The Truth About Calories and Weight Loss | Dr. James Hill

TRANSCRIPT:

Dr. Gabrielle Lyon: 00:00

If weight loss was as simple as eat less, move more, we wouldn't have an obesity epidemic. 42% of American adults are obese, and diabetes is skyrocketing. This is what people aren't getting long term, weight loss isn't just about cutting calories, it's about it goes

Dr. James Hill: 00:19

just beyond diet and exercise, because now the mind comes into play.

Dr. Gabrielle Lyon: 00:24

Dr Jim Hill has spent decades studying the science of fat loss, and today we're exposing some brutal truths. If

Dr. James Hill: 00:31

a population is going to be this sedentary, obesity is inevitable. Isn't enough, and most people have failed, we know that most people who have lost weight, very few keep it off. People in the National Weight Control Registry are clearly in the minority. Matters

Dr. Gabrielle Lyon: 00:50

more than you would think. And quitting weight loss meds like ozempic can and

Dr. James Hill: 00:55

we know from the clinical trials is when you stop the drugs, you tend to gain the weight back.

Dr. Gabrielle Lyon: 01:00

If you want to lose fat and keep it off for good, you need to hear this. I just wanted to jump on here with an exciting announcement. I am hosting the second ever forever strong Summit, April, 26 27th in Houston, Texas, 2025 there's going to be two days the VIP day on April 26 you will learn from former Navy SEALs, from former secret service, from individuals that you do not want to miss myself, my inner tribe will be there to support you to learn everything from muscle health to science to nutrition. You don't have to be an expert. You don't even have to have a background. All you have to have is a will to win and stay strong. I will put a link in the show notes below. Please go to my website. Dr gabrielline.com we sold out last year, and I would hate for you to miss this opportunity. So if you're waiting for a sign, if you're thinking you need to change something up and you need community friends, we've got you covered. Dr Jim Hill, welcome to the show. Thank you. I'm happy to be here. I feel like I'm sitting with a celebrity. No,

Dr. James Hill: 02:21

I've just been around for a while.

Dr. Gabrielle Lyon: 02:23

You are the co founder of the National Weight Control Registry, correct for people who don't know what that is, that has really been a tool that has absolutely changed the game for our understanding and what it means to lose weight, but more importantly, keep it off. Yes, I would love to hear a little bit about your background for the listener or the viewer, because you are, I would say, an icon in the weight loss, metabolism community. I

Dr. James Hill: 02:53

started research in this area in the late 70s, early 80s. So literally, I've been around for a long, long time, and in the in the late 70s, obesity was not seen as a problem. Yeah, there was some obesity out there. It was maybe 10% in the population. Nobody really cared about it. That wasn't one of the big issues that wouldn't have made anybody's top 10 list of things to a study. I actually started out studying how the brain regulates energy balance. So I was struck by the fact at that time, most people kept the stable weight throughout their lifetime despite changes in intake and expenditures. Like, how does that work? So I was really interested in the role of the brain in maintaining energy balance. And I studied energy expenditure a lot. A lot of people look at food intake. I was looking at energy expenditure the calories should burn. And I thought the calories should burn might be important part of regulation. And then it was really in the mid 80s that the national surveys began to pick up a pretty dramatic increase in obesity, okay? And suddenly people got interested. And I thought, this is perfect for what I'm looking at. And so I thought the reason people were getting obese is because they had a low energy expenditure. It wasn't what they were eating, it was their energy expenditure.

Dr. Gabrielle Lyon: 04:21

And, yeah, and we have to just point out that this is how new obesity research is. That's right, that there was a point in time where obesity wasn't thought of. People had no idea what was. No

Dr. James Hill: 04:34

idea, no idea. And still, in some parts of the world, obesity and diabetes is so new that they're still trying to get a handle on it, but we've been dealing with it for a while. So my hypothesis that it was energy expenditure, no first, first wrong, but not wrong. We learned a lot from it, and what I learned is that for most people, their energy expenditure was exactly what would be predicted. Did from their body composition. Boy and I thought, I'm going to find this defect in energy expenditure and be famous. Nope. So I began to look at other things. Is it food intake? Is it metabolism? And that led to a journey to try to both understand why obesity occurs, and in my recent years, really trying to do something about it. Can we prevent it? Can we treat it? When

Dr. Gabrielle Lyon: 05:25

you were looking at energy expenditure for the audience, what does that mean?

Dr. James Hill: 05:30

So let's look at the concept of energy balance, which has kind of driven my research, and it's the laws of thermodynamics. Energy that comes in, the body has to go somewhere. Energy doesn't just disappear or appear. So energy balance is following that energy through the body. So you take in calories from food, some of those calories you use just to maintain your body. We call that basal or resting metabolic rate to make hormones and your heart beats and your kidneys function. All that requires some of the energy in you require some energy to process food. So when you eat a meal, you've got to absorb that that meal, etc. And then the third big one is physical activity. If you move your body, it takes more energy for that. So if you had good enough techniques, I could take every calorie that you consume and I could tell you where it goes. Can't always do that because it's tough to measure, but theoretically, energy intake and energy expenditure are related such that if intake is higher than expenditure, you're going to gain weight, and if it's lower than expenditure, you're going to lose weight. There is no way to lose weight without your energy intake being less than your energy expenditure.

