Lose the Fat, Lose the Years A 30-Day Plan That Will Transform the Way You Look and Feel

JAMES R. LYONS, M.D., is a plastic surgeon practicing in Westport, Connecticut, a former clinical instructor at Yale University, and a diplomate of the American Board of Plastic Surgery. He is certified by the ABPS and is a member of the American Society of Plastic Surgeons, the American Society of Aesthetic Plastic Surgery, the Connecticut Society of Plastic Surgeons, the New Haven Medical Society and the Yale Surgical Society. Dr. Lyons lives in Connecticut with his family.

Fat is your friend.

I’m determined to help you rethink what your fat is. It might take some time to wrap your mind around that idea, but the simple truth is that everyone needs fat. Not a diet that’s fat-free. Not a diet that’s low-fat. Not a diet fueled by the notion of “I’ll get fat if I eat fat.”

You need good, nutritious, healthful fats in your food. And you need good, firm, resilient brown fat in your body—not the old yellow fat that’s basically mush—for not just optimum health but optimum beauty, too. The difference between young fat and old fat is like the difference between a smooth round plum and a wrinkled prune. One is dense, smooth, and rounded, and the other is not.

Furthermore, the recently published studies on deep, functional brown fat provide clear evidence that, ironically, the answer to the obesity epidemic may be more straightforward than formerly thought. For these scientists, the answer lies in the fat cell itself!

So let’s take a look at the crucial role of fat—and what you can do about getting rid of old yellow fat and replacing it with new brown fat.

We’re Obsessed with Fat—but for all the Wrong Reasons

Too many people in our country are becoming alarmingly obese. Cookbooks and health books and talk shows and magazine articles are constantly bombarding us with images and facts about the fat that causes diseases—and kills. There is, in fact, a particular mindset where it’s all too easy to see fat as the enemy without understanding how and why the right kind of fat is so important. And because many people do not understand what nutrients the body needs and when to eat them, they end up eating all the wrong things, and put on more weight. Or they become alarmingly thin, somehow thinking that starving themselves of all fat is the only way to achieve that superflat belly and those jutting cheekbones.

Michelle Obama has Great Fat; Madonna Doesn’t

Michelle Obama has an amazing body—not because it’s got the most amazing shape, but because she’s amazingly average, with exactly the right amount of good brown fat in her face and body.

It’s interesting to take a look at her figure, as she’s got broad shoulders, a small bust, and a small waist, yet wide hips, an ample butt, and long legs. She’s not skinny, and she’s not fat—she’s firm and toned, with exceptionally well-defined upper arms. She exudes health and vitality. Her posture is perfect and she carries herself with elegance and grace. Most of all, she’s a woman comfortable in her own skin.

Compare Michelle’s lovely strong curves with Madonna’s angular, supermuscled and almost terrifyingly buff body. Although Madonna is only five years Michelle’s senior, she looks much older, because she has almost no body fat at all. Unless she’s carefully lit in photographs, she can look harsh, haggard, and tired.

In other words, Michelle Obama has got great fat. Madonna doesn’t. That doesn’t mean I don’t admire Madonna for her singing and dancing talent, her staggering discipline, her work ethic, and her seemingly inexhaustible energy and stamina. Personally, I believe that if Madonna stopped her compulsively long workouts (a reported minimum of four hours a day) and gained about fifteen pounds, she would look so spectacular she’d knock your socks off.

But the right fat in the right areas is a good thing. It’s an intrinsic part of your body. If you want to feel good and look good, it’s essential to have a body where all systems are functioning at optimum levels, both physically and mentally.

Just as important: understanding that eating the right kind of fat will not make you fatter.

That is, you will not get fatter if you eat the kind of fat that’s good for your body; eat it at the right times during the day, along with carbohydrates, to keep your metabolism on an even keel; and don’t eat so much of it that your body automatically stores it instead of burning it off.

