever possible. Different machines and algorithms can produce different absolute values, so trends over time are often more useful than comparing results from unrelated facilities. There are many low cost (<$100) facilities, including independent radiology and imaging centers, that offer this service as a self-pay option – but if you want the visceral score, you may need a physician’s order for that component, so be sure to ask about that before your visit.

PRACTICAL STRATEGY: Use DEXA with waist measurements

• Waist circumference: every two to four weeks.
• Strength and exercise performance: continuously.
• DEXA: periodically, often every 9 to 12 months during an active body-composition intervention, depending on goals, access, and clinician guidance.

DEXA versus home body-fat (bio-impedance) scales

Home body-fat scales generally use bioelectrical impedance analysis, or BIA. The device sends a painless electrical current through the body and estimates body composition from the body’s resistance to that current.  Water conducts electricity better than fat, so that means your hydration status has a major effect on results.

DEXA versus skinfold calipers

Skinfold testing estimates body fat by measuring the thickness of pinchable subcutaneous fat at specific body sites. A technician then enters those measurements into an equation to estimate total body-fat percentage. Skinfold calipers can work reasonably well when one experienced technician uses the same technique, sites, calipers, and prediction equation over time. However, skinfold calipers have several limitations:

• They measure only subcutaneous fat, not visceral fat.
• They do not directly measure lean mass, muscle distribution, or bone mass.
• Results vary substantially with technician skill.
• Accuracy declines when skinfolds are difficult to grasp or when body-fat distribution differs from the population used to develop the equation.

DEXA versus Bod Pod and hydrostatic weighing

The Bod Pod uses air-displacement plethysmography. Hydrostatic weighing uses water displacement. Both estimate body density and then use mathematical models to divide the body into fat mass and fat-free mass.  These methods can provide useful total body-fat estimates, but they typically operate as two-compartment models:

• Fat mass
• Fat-free mass

They do not separate bone from lean soft tissue. They also do not show regional fat distribution, muscle distribution, visceral fat, or subcutaneous fat as DEXA can.

Strategies to Lose Fat While Preserving Muscle

The most sustainable fat-loss program does not require starvation, fear of food, or a rigid elimination diet. It requires an eating pattern that provides adequate protein, fiber, micronutrients, and satisfaction while creating a moderate calorie deficit. A Mediterranean style balanced fat-loss plate is a good place to start.

Your Goal: at meals aim for:

• One-half plate: leafy greens and non-starchy vegetables.
• One-quarter plate: lean protein.
• One-quarter plate: high-fiber, complex carbohydrates or unprocessed whole grains and resistant starches and fibrous low glycemic fruit (such as berries).
• Small, measured amounts of healthy fats.

I have discussed this plate in many health tips and continue to encourage its use because of the nutrient density and fullness it provides without demanding extreme caloric restriction. Remember food is fuel and we need energy to enjoy life!

Exercise: CRITICAL to Lose Fat While Preserving Muscle and Bone

Exercise helps reduce visceral fat, supports cardiovascular health, improves insulin sensitivity, and protects muscle during fat loss.

• Moderate aerobic exercise – Aim for at least 150 minutes per week of moderate-intensity aerobic activity (walking, swimming, cycling, dancing) building gradually based on current fitness and medical status.  Brief activity sessions also count. A 10- to 20-minute walk after meals can be a realistic way to increase total activity and support post-meal glucose control.
• Resistance training – Resistance training is the most important exercise strategy for muscle preservation during fat loss. It gives the body a reason to retain lean tissue while calories are lower. Aim for at least two full-body strength sessions weekly.
• REMEMBER: Hard training increases energy needs. If you combine a very-low-calorie diet (or even a low carbohydrate diet) with frequent high-intensity exercise intervals, long aerobic endurance sessions, heavy resistance training, or inadequate rest, this combination creates a “low energy availability” state. This means that too little dietary energy remains after exercise to support basic functions such as hormone production, bone remodeling, immune activity, recovery, and reproductive health.   The appropriate response is not to just “push through” and overtrain to lose weight. It is to restore adequate energy intake, reduce excessive training volume or intensity, improve recovery, and seek individualized medical guidance when needed.
• Caution: Do not combine severe caloric restriction with punishing exercise! Exercise is one of the best tools for preserving muscle and reducing visceral fat—but more is not always better especially when food intake is very low.
• KEEP IN MIND: The scale may move more slowly when you preserve muscle and gain strength. That is not failure! It reflects a healthier quality of weight loss.

SUMMARY

The best fat-loss plan is NOT the one that produces the fastest scale change. It is the one that reduces visceral fat and cardiometabolic risk while helping a person become stronger, better nourished, more active, and more capable over the long term. What does that mean, in summary?  A moderate calorie-reduced diet combined with resistance exercise and adequate protein is generally the best strategy for improving body composition because it promotes fat loss while protecting lean mass.

Here are some research findings to support that: a 2025 systematic review found that resistance training during diet-induced weight loss preserves fat-free mass even when total scale loss is similar.  GLP-1 medication can produce substantially greater overall loss—for example, in the STEP 1 semaglutide 2.4 mg DXA substudy, fat mass fell 19.3% and visceral fat 27.4% over 68 weeks, but lean mass also fell 9.7%.  Very-low-calorie diets can produce rapid loss but carry greater lean-mass risk unless they are medically supervised, protein-adequate, and paired with resistance training; in one study, adding interval training to a very-low-calorie ketogenic diet produced about 11.4% body-weight loss while preserving fat-free mass better than the diet alone.

As you put all the pieces together that I have described today, I encourage you to consider our other natural medicines with our top quality, cGMP-compliant professional formulas: TruMitochondrial™ Boost,  TruNAC™, Tru BioD3, Tru B™ Complex Full Spectrum, TruZinc™, TruC with BioFlavonoids  (Natural sourced Vitamin C with complete Bioflavonoids), and TruProBiotic™ Daily to replenish critical bifidobacteria depleted by COVID shots, viral illnesses, and antibiotic therapy.

All Truth for Health Foundation Products Meet or Exceed cGMP Quality Standards, the highest quality standard for supplements sold in the USA. For more information, references from studies are listed in the Product Data Sheets for each product, available on our website.  Check us out at www.TruthforHealth.org Click on tab for Store.  OR www.shopTruthforHealth.com

CAUTION: As always, we urge you to avoid supplements without checking knowledgeable sources to evaluate your medical situation, proper lab tests to verify what is needed, and to make sure to avoid adverse interactions with prescription medicines and other supplements you take.  Under medical practice regulations, we are unable to answer individual medical questions or make specific individual supplement recommendations for people who are not established patients of Dr. Vliet’s independent medical practice (www.ViveLifeCenter.com).

To Your good health and improving resilience!
Elizabeth Lee Vliet, MD