Dr. Gabrielle Lyon: 06:50

That's fascinating. You would think that that would solve it. Yeah. People

Dr. James Hill: 06:54

say, Well, it can't be that simple. The problem is, it isn't simple. So if I look at all the things that affect your food intake, you know, your environment, the number of people you're with, the type of food, and the things that affect your expenditure. It is very, very complicated. And then more recently, one of the things I've been very interested on are differences in metabolism. So let's take two people that, let's take two women who weigh the same, exactly the same body composition, and I feed them the same amount of calories. You would expect the body weights would be the same. In fact, because metabolism is different, that the body weights may change. Some people may have a little bit more efficient metabolism. Some people may have a microbiome which is a little bit more leaning toward burning calories rather than storing calories. These are small differences, but it's why people always say, How come my neighbor can eat what I eat doesn't gain weight. I gain weight because metabolism can differ. And I think we're beginning to learn a lot about the aspects of metabolism that relate to body weight.

Dr. Gabrielle Lyon: 08:08

When you moved on from energy this energy expenditure hypothesis, what was there a moment in time where you said, You know what this, This just can't be. It. Can't be it,

Dr. James Hill: 08:17

yes, there was. And then the question is, what is it? Okay, and so you begin to look at energy intake, and I did a lot of work with different kinds of diets, macronutrients. What about fat? What about carbohydrate? What about protein? A lot of different studies looking at how those different nutrients are metabolism, are metabolized by the body. So fat comes in, it has more calories, has nine calories per gram. Carbohydrate has four calories per gram, but they're handled very differently by the body. And for example, you have virtually an unlimited ability to store fat. You are never going to run out of storage space for fat. You don't have an unlimited ability to store carbohydrate. You can store a little bit in the blood and a little bit in muscle and liver. So the body, I think, prioritizes regulating carbohydrate, because it's important that you do something, and it's not so important you regulate fat. So I really did a lot of research looking at how diet composition affects metabolism and ultimately, may affect body weight.

Dr. Gabrielle Lyon: 09:23

You know, Don Lehman had mentioned that, I guess there was a period of time where you went to go. Maybe you were visiting professor at the University of Illinois. Is that what happened? I think so. And you went, you visited the campus, and I think at that time, that must have been the early 2000s perhaps I'm curious as to what you were looking at. You know, you are very unique in the way that you're also somewhat of a historian. Yeah, you've, there's, you know, the first generation, you know, there's Ancel Keys, and this kind of generation of nutritionists and biochemists. And then there's the generation after, which is Don Lehman, which is, you. Which is Bob Wolf, you have a historical perspective more so than any one of us, and at the time, what were you thinking? And I know that was some time ago, but that was really probably towards whether it was maybe the food dye pyramid, or is it carbohydrates? Is it protein? Is it fats?

Dr. James Hill: 10:24

So at that point, and you're forcing me to think back, you know, you get old, your memory's not like it used to be. There were a couple things I was continuing to look at diet composition at that point. One of my scientific heroes was a biochemist named j, p flat. And this guy brilliant. He couldn't write so that he could understand it at all. You almost had to go through and decode his papers. Was brilliant, and he was arguing why fat was a problem more so than other nutrients. And I think it still is, I think it's gotten complicated, because the problem, and he actually outlined it, he said the most obesity producing diet is one that's high in fat and high in carbohydrate, and that's what we're eating today. We're eating that diet. And so what happens when you have a lot of carbohydrate is you burn the carbohydrate and store the fat. So, is the problem carbohydrate, or is it fat and it's not, you know, it's not as simple as one versus the other.

Dr. Gabrielle Lyon: 11:29

Where did the weight registry come in? How was that and why was that developed?

Dr. James Hill: 11:34

So this is, I kid you not. This was a project developed over a beer.

Dr. Gabrielle Lyon: 11:41

I hear that those are where great projects are developed.

Dr. James Hill: 11:44

I was at a conference with my co founder, Dr Reena wing, who's one of the most brilliant psychologists. She's now at Brown University. So we went to break from the meeting. We went to the bar, and we were talking about, gosh, the media just portrays that nobody succeeds at weight loss. You know, there's got to be people out there who succeed. And we kind of looked at each other and said, You know what? Maybe we could find them. Okay, so then we put it together. Reena and I put it together. We came up with the criteria. We said, We came up with all kinds of ways to recruit, okay, and you'll love this being in the media. Then we had these plans to reach out to physicians, da, da, and just by chance, I remember I was asked to do an interview with the Orange County newspaper just on something else, and I mentioned that we were starting the registry, and we got letters that just flooded in. And so being a brilliant scientist, I said, this is where the media may have some value. And so we largely recruited through the media, and they all wanted to do a story, and they wanted to talk to somebody in the registry. And so we said, if you talk to someone the registry, you have to put our information in your article. And we populated the registry that way.

Dr. Gabrielle Lyon: 13:10

And, you know, I have here, this definitely is just a massive contribution. It was, you know, a study of long term weight loss maintenance, and this, this was co founded in 1994 and is the largest ongoing study tracking individuals who lost significant amount of weight. And this was 13.6 kilograms, right, greater than or equal to 13.6 kilograms, and maintained that for a year or longer

Dr. James Hill: 13:41

to as the entry criteria. In fact, we ended up with over 10,000 people, and I think the average length of maintaining was five or six years. So these weren't people that are a little bit successful. These were people that were very successful. And when we started out, we thought, wow, we're probably going to identify the right diet for weight loss, and that's going to make us famous. Well, what we realized is there was no similarity in how they lost weight. They lost weight with good diets. They lost weight with the beer diet. They lost weight with the red, green, you name it. They lost weight with that no similarity, but when we were looking at how they were keeping it off, that's when we began to see the similarities, and that's what led me, for the first time, to understand that losing weight and keeping weight off are totally different processes regarding requiring totally different skills. I'm

Dr. Gabrielle Lyon: 14:42

going to say that again, because I don't think that it's nearly ever discussed that weight loss is an different skill than losing weight and keeping it off, essentially weight loss maintenance.