So when did we make the switch from looking at adorable little babies with rolls of fat on their thighs, wanting to blow on their dumpling bellies to make them peal with laughter…to being afraid to eat properly and obsessing about every calorie we put in our mouths, even as we struggle to maintain a healthy weight or a figure with curves where we want them?

I’ve spent many hours trying to figure out when fat became a four-letter word. I clearly remember the day when the daughter of a family friend was over, and my wife and I were watching a Marilyn Monroe movie. This teenager had never seen Marilyn in her prime before. And what was the girl’s response? That Marilyn was sexy, or beautiful, or vulnerable? I wish! Instead, she said, “Oh my God. She’s so fat!”

It was a disheartening moment, I have to say, as Marilyn’s glorious curves are certainly not what I’d consider to be “fat.” And, as someone who’s devoted his life to optimum health, it pains me to look at images of seriously underweight and undernourished Hollywood stars, with their toothpick legs, pin-thin arms, and cheeks that are rounded due not to good brown fat but to the miracles of modern medicine, which has created the kind of substances that can be injected or inserted into them to plump them up. I’m left wondering how these stars can continue to function with such patently unhealthy bodies—and what kind of role models they are for the women of the world.

Frankly, I think thin is bad. You can’t be a stick and be healthy. And the older you get, the more aging this gaunt thinness becomes.

I have an intimate knowledge of the danger of thinness, because as a plastic surgeon, I deal with it on a daily basis. From my point of view, what I do for a living is plump up thin faces, and put implants in areas of the body perceived by their owners to be too thin, whether their cheeks or their jaws, their breasts or their butts. Not that any of this is wrong, of course. But what, really, is the heart of the issue?

It’s fat, of course!

Fat Basics

Your body intrinsically knows, within the modulation of its metabolism, how much fat it needs to function. Anything beyond that will be stored for future use, to supply energy when needed.

Your body prefers to store energy as fat, as a direct result of tens of thousands of years of evolution. Early humans had trouble finding food, especially calorie-dense food. Plus they were in constant motion as they went hunting every day. As fat is calorie dense, with nine kilocalories per gram (carbohydrates and protein each have four kilocalories per gram), it became the most efficient way to provide the stored energy our ancestors needed for survival.

Fast-forward to the present, when we’re no longer hunter/gatherers and have every conceivable food at our fingertips. While we’ve evolved enough to create art and music and send a man to the moon, the human body’s technology has not evolved at the same pace. It still thinks it’s going to have to hunt for its next meal, so it will always hoard all excess calories in the form of fat—if you let it.

Why You Need Fat

Fat is necessary for several basic bodily functions. Your body needs a certain amount of fat to store the vitamins A, D, E, and K, which are necessary to maintain the health of your cell membranes and its walls, as well as the overall health of skin, bones, and the immune and clotting systems. Bodies must also have fat for the brain and the neuro-system, so nerves can fire properly and communicate with each other. This is why it’s so important for babies to have a lot of fat in their diets; without it, their brains won’t develop properly.

With only a minimal amount of fat in your body, you won’t feel very well and you’ll look horrible. Your skin will be dull, your immune system will be compromised, and your energy level will be nonexistent.

I’ve seen the horrifying effects of a superstrict no-fat diet in the bodybuilders who train at my gym. In the weeks before a competition, these guys starve themselves to make their muscles look more ripped. Not only is this unhealthy, but their faces become so drawn and pale, it’s not an exaggeration to say that they look like they’re dying. Their brains are so starved for fat and carbohydrates that their synapses aren’t firing properly. They tell me they feel like they’re out of control. Basically, they are, as they literally can’t think straight.

About Insulin, Glycogen, and What Causes Yellow Fat

Since your body will always store excess calories as fat, if you eat too much of any food that is converted into fat, it’s converted into the kind of bad yellow fat you don’t want.

Think of your food as coal being added to a furnace. If you add too much coal, the fire gets too hot and then burns out. If there’s always way too much coal, the bottom of the pile will become powdered and useless, similar to low-quality yellow fat.

Whenever you eat carbohydrates, your body secretes insulin, the hormone that regulates blood sugar, to maintain an even blood-sugar level. Insulin wants excess sugars out of the blood, so it immediately spikes and then falls to move the excess someplace less harmful—like your fat cells. Your yellow fat cells.

An additional part of the process has to do with glycogen, the name for your body’s initial stores of carbohydrates. Most glycogen is stored in the liver and muscles, and released when your body needs it. In other words, glycogen is an energy source that is immediately available so your brain can function well and your muscles can move where you want them to.

If you eat the right amount of food, your body will not need to store any excess calories, which are always stored as fat. Instead, it will store the calories only as glycogen. When glycogen storage is exceeded, the extra glucose is deposited as fat. At first, it’s deposited into good, brown fat cells. Healthy brown fat tissue is well contained in a framework of fascia, which keeps fat in a tight cluster supporting the overlying skin and firmly attached to the underlying muscles. There is a defined level at which fat tissue can maintain a homeostatic relationship with the surrounding fascia, blood supply, and lymphatic drainage—the three work together to create the shapes of youth in the face and body.

Now, fat cells do not increase in number as we gain weight. They only get larger. If you overeat, eat poorly, or don’t exercise, excess fat increases in volume. As the fascia stretches, the fat starts to fall off the muscles and does not buttress the skin with the same firmness. If the cells become too enlarged, the fascia stretches along with the connective tissue holding the cells together and thinning of the nutrient blood vessels cannot contain the cell volume and the shape and tone, so they start to look loose and yellow—shapeless. The scale of fat quality is a continuum, from brown to yellow. Yellow fat is brown fat turned bad.

So if you eat too much, your insulin will keep on desperately trying to get the excess sugars out of your blood, and you’ll never be able to deplete your glycogen stores to trigger the conversion process from bad yellow fat to good brown fat. Instead, you’ll just get fatter and fatter in an endless cycle of blood-sugar highs and lows followed by increased storage of yellow fat.

As you’ll learn in chapter 4, figuring out the balance of glycogen storage (to prevent excess consumed calories being stored as fat) with glycogen availability (to give you energy and to avoid any breakdown of your muscles) will be the foundation of your Eating Plan. Mobilizing glycogen for energy use is determined more by diet than by exercise.

The evolutionary “excess calories automatically get stored as fat” phenomenon is the basis of understanding yo-yo dieting. If you stick to a very calorie- and fat-restrictive diet, your body will automatically click into starvation mode, lessening its daily caloric need. Yet even when you start to eat normally again, your body will remain less efficient at processing the nutrients, and you’ll quickly gain weight, and then some. Then you go back to a superrestrictive diet to lose the weight, and the vicious cycle of yo-yo dieting spirals out of control.

In addition, those who work out like crazy but don’t eat properly will shrink in an unhealthy fashion; since they rapidly deplete their glycogen, they end up burning both fat and muscle for energy. Their bodies read the lack of glycogen as starvation, so their metabolism slows down, too. And those who work out like crazy but eat too much do not lose weight because as their glycogen is replenished, their appetites increase. As soon as they replenish their glycogen stores, any excess calories turn into yellow fat.

Your body weight is not the only indicator that you may have a lot of bad yellow fat. Sometimes those who are only very slightly overweight, who appear to be in excellent health, who have normal blood work and blood pressure and no inclination toward type 2 diabetes, have too-high yellow fat stores. Yet the damage that’s going on hasn’t been noticed yet because it’s all internal. It’s like a car that stalls suddenly for no apparent reason, and you’ve got no idea the engine is about to blow up!

Converting Yellow Fat to Brown Fat

Since you know that once your glycogen stores are all filled up, any other calories that come into the body are going to automatically be stored as yellow fat, the trick is to keep this glycogen storage level as close to even as possible. Have too little fat and carbohydrates, and you’ll go into starvation mode. Have too much and you’ll develop too much yellow fat.

What you want instead is healthy brown fat.