Dr. James Hill: 14:58

And I could talk for a long time. Time about the differences, but I'll give you a few. The key to losing weight is food restriction. Let's face it, you can lose weight with exercise, but you got to do a lot of it, and for most people, it's not practical. And let me preface this with I'm going to tell you that exercise is critical, but for weight loss, you don't have to exercise to lose weight. So food we we always say food drives the bus on weight loss, and all you have to do is food restrict. And I think what we're seeing is it really doesn't matter what you eat, as long as you eat less. And that's why every diet works. Don't eat carb, don't eat fat, don't eat this. They all work protein, proteins the same way you can say, you can you can tell people not to eat a single macronutrient, and the end result is they eat fewer calories and they lose weight. And so if you think about it, weight losses generally will get to the medications, but leaving the medications aside, weight loss has generally been like a three month process. Most people with lifestyle changes who go on a weight loss go on a diet, are going to lose all the weight they're going to lose in, say, three months. So for three months, think about what you can do. Number one, you restrict your food. Number two, you avoid any kind of situations. You avoid going out to dinner with friends. For the three months. Maybe you don't drink any alcohol. You kind of put your life on hold. For Weight Loss maintenance, you have to live your life. You can't do this. And for weight loss maintenance, this is where physical activity now switches and becomes the driver, the the reason that most people have failed, and most people have failed. We know that most people who have lost weight, very few keep it off. People in the National Weight Control Registry are clearly in the minority. So for most people, what happens is you go on a food restricted plan, you lose weight, and you try to restrict food forever. Well, guess what? You get hungry. And we have, I think we have decades of information showing that doesn't work, back to the energy balance point, which is critical. When you lose weight, your body size is going down. Your energy expenditure is tied to your body size. So as you lose weight, you need fewer calories to maintain your reduced weight. Okay, so now you are in a situation where your energy expenditure is low. You're trying to food restrict to match that low energy expenditure, and people just can't eat enough to be satisfied. Alternatively. Now if you increase your physical activity, even though your energy expenditure went down with weight loss, you're sort of replacing that drop with physical activity. So at the end of the day, people are eating an amount of food, an amount of calories that may not be different than they were eating before, because they filled what we call this energy gap with physical activity rather than food restriction.

Dr. Gabrielle Lyon: 18:01

That's so fascinating. I want to circle back to this idea that exercise is not needed for weight loss. Can you parse that out for me? Yes,

Dr. James Hill: 18:12

there is no time where I wouldn't recommend weight loss and exercise. Weight Loss too, but exercise so, yeah, so you don't need it. It helps a little bit. And the data are a little mixed. Some studies show that with exercise, you lose a little bit more weight. Maybe you lose a little bit more fat versus muscle, but, but there are tiny differences. You can totally lose weight with zero exercise. Now we recommend that people do exercise with weight loss, but it shows the critical thing that's getting the weight off is food restriction, totally different in weight loss maintenance, and this is where, and hopefully we can talk about this too. It goes just beyond diet and exercise, because now the mind comes into play, because now you have to live your life. You have to find a way of living your life. You are going to face challenges. With weight loss. You can sort of remove those challenges for a period of time while you lose weight, but with weight loss, maintenance is forever, so you're going to have problems. And we tell people, it's not if you're going to have a problem, it's when and it's how you're going to handle the problem. So resiliency, positivity, I'm beginning to believe that these characteristics may be even as critical as diet and exercise in terms of long term success, I love

Dr. Gabrielle Lyon: 19:34

that, and we agree on that. So what you're talking about are these attributes of grit and courage. Yeah,

Dr. James Hill: 19:42

we call it mind state. We don't like mindset per se. We like mind state. And what we've learned, you absolutely can improve your mind state. The example, we get a lot of people that would come into our weight loss programs and say, Okay, I'm here. But you know what, it's not. Going to work. I've tried this before. I'm going to give it a shot, but, but it's not going to work. Well, guess what? It doesn't work. Things like positivity, things like recognizing if you're going to have a problem, how are you going to solve it? How? What's your mind state to say, I know there's going to be a problem, and I know have the skills to get through it. It may not be easy, but I'm going to get through it, because so many people a problem arises and they say, To heck with it. I'm just going to give it all up. And so you lose all this ground you've done, and it's really devastating to see people succeed, succeed, and one thing throws them for a loop, and they regain it all back.

Dr. Gabrielle Lyon: 20:39

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Dr. James Hill: 23:10

I we're We're fans of higher protein, and higher protein does a couple things. One, that's more satiating, so it helps you feel full. And you know, we've done a lot of work of people that come off of the weight loss medications, and that's where, like ozempic, or we go V or Z bound, and that's where protein and then I would say protein combined with exercise is the single best way to minimize loss of muscle mass. Now, when you lose weight, you're going to lose some muscle and some fat. Well, however you lose weight, but what we want is for most of that weight loss to come from fat and as little as possible to come from muscle. And I think the combination of high protein diets and exercise may be probably the best thing you can do to favorably get that composition of weight loss

Dr. Gabrielle Lyon: 24:04

in the registry. Were you and you guys were looking at the composition of the diet

Dr. James Hill: 24:09

we were but let me tell you right up front, I'm not a fan of self reports of food intake. Why is that? Because I just don't think people are very accurate on what they eat what people told us, and this is just food records, they're eat. We're eating a low fat diet, a little bit higher protein, a little bit higher carbohydrate. I don't, I don't hold a lot in those records, because I don't, and it's not that people lie. It's just so hard to recall what you've eaten and recall portions and everything. But, yeah, we do have that information, but it's not among the information I think is most reliable.

Dr. Gabrielle Lyon: 24:49

What do you think when you so the people can lose weight? Is there something to be said for the speed at which they lose weight? I think it was that. Was it the ABC composition study? Is that? What that was that showed, Chris Gardner, okay, that showed that within the first was it three months, or six months, that those that lost a substantial amount of weight swiftly were the ones that were able to keep it off. You

Dr. James Hill: 25:11

know, for many years, the sort of the dogma in the field was pound or two a week, slow, steady weight loss. I'll tell you, I've come to the conclusion I don't think it matters. I think rapid weight loss is fine. I almost, almost, I'm not going to quite go there. I don't think it matters. How you get it off? I think the key is having a plan for keeping it off. Now there are some unsafe ways to do it. What we know is different compositions of diet all lead to weight loss. And we've had tons of studies now comparing low carb and low fat diets for weight loss. In the end, they're exactly the same. And I used to be, you know, like everybody else in the field, when the Atkins diet first came along, it was like, Oh my gosh, this is awful. Fat, unlimited carbide. We were the first group to actually do a study of the Atkins diet, and turned out people lost weight and their metabolic health improved. And so it's like, well, you know what? It's okay. And I think what it says is weight loss trumps the method of weight loss. Weight Loss is so powerful on metabolic health that whether it's high carb, high fat, high protein, you're still going to get tremendous benefits from the weight

Dr. Gabrielle Lyon: 26:27

loss is that in the acute setting versus long term. Because I just, I can't help but think, you know, in our so we have an active clinic, and when people lose weight rapidly, if we don't protect their muscle, and we track it over time, because we will use things like ozempic and maybe not at the robust doses, but if we don't protect their muscle, we see increased level of insulin, increased level of glucose. They just they can't seem to manage their glucose. Yeah,

Dr. James Hill: 26:56

interesting, and that's where I think especially research with the new round of drugs is going to be particularly important, because that's one of the things we're concerned about, is loss of muscle mass on the medications too early to say there's a problem, but it certainly is something that's on people's minds as a potential problem. You

Dr. Gabrielle Lyon: 27:16

know, there's a wonderful paper that you wrote to energy balance and the small changes approach to obesity prevention. And you made some very great I mean, there's some great points here. And one of the things is that you point out that since the 80s, people of all body weights have been slowly gaining weight, implying environmental and behavioral changes rather than sudden, sudden genetic shifts. So this is

Dr. James Hill: 27:44

we had several years of really having the fun with the small changes. And what started it is we basically said, Let's look back about how people have been gaining weight. And so we took some surveys. We took the NHANES survey, we took a couple of other of these large databases, where they tracked people's weight over time, and we said, on average, how many extra calories are leading to the weight gain we've seen in the population? We were astonished. It was like less than 20. And we said, nobody's going to believe 20. So we went through, well, maybe it's energetics and everything, we came up with 100 calories, which isn't very much, but it was more than actually we saw in the data. And the idea is, now that doesn't mean you're eating 100 extra calories every day, but over a period of time, your weight gain is due to an average of less than an extra 100 calories a day. And so we said, well, we could prevent weight gain. This is not weight loss. The small changes was taken for weight loss, and it doesn't work for weight loss. What do

Dr. Gabrielle Lyon: 28:56

you mean by that? What do you mean by that? So small changes,

Dr. James Hill: 28:59

100 calories a day will help prevent weight 100 calories a day, you need more for weight loss. It isn't going to do much for weight loss. So it's always been a strategy to prevent weight gain. And the idea was to say, could we get people to change their behavior by 100 calories a day, whether they're normal weight or obese, and stop the weight gain. Never meant as a way to reduce weight, but to say first step in solving a problem and keep it from getting worse. And so we started, it started in Colorado. We did a program called Colorado on the move that was really, really popular in Colorado, and we took it national and created a nonprofit called America on the move. And the idea of America on the move was to get people we said, well, people won't do exactly what you tell them, so let's ask them to do 100 calories on the food side and 100 calories on the physical activity side. And if the net result was 100 calories would be great. And. This thing took off like crazy, and we reached millions of people. We were in schools with USDA funded a big school project, and it was really, really amazing. We had, we had a lot of industry support. So food companies advertised in the grocery stores. We had this. We had the YMCA was one of our big partners, the CDC. It really was a fabulous partnership. And unfortunately, as these things happen, our we had a wonderful CEO. She went off and got married that we had some switch, and the industry people and support went down, and it sort of dwindled, unfortunately, but I feel like we made a huge difference for a while, and I still believe the small change approach will work for prevention of weight gain. Unfortunately, in this country, we have 75% of people that are already overweight. It's not going to work for weight loss maintenance. You need big changes for weight loss and weight loss maintenance. Small changes can prevent weight gain. But I remember people telling me, you're the first people that have actually asked us to do things. We could actually do behavior changes we could actually do people tell us to go out and exercise 30 minutes a day, and I hadn't been off the couch in 10 years, but you're telling me, all I have to do is walk to the mailbox and back and I get credit for it. And then we use pedometers, which was a wonderful I use those to measure they're brilliant. They're cheap. There are wonderful tools. And so getting people to do 2000 extra steps a day.