When you add fuel slowly and continuously, the fire in your body’s furnace will burn evenly and steadily. Our bodies are designed to burn fat preferentially, so if the bad yellow fat becomes the most available form of fuel—in other words, when you can use it up instead of storing it—it will keep on getting burned up. Instead of losing muscle, healthy brown fat, and bone, as happens on most restrictive diets, all you’ll lose is your bad yellow fat.

At the same time, when you eat nutritionally sound foods like complex carbohydrates, your body’s need for the fat it must have for cell functions remains stable. With a constant and even concentration of glycogen in the muscles and liver, the body now thinks that glucose is no longer needed, so it’s not immediately stored as bad yellow fat.

Our bodies “make” brown fat the same way we make all our tissues healthy anywhere. So instead of just thinking about losing pounds as you would during a typical weight-loss diet, I want you to be thinking about fat replacement, too—as in replacing yellow fat with dense brown fat.

That’s because, as you know, the right volume in the right place is what makes you look shapely and youthful. Brown fat is not about weight—it’s about shape.

What do Yellow Fat and Brown Fat Look Like?

From my perspective as a surgeon with thirty years of experience cutting into bodies of all shapes and sizes, it’s immediately apparent that yellow fat and brown fat look and feel and behave very differently.

If you look at yellow fat under a microscope, it’s all white. It appears to have large vacuoles, which are large spaces inside a cell. The cell walls are stretched and there’s very little fibrous tissue or blood vessels.

When I cut through yellow fat during surgery, there’s little to no bleeding, which is very unhealthy; it’s an indicator of how bad eating habits have a visible effect on the health of your tissues, even when you can’t see them on the surface. Seeing yellow fat on the inside is like seeing the leathery, wrinkled skin on the outside of a woman who smokes and tans too much.

When I’m performing surgery on a healthy female patient, however—one who’s nourished herself well and exercised often—I don’t see yellow fat. I see firm brown fat in certain areas of the body—the areas that define the patient’s gender.

Your body has well-defined areas where fat cells are located: on top of the muscles (subcutaneous, deep fat), in the abdomen (intra-abdominal fat), and in the organs (like the fat in the liver, for example). We’re born with the number of fat cells, or adipocytes, that we’ll carry through life; these cells can get larger or smaller as you gain or lose weight, but they can’t multiply.

In each area, there is a predetermined network of connective tissue to organize and form the fat cells, a certain number of blood vessels to supply the fat with nutrients, and a certain number of lymphatics to drain the fatty tissue. If the size of the fat cells does not overwhelm the network of connective tissue; if the blood supply keeps up with the metabolism of each cell so it functions at the optimal metabolic rate; and if the size of the cells does not overwhelm the lymphatic drainage channels, you have brown fat.

Brown fat gets its color from thick, fibrous tissue between its cells, as well as countless blood vessels. As a result, it looks brown—more of a tan color, actually—because blood is constantly supplying and replenishing the fibrous tissue and fat.

In addition, brown fat is compact and shapely. It looks youthful (because it is). Brown fat adheres tightly to the overlying skin and underlying muscles. This cohesive relationship of skin, fat, and muscle defines youth!

With yellow fat, on the other hand, the network of connective tissue is over-stretched due to the enormous fat cells, the equally stretched blood vessels course scantily through the cells, and cell membranes are loose and sometimes fragmented due to sluggish cellular metabolism that gets little nourishment because there’s no blood to supply it. Yellow fat actually feels greasy as a result. Nor does it support the overlying skin or have the resilience to help contour the underlying muscles. It’s blobby, with no defined volume. Or rather, its volume translates to old!

You can easily get an idea of what old yellow fat looks like every time you see a raw steak. When raw, the thick lumps of fat on the end are a dense, opaque white. It’s got a very specific kind of greasy feel to it when you touch it.

On a raw chicken, yellow fat is definitely bright yellow, and in big clumps that you can pull out of the cavity or trim near the tail. Many chickens, though, don’t have a lot of visible yellow fat anymore, as they’ve been bred to be extra-lean. Which is a good thing for you.

(Moral of the story: Always trim your meat. The kind of fat that’s bad for you looks pretty gross on the outside—and you don’t want it on your insides!)

Yellow Fat is Pervasive, Too

One of the biggest problems with yellow fat is that it’s pervasive. It moves into your vital organs, and particularly into your abdomen area and around your intestines. This pervasiveness is basically why people who are overweight have so many health problems. The quality of their tissues is poor; their metabolism is sluggish; and there’s an increased demand on the heart and lungs. The body is in chronic overload, as if it’s a truck dragging an entire house behind it all the time.

I was reminded of the pervasiveness of yellow fat when I was discussing it with a patient recently, and she told me about an incident that happened to her decades before, when she had gone to the hospital for some severe endocrine problems and had shared a room with several other patients, including a morbidly obese woman. This woman urgently needed a liver biopsy, normally a simple procedure done under local anesthesia, so one day the surgeon and his team came into the room, drew the curtains around her bed, and sedated her. They got to work, and then a few minutes later there was an ungodly crash. The surgeon came stomping out, his face beet red, swearing at the top of his lungs. What had happened? He’d been unable to find this woman’s liver. Her yellow fat had completely obscured her internal organs.

Anyway, this hot-tempered surgeon got so frustrated—inappropriately so, I might add—that he knocked the instruments to the floor. But I could understand his frustration, because he wanted the best for this woman. He knew her life was now at grave risk because she’d have to have general anesthesia for a simple biopsy.

The bottom line is, there is never going to be any need for yellow fat. We don’t need it to give us energy—we have glycogen and good brown fat for that. So beyond what you look like, it increases your need for insulin, makes you prone to diabetes, makes you feel sluggish, and may increase your risk during medical procedures. It is intermingled with all tissues of your body—your heart, liver, everywhere. It’s pretty gross.

The Skinny on Fat

Anyone who’s seen a recent fashion show knows that the runway models are so skinny you could seemingly blow them over like a feather—but they’ve also got jiggly bottoms and wobbly thighs. Why? Because they don’t eat enough, or they don’t eat properly when they do eat, and many don’t exercise. (Believe me, I’m not blaming them—I’m blaming the fashion industry.) So the tiny amount of fat these models have is mushy yellow fat. These women are barely out of their teens, a size 00, yet they’re fat and skinny at the same time.

Superskinny models are the visible embodiment of yellow fat versus brown fat. That they deprive themselves of good nutrition means they don’t have good-quality tissue. Just as skin will reflect damage done to it by smoking and excessive tanning and look old before its time, doing the wrong things to the tissues of your body will be visible, too. Poor-quality tissues, such as yellow fat, are going to look and act a certain way whether there’s too much of them (as in an overweight person) or too little (as in a severely underweight person).

Next time there’s a Hollywood award show on TV, watch the actresses walking down the red carpet—you know, the actresses who are lovely, gorgeous, talented, and starving. See who’s very thin, yet still has a little pooch in the front. That’s bad yellow fat.

Even though these actresses often follow vigorous exercise regimens, they don’t know how to target the excess yellow fat in their abdomens or butts and replace it with healthy brown fat. Their bodies are desperate for any fat at all—so they’ll hold on to whatever they can get. This is due to a condition called lipodystrophy, the hormone-driven phenomenon responsible for areas of collected fat in certain areas of the body. These areas are the most resistant areas to weight loss, and need a little push—namely Lose the Fat, Lose the Years program.

Yellow fat has no purpose except to, well, hang there and make you feel miserable and look older.

Too Little Fat

While I can’t do much about the bodybuilders who are starving themselves before a competition, I can try to do something about the countless patients who erroneously think that avoiding fat or severely restricting calories will help them get or remain superthin.

If you don’t have enough of the good brown fat, you’ll get way too thin—not attractively lean, but scary skinny!

Without fat for energy, you’ll have minimal glycogen stores in your body. Then if you decide to work out, you’ll deplete all your stored glycogen, and your muscles won’t work properly. They’ll be too weak. And weak muscles can’t get stronger, so you won’t put on any of the lean muscle mass that makes you look youthful and strong.