Dr. Gabrielle Lyon: 31:36

How so that that is exactly what I was looking at was the extra 2000 steps. You said something that's really fascinating, that, how do we prevent weight gain? It's almost this idea that we're thinking, how do we prevent Alzheimer's, how do we prevent heart disease? This idea of of weight gain seems as if we're also thinking about it as something that, if we don't pay attention to, we're going to gain weight. So

Dr. James Hill: 32:05

theoretically, everything I know about energy balance, it should be easier to prevent weight gain than to treat it once it's there. So in a way, and you know, several people have said this a little bit tongue in cheek, but maybe not totally is we should forget adults, and we should take all of our efforts and we should apply it to kids. So think about this. You have kids that are basically in a school setting through high school. There is no reason we couldn't create an environment to help keep those people healthy during that period of time, and then they go off to college and whatever, but you've given them a good start. So I think there is some value in saying maybe we should look at devoting more resources toward our kids.

Dr. Gabrielle Lyon: 32:53

Are we less active now than we used to be? Yes, tell me yes.

Dr. James Hill: 32:58

So my late friend Steve Blair did a lot of this work around showing how activity had decreased. He shows that activity in the workplace, people used to be physically active to work, and now they sit in front of computers, meaning

Dr. Gabrielle Lyon: 33:15

they used to ride their bikes, or they used to,

Dr. James Hill: 33:17

they used to have to do manual labor in you know, at jobs would require a manual labor. I'm talking, you know, I think the decrease in physical activity started probably after World War Two. So if you look in the 40s and 50s, most people, they were laborers. They had to you wouldn't have computers, so they didn't sit at their desk. And I think what happened is you had this gradual decrease in energy expenditure. And I think right now, we're just about as sedentary as we can be as a population. And I maintain totally that if a population is going to be this sedentary, obesity is inevitable. You cannot have low rates of obesity and low physical activity. And in fact, I keep saying, I've never, I've never known a population that's existed on Earth with low physical activity and low obesity,

Dr. Gabrielle Lyon: 34:14

low physical activity and low obesity. Do you think from all of your studying that, and I don't want to ask the question, is it exercise or is it diet? Because clearly it's both, and you've done yeah, a ton of work on frustrates

Dr. James Hill: 34:30

me when people ask that. It's like me asking you if your net worth worth is due to your intake or your expenditure. The answer is yes, and the unfortunately in our field, the nutrition people and the exercise science people develop differently. Yes, lots of donation studies don't measure physical activity and vice versa. It's one of the things that it's frustrated me my whole career, but it's still happening. It's both. You cannot understand it without understanding both intake and expenditure.

Dr. Gabrielle Lyon: 35:07

Speaking of intake and expenditure, why and you are really the predominant expert. Why do people fail from long term weight loss?

Dr. James Hill: 35:17

A couple of reasons. We we and others have typically approached obesity treatment as getting the weight off and keeping it off. Okay, before the medications, we would see a few, but very few people that were ever ready for weight loss maintenance. They would they they might have lost 10% or 15 they would say, Yeah, I'll be ready for weight loss maintenance when I lose another five or 10 or 15% so we always had trouble getting people to change their mindset from losing weight to keep it off, because they weren't reaching their goals. You know, we did work with Gary Foster and Tom Wadden, where Tom and Gary did a simple study. It was brilliant, and then we repeated with them. You simply ask people what their goal weight is before they start a weight loss program, and their goal weight was like 20, 25% Well, the programs then could produce 10, maybe. So you get a situation where and 10 wasn't even their disappointed weight. They ask them what their disappointed weight was, and so the program couldn't even produce the disappointed weight. And that's why I'm actually excited about the medications, because if the medications can get the weight off, great, I don't have to do that now. I can work on weight loss maintenance.

Dr. Gabrielle Lyon: 36:35

That is really fascinating. And what you're saying here for the listener, if we just parse this out is that initially, before these glps, GLP ones, and these various generations of these drugs, because these drugs are here to say, Stay we're talking about ozempic. We're talking about moderna, you, and there's more coming out. One that before, the best anyone could do outside of geria, bariatric surgery was you're hoping for 10% 10%

Dr. James Hill: 37:04

is success. Some people, we would get 12% in some studies, but we and individuals could do more. But as a group, we couldn't even approach 20%

Dr. Gabrielle Lyon: 37:15

and now with these medications, the average is 20%

Dr. James Hill: 37:19

which means half the people are even losing more than 20%

Dr. Gabrielle Lyon: 37:23

and we have to pause and acknowledge how deeply impactful that is.