From the Inside Out: The Importance of Nourishing Your Cells

As I discussed in the introduction, on April 9, 2009, several articles in The New England Journal of Medicine discussed the thermogenic, or heat-producing, properties of brown fat cells found deep in the body. The findings were particularly newsworthy because these researchers discovered that the thermogenic effects of these fat cells can be activated in adult humans after long exposure to cold temperatures.

The researchers also showed that the number of thermogenic brown fat cells you have, like the subcutaneous brown fat that I have studied and operated on for decades, is inversely proportional to your weight and your body mass index (which is a measure of fat, not just weight). Leaner people have more brown fat cells than overweight people.

Fat cells and all other cells are the basic building blocks of your body. If these cells aren’t properly nourished, it’s going to show, particularly in the luster of your skin and the shape of your muscles.

What you eat and the way you behave affects all cell functions. It’s actually at the cellular level where it’s determined how you’re going to age—and where your young fat is going to go. Furthermore, the reasons why the right kind of exercising makes you look more youthful is because it stimulates and replenishes cells, improves blood flow, and more efficiently moves nutrients to where they are needed.

If you don’t nourish your cells properly, it’s as if you are creating a toxic situation in your cells. Fortunately, replacing old yellow fat with new brown fat is going to nurture your cells so they work at peak efficiency.

But Lose the Fat, Lose the Years is designed to replenish these glycogen stores throughout the day, to keep the fuel burning evenly. Which is why it’s absolutely essential to eat a postworkout meal, as this will supply instant calories for your muscles so they’ll be able not only to replenish themselves, but to prevent the stressed muscles from cannibalizing other muscles after the demands of the workout.

With the Eating Plan, you’ll keep your metabolism evenly burning and therefore working most efficiently, so your body won’t be converting calories into fat deposits. It won’t need to. And that’s when the weight will finally come off—and stay off.

Fat: It’s all About the Volume

My son Blake used to be on his college dive team, so he gets what makes muscles work and become shapely with the right kind of weight training; and after listening to me discuss my theories over the years, he gets metabolism and brown and yellow fat.

“Fat is the language of volume,” he told me. “Because volume is created by fat.”

And volume is what makes us look youthful.

If you close your eyes and envision a twenty-year-old face and a fifty-five-year-old face, then erase all the wrinkles from their skin, which face will appear older?

The twenty-year-old face will be round and curvy. The fifty-five-year-old face will be thinner and more angular. It’ll look older due not to the amount of wrinkles, but to its shape, lost volume, and the distribution of fat.

Having the right amount of good brown fat that will keep you looking and feeling youthful is like building a house with a strong and sturdy foundation. You want a structurally sound house—and you want a structurally sound body, too. If you don’t create a solid structure that will properly support what’s built upon it, anything you do to the surface will be cosmetic only. It’s like painting a house without priming it first—the paint will soon peel and flake, leaving the raw wood exposed to the elements and ruining your house.

Fat and Your Face

You need good brown fat supporting the tissues in your face to create a soft, youthful look. Losing this fat as you grow older changes the volume of your face, making it look gaunt. Despite what cosmetics companies often claim, their moisturizers and creams can treat only the outer layers of your skin—they can’t treat the underlying tissues, so there’s nothing you can buy over the counter to replace lost volume in your face.

The Fat and Fat Pockets of Your Face

What surgeons have learned is that you don’t have one solid sheet of fat under your skin, although it looks like that when you’re young. Instead, there are several fat “pockets” that all have their own internal aging clock. The different pockets of fat gain and lose volume separately, and sag with gravity at different rates—explaining why your face doesn’t age uniformly.

Although you have no control over how these pockets of fat in your face are going to age, since you can’t control the pull of gravity, you do have the ultimate control over how you affect them—by the way you behave. And the way not to behave is by losing all your good brown fat. As you know, brown fat creates volume and plumps up skin to make you look youthful. So when you get rid of bad yellow fat and replace it with dense brown fat, it will make a startling improvement to the shape of your face.

Aging from the Top Down

Let’s divide the face into four segments, so you can more clearly understand how it ages: the forehead, the eye area, the cheeks, and the central face (the lips and chin, or perioral area, meaning around the mouth).

These four segments are all unique, especially in texture; the forehead skin is fairly thick, while eyelid skin is more like silk, and cheek skin is smooth and peachy. They age at different rates, because they’re affected by different processes. Foreheads and the perioral skin, for example, respond to the constant movements of the muscles underneath; eyelids are affected by wrinkling and by fat; cheeks are affected by how the fat gradually slides down toward the jawline.

The key point is that the four segments usually age from the top down. This is relevant to understanding fat because what fills your face with volume, what supports your skin and creates the undulations of youth, is brown fat. With age, facial fat descends, diminishes in quality, and becomes more yellow in consistency.

Improve the quality of your facial fat, and your face will automatically look better. Dense, toned brown fat hugs the bones and muscles and intimately supports the overlying skin; lose the coalescence of these tissues and you’ll have a face that truly shows its age.

Aging from the top down happens externally and internally, on the topical level of your skin itself and to the underlying structure of fat, muscle, and bone. Most often, you’ll first see wrinkles on the forehead, then on the eyelids, then in the crow’s-feet area, then the cheeks, and then the nasolabial fold, or the line running from your nose down to your lips.

As we get older, vertical lines—what I call the elevens—start to appear between your brows and in the deepening of the nasolabial folds. You’ll also see the eyebrows descending, the cheeks losing shapeliness, and the chin line becoming less defined and more jowly.

To me, the cheeks are the most interesting part of the aging face, as well as the most difficult part to correct without the correction being obvious. That’s because the volume of the cheek, the beautiful curve right over the cheekbone in the apple (referred to in medical terminology as an ogee curve), which then descends down to the mouth segment, has nothing to do with skin. It has everything to do with fat.

I like to call the aging of the cheek “devolution.” The fat actually flattens out and falls down, leaving a hollowing-out under the eye. The apple descends and creates a jowl, as if it were dripping fat like wax melting down a candle.

Restoring the quantity and quality of the volume in your cheeks is what truly creates a youthful contour, whether you’re thirty or seventy.

Fat and Your Body

Aging from the top down doesn’t just affect your face. Your entire body starts to, well, droop from the neck down to your torso and eventually reaching your ankles and feet—primarily due, of course, to changes in fat distribution. But, as you’ve figured out by now, only if you let it!

The controlling factor when it comes to the distribution of fat in the aging process is your hormones. They’re responsible for the shape of your body, whether it’s 99, 150, or 250 pounds.

About Hormones

Estrogen is the female hormone that rules all other female hormones, particularly during its profound fluctuations during puberty, pregnancy, and perimenopause/menopause.

The amount of estrogen your body produces will define your fat distribution. It’s that simple—and the reason why men and women put on weight differently.

When a young girl moves toward puberty and gets her first period, she’ll start to deposit fat in her thighs. During the ensuing decades of fertility, fat will obviously be distributed in the breasts and abdomen during pregnancy. As estrogen as well as progesterone levels begin to decline, changes in fat distribution become even more pronounced. At the same time, the male hormones, or androgens (which all women have), become more pronounced, triggering the movement of fat to areas like the arms, the front of the neck, the sides of the breasts, and the central abdomen.

Obviously, hormonal changes are happening slowly over time, and there’s no predicting how you’ll fare during your lifetime. But it must be said that if your health isn’t good, if you don’t eat well, and if you don’t exercise, chances are much higher that you’ll suffer more extreme symptoms as menopause approaches, because you’ll have less brown fat and more of the yellow fat that wreaks havoc on your body.

Why “Spot Reducing” is a Fallacy

There’s no such thing as “spot reducing”—but I can’t tell you how many of my patients think that if they do a lot of crunches, their bellies are going to get thinner. Or that if they do a lot of arm exercises, their arms will lose fat, too.