Dr. James Hill: 37:29

It's a game changer. It's a disrupter, and I say that in a positive way, these meds has have disrupted obesity research, and we needed disruption because we've made incremental progress lately. Now we have something big and new, and so these are wonderful, wonderful tools. They're not the magic bullet, they're not the

Dr. Gabrielle Lyon: 37:51

only bar, but they are initially, they're the, the initial magic bullet, you know, to be able to lose, you know, I, you know, I have one of your studies here, which is high in normal protein diets, improved body composition, glucose control in adults with type two by diabetes. This was a randomized trial that you did, and the goal that we were, you were hoping for was, you know, weight loss of greater than 10% improved glucose control exactly to remit type two diabetes. Now, with these medications, and you're

Dr. James Hill: 38:19

what you're seeing is people are getting rid of their diabetes, getting these rid of their diets, are wonderful drugs for weight loss now, then you have the weight loss maintenance. I think the drugs, more than anything else, point out the difference between weight loss and weight loss maintenance. And so the way the drugs were developed, the idea is, you go on these meds, you lose weight, you continue taking them forever, and you keep weight off, which is fine. We do that with blood pressure meds and other kinds of things. And the data we have, I think we have four year data, suggests that people that stay on them in clinical trials keep the weight off. And

Dr. Gabrielle Lyon: 38:58

when you say four year, when you say four years of data, the GLP ones have been used for

Dr. James Hill: 39:06

weight and keeping weight off. We have good clinical trials for about four years. So my guess is, as long as you continue to take them, they're going to work, which is fine. I have no problem if you want to go on the meds and stay on them forever, and it works for you fine. But here's the issue, is the data coming out, and it's mostly coming out from insurance companies that are looking at large databases show that at least for weight loss, less than half the people stay on them for a year. Why do you think that is? Well, I'm going to tell you, but before that, one of the things, again, we know from the clinical trials is when you stop the drugs, you tend to gain the weight back. So the idea is, you take these drugs, they fix something. Your weight is okay, no, no, no, no. The drugs only work when you're taking them. They work very effectively. But when you stop taking. Numb your your hunger comes back, and so most people are going to regain weight. The number one reason that people seem to discontinue or side effects. Now the side effects are mostly gi you know, the nausea and vomiting and everything. And again, while people are losing weight, they're much more tolerable of side effects than Okay, your weight isn't changing. If your weights going down, you're saying, I can, I can take this. So there are some people that just don't want to manage the side effects. Long term seems to be one a second one is cost. Because again, right now, insurance reimbursement is erratic, and if you don't have insurance reimbursement, it can be up to $1,000 a month. So there are a ton of people who can't afford to do that. Another one, and this seems to be a big one, and maybe we can do something about this. It's just the sense that I shouldn't have to take a drug to manage my weight. It's like, it's almost like cheating. It's unethical to do that. And that one I don't buy. It's like, come on, you. You Your biologist working against you. Fixing your biology is fine if don't use that as an excuse. But for some reason, a lot of people want to do it without the medications and then a couple more things that we find. The foodies Miss food

Dr. Gabrielle Lyon: 41:20

that is interesting. Yes,

Dr. James Hill: 41:23

it is, and I can relate to that. I mean, we, a lot of our social life revolves around dinners with friends and eating out at restaurants, and I'm not hungry. I don't really want any of that. So people miss that. So there are several reasons why people go off and again, let me make it clear, if you want to go on the drug, you do well, you stay on the drug. I have no problem with that. What I want is to help provide some alternatives for people who have to or want to discontinue the drugs. And

Dr. Gabrielle Lyon: 41:55

why do people regain weight so quickly, whether they're on the drug or let you know, there could be a drug arm and then a non drug arm. Why, in general, do people, and

Dr. James Hill: 42:05

we've learned this from the National Weight Control Registry. So again, I told you, as you lose weight, your energy expenditure goes down, your hunger hormones go up. So in a way, your body is set to regain it. It's

Dr. Gabrielle Lyon: 42:18

like that adaptive thermogenesis,

Dr. James Hill: 42:22

adaptive. Thermogenesis might be a part of it. It's how you define it. So, yes, your energy expenditure is lower. It adapts. What we seem to know is that the drop in energy expenditure is appropriate for your body composition change, but it's still what it means is you're at risk because you don't need as many calories, and you're hungrier, your hormones increase to make you hungry, so you have a low energy expenditure and a high hunger. And that's, you know, it's, it's almost like yours. Your body wants you to regain the weight, and these people who succeed really have to fight that, and I personally think high levels of physical activity are the way that most people overcome this desire to regain weight.

Dr. Gabrielle Lyon: 43:13

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Dr. James Hill: 45:00

because you get your energy expenditure back up, but it seems to modulate these hormones that drive you to eat more.

Dr. Gabrielle Lyon: 45:07

Is there a baseline level of activity that someone would have to partake in? So

Dr. James Hill: 45:13

from the National Weight Control Registry, again, 10,000 people keeping off a lot of weight. The average physical activity is an hour a day. Is

Dr. Gabrielle Lyon: 45:26

that walking? Is it jump roping? Great push ups. Great

Dr. James Hill: 45:30

question. It's movement and again. So there is a range. 8% of people in the registry didn't do any exercise 8% okay, 92 had to exercise to keep it up. So, you know, is that genetic or what is that? Yeah, who knows? Probably. But if you want to be in the 8% good luck. But everybody else is is active, and that activity differs a bit. And when we break it down, it's the combo. They do several things. They do planned activity every day. It's hard to get an hour in without doing some planned but they do a lot of lifestyle. They do a lot of walking and just moving around. And walking is a big part of what they do. But it's usually walking in something else, walking in aerobics, walking in you know this and that the other thing is, they do more weight lifting than one would expect from a population. Pause, what? Yeah, that, yes, resistance training. I've never heard of them. There may be something about resistance training that may be important. What do you think that is? Well, again, I think it's may relate to muscle mass. Is it may help these people maintain muscle mass. They also tend to do a little bit of intense activity too. So I think this is a wonderful area for future research. What's the right combination? What where we are is first step is you move any way to move. Move now, then we can talk about maybe trying some intense maybe trying some resistance training, but we recommend that people do it in three ways. You have some planned activity every day, and that might mean 30 minutes, or whatever you look at, being active in your lifestyle. You walk around more. You're the meeting early. You don't sit, you walk around. And the third one is that you really try to add walking whenever possible to your life. Oh, the other one is is decreasing your sedentary activity. So less sitting. We know more and more that sitting is a marker for health problems, and one of the things we recommend is people look at reducing your sitting during the day. Sit for 30 minutes or less, less tomorrow than today. Doesn't matter what you do. Anything you do other than sitting is good. So it's accumulating activity, both planned and lifestyle. When

Dr. Gabrielle Lyon: 48:00

people I just want to circle back to muscle. Muscle really hasn't been a focal point up until I would argue when I say recently, maybe the last 20 years, and really in the last seven, and I'm picking an arbitrary number where it's beginning to hit a stride. Where do you think muscle mass plays in the role of not weight loss? Because I do want to talk about weight loss, and what from your data you feel would be an effective diet for weight loss, which we talked about briefly, that it's really any diet, but I think there is so much confusion about what that means. And we also have to think long term, that if we lose weight rapidly, which, again, is not bad, but if one is more mature, and the balance of weight loss is 50% lean mass and 50% fat, then with the recidivism rate, you get into this cycle of sarcopenia, obesity, which is very concerning. Absolutely, when you think about muscle, how do you think about resistance training and then that kind of dietary piece for weight maintenance?

Dr. James Hill: 49:14

Well, again, I think you're talking about protein and exercise, the combo that's going to work. And one of the things we know about muscle, it's probably the best predictor of your longevity, is your muscle. So it's critically important to do muscle. And you know, it's only recently, I think the GLP one meds have focused on this is we would measure fat and fat free. Now fat free is a lot of stuff other than muscle. And now there's really an effort, and there are some techniques you can use to actually measure muscle, like c3 creatine, exactly, exactly, MRI you can do that with and so I think we're we're going to see much more about muscle. Quite simply, if you have more muscle, you're going to have a higher energy expenditure. You're. Going to be able to do more exercise and move around. I think it's one of the things we should focus on, and particularly people like me, old people, we don't need to lose great

: 50:09

for 25 I know you're talking about we cannot afford

Dr. James Hill: 50:13

to lose muscle mass, and that's one of the problems with weight loss and older people as some data suggesting that you lose it, but when you regain it, you might regain more fat and not as much muscle as you had. And having less muscle is not a good thing.

Dr. Gabrielle Lyon: 50:30

I was reading some of Bill Evans work, and he is, he a friend of yours, yeah, oh yeah. Bill's

Dr. James Hill: 50:35

developed the technique, yeah, doing muscle mass. And he's, he really pioneered this whole sarcopenic obesity, and he showed, I remember years ago, he exercised 90 year olds and showed that you could have a huge benefit, even if you were in your 90s, with adding some resistance drain. It's

Dr. Gabrielle Lyon: 50:52

incredible. Do you think that as we become better at identifying skeletal muscle mass, that we will have a better way to tell people numbers to shoot for. Yes,

Dr. James Hill: 51:05

it's hard right now because you have to use some, some, you know, techniques that not everybody has access to, but, but I people love numbers. And if we could figure out some way that they could really know how much muscle mass they had, I think it would be

Dr. Gabrielle Lyon: 51:22

great. How do you recommend people track their body composition? So if

Dr. James Hill: 51:26

you want to do it at home, a bioelectrical impedance scale is a good way to do it. It's not as accurate as some of the lab techniques, but it will give you a general sense, and particularly allow you to track changes over time if you're losing weight. So that one's pretty easy. In a Research Unit, we use DEXA, dual X ray, absorb geometry. Your physician can do that oftentimes, even some of the fitness wellness places have. It's called a DEXA, and it's pretty accurate on separating your body into fat and everything else, which is called fat free mass, directly measuring muscle mass is really done right now, only in a research setting, and the hope will be as the techniques are get better and better, that will be more available, maybe to primary care physicians so bioelectrical impedance at home, and then look around. If you really want more accuracy, try to find someone that offers DEXA measurements of body composition. Do you think we'll get there? I think we'll get there. I don't see it happening anytime soon, because right now, the techniques to measure muscle mass aren't going to be widely available to the public. I would love it. If your patients could come in and you can tell them, I'm special messy,

Dr. Gabrielle Lyon: 52:43

and we do in in a roundabout way with bioimpedance, I'm sure,

Dr. James Hill: 52:47

yeah, that, and that's good, that's something, but you're Yeah. The reason I

Dr. Gabrielle Lyon: 52:53

asked that is because you and I can say, at 25% a man is going to be considered, you know, overweight or obese at 30% of body fat percentage, we know women are going to have problems depending but I can't say, you know, Jim, we need to see 40% of your weight. We need to see 40 pounds of muscle mass.

Dr. James Hill: 53:13

See, we don't have those norms. As we're able to measure muscle mass, we can actually get the norms. What is the right muscle mass for a 30 year old female. You know, this is where science is a wonderful thing. It's going to move forward. And the good news is, there is a huge focus on muscle mass right now. So I think we're going to get better at measuring it, and hopefully one day, before too long, we'll be able to give people that information to

Dr. Gabrielle Lyon: 53:42

use. I hope so it would just again, give people like numbers, absolutely. Are there things that Well, number one, do you think there's a genetic propensity to gain weight?