Your body is predisposed to put on fat in certain areas, and from a physiological point of view, there’s just not anything you can do about it. But—and this is the crucial but—if you have good brown fat in the areas where fat tends to be visible (like the belly), you won’t really notice it. It will lie flat near your muscles. It will be dense and resilient and supportive, so you won’t get that droopiness or pooching that you associate with getting older. It will create the curves and shadows of a healthy, attractive body.

The Rest of the Body Ages, Too

Why do we age?

Basically, all of the structures of our bodies are held together in a toned fashion by elastic fibers and collagen. Together, they make up the “scaffolding” of what we call connective tissue. The matrix, or substance that surrounds the elastic fibers and collagen, is made up of mucopolysaccharides, which are what hold water in tissue. Think of it as the fabric or the netting in between cells. With age, the connective tissue loosens and becomes more lax.

While there’s nothing you can do about the fact that collagen and elastin are going to degrade over time, you can certainly retard the process by living and eating well. A fifty-year-old woman who’s in good shape and who’s never smoked is much more likely to look vibrant and youthful than an overweight smoker, due to the better quality of her connective tissue. It’s why such a woman will have a younger “Visual Age” than her overweight, smoking counterpart who is the same chronological age.

Ideally, you want to have a Visual Age that is lower than your chronological age. You’ll certainly be able to do that when you follow the Eating and Exercise Plans in this book.

How your skeleton holds up over the years is one of the basic markers of aging. Bones tend to demineralize and therefore get softer over time, especially in women. This can be exacerbated if you’re calcium deficient, leading to osteoporosis. If the osteoporosis is extreme, you literally lose inches of height.

Your organs also work less productively as you age. This has nothing to do with fat. Believe me, if scientists could figure out how to stave off these inexorable changes, we would all live a lot longer.

And Now…Onward to Lose the Fat, Lose the Years

What is the essence of Lose the Fat, Lose the Years?

When it comes to fat, what do we all want to do? We want to control the volume of fat in our bodies as well as the quality of this fat. We also want to have faces and bodies that are as healthy and youthful-looking as possible.

So why do people get fat? The principle is simple: You put on fat when you put more energy into your body (with food) than you put out (with energy expended, as with exercise). But the solution to managing fat in/fat out is not simple at all—which is why obesity is at epidemic levels. The average American doesn’t know how to eat well or when, or how much exercise to do and what exercises will be best for them.

Lose the Fat, Lose the Years will show you that instead of thinking of fat as the enemy, you can learn how to harness its power to reshape your body and improve your health.

The Eating Plan will teach you that when you eat specific kinds of foods (either carbohydrates or protein) at specific times during the day, you won’t have any excess carbohydrates left in your body to be converted into yellow fat.

Eating six times a day will keep your blood sugar at an even level, so you will avoid the peaks and valleys of cravings that lead to bingeing. Your body will quickly come to realize that more nutritious food will always be coming every few hours, so it will no longer be primed to store any excess as yellow fat. Calories will automatically become good brown fat.

The Exercise Plan will help you strengthen and shore up the nonbulky muscles of your core—all the muscles that define a youthful silhouette. Lean muscle has high energy requirements, so even at rest it will keep your metabolism elevated. (It’s as if you’ll be creating a muscle furnace!) Combine the new, stronger, leaner muscles with the balanced approach to eating, and you will not only get rid of your yellow fat, but also strengthen the rest of your body as well as improve your posture.

This system will work even if you have declining hormone levels—the hormones that trigger more fat deposits as you age. As you get older, your body preferentially deposits fat in specific sites, most noticeably the abdomen, flanks, outer thighs, and upper arms. (When this happens is determined by your genes and your gender.) But once you replace these hormone-triggered, “middle-age” zones of yellow fat with dense and resilient brown fat, your body will once again look younger and more shapely.

Read on, and you’ll see how Lose the Fat, Lose the Years will work for you.

LOSE THE FAT, LOSE THE YEARS Copyright © 2009 by James R. Lyons, M.D

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