Dr. James Hill: 53:53

Absolutely, you do absolutely, genetics play a role. But genetics the one message to the listener says, Don't blame your genetics. There are very few people. There may be a few who have genetics such that they're destined to be obese. There's maybe those disgusting people that have genetics that they're never going to be obese. I know that's not very many of them. Most of us are in between. Think of it as you probably have genetic limits on your way. You could possibly be this high, you could possibly be this low. So it's your lifestyle within those two that determines where you are. But I definitely think that people do differ in how susceptible they are to gain weight or to regain weight after they've lost it.

Dr. Gabrielle Lyon: 54:39

What are the people doing that never have a weight issue versus the people that have weight issues? What are they doing differently? I

Dr. James Hill: 54:46

don't think we know. There have been a couple of studies to try to look at that. My former colleague in Colorado, Dan bessesen, did some of that, and he basically, I think what he found it was they used the fat more efficient. So fat and a meal was used more efficiently. But bottom line is, I don't think we have a good explanation for exactly how genetics make you destined to be lean.

Dr. Gabrielle Lyon: 55:10

What are some of the things that people do that make them most successful so they never fall back into that weight regain pattern?

Dr. James Hill: 55:19

Yeah, so in the National Weight Control Registry, the techniques that we've gotten that we see, self monitoring is right up there. These people monitor their weight, usually once a day. Some people multiple times

Dr. Gabrielle Lyon: 55:34

a day. We don't recommend that, meaning they get up in the morning. They get up in the morning,

Dr. James Hill: 55:37

they weigh themselves. And you know, people say, Oh no, no, you don't really don't pay attention to the scale. And if you ask these people, they're going to say, how am I going to know if I'm gaining weight if I don't get on the scale? So we recommend weigh yourself every morning, get up, brush your teeth, get on the scale. And the other thing we know is that weight will differ. For some people, weight can vary four or five pounds from day to day, so do not take a single weight. And by the way, the scale is not your enemy. The scale is simply a tool. Do not give it any power over you. But what we recommend when people start losing weight is weigh yourself every day for a week, get a baseline, take the average of the baseline, and then track every day, but don't look at a single day average over a week at a time. So they self monitor, they self monitor their physical activity too. They keep physical activity diaries of how much they've done,

Dr. Gabrielle Lyon: 56:33

so what? And now it's easier than ever, right? Because now we have tracking wearables. I

Dr. James Hill: 56:37

mean, wow, these people would do diaries now wearables. I love wearables. They're wonderful. Simply pedometers. You can get as sophisticated as you want with actigraphs and Fitbits and all that easy to track your activity. So they track their activity. The other thing that we find is they're consistent. They don't take days off, they don't take weekends and holidays off. They basically have a plan. They stick with their plan. Then the activity, our day of physical activity. And so they

Dr. Gabrielle Lyon: 57:11

think about, is that premeditated, or is that something? Oh

Dr. James Hill: 57:13

yeah, oh yeah. And a couple of things about that. So first of all, these people do not get to the point of they live to exercise, they'll say something like, I don't love it, but it's become an important part of my day, and I wouldn't miss it. Okay? And you say, how, when we talk to people about physical activity, it's all in how you approach it? Gabrielle, you need an hour day of physical activity. What's an hour a day, a lot or a little, you have 24 hours in the day, if you can keep off 70 pounds with an hour a day. So you approach it to say, look, all it takes is accumulating an hour a day to do this. So it's how you do it. And where do you find time? Well, we looked at TV watching, and these people watch less TV. So you know, one program less a day that you watch, and there's your time for physical activity. You can even exercise while you're watching TV. And

Dr. Gabrielle Lyon: 58:07

it's interesting because it makes me think of our current exercise recommendations of 150 minutes and two days a week for

Dr. James Hill: 58:15

keeping weight off. That for the general public, yes, but I will tell you that if you want to keep weight off, it's going to take more and that's

Dr. Gabrielle Lyon: 58:23

a very important point, because, well, first of all, 50% of Americans don't exercise, and now we have this guideline that's 150 minutes, and you, being a weight loss expert, is saying that if you want to lose weight and keep it off, that's not

Dr. James Hill: 58:37

going to do it. And again, I think we have to be, we have to be transparent with people. 150 minutes a week. Won't do it for most people. And I would tell someone if, and we actually do, we tell people, if you're not prepared to significantly increase your exercise, you might as well just not do it, because you aren't going to be successful. And

Dr. Gabrielle Lyon: 58:57

you hear people say, I don't know. Again, if you've heard this in social media that exercise again, and we kind of touch on this is not an effective tool for weight loss, and you have to clear that. You have to clear this up for us. So

Dr. James Hill: 59:11

my friend, another of the people that are my scientific heroes, is a guy named John Blundell, who's a psychologist in the UK, he has done these studies over and over and over, if you exercise, people during weight loss, yes, they compensate, but they do not compensate completely. They partially compensate. You still get a negative energy balance from exercise. So the idea that people exercise more? Will you just eat more to make up for it? No, not true myth. But the other thing that exercise does, I don't think burning calories is the single best thing that exercise does. I think exercise actually optimizes your metabolism. Tell

Dr. Gabrielle Lyon: 59:56

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Dr. James Hill: 1:02:00

So there's a concept called metabolic flexibility. It's kind of a hard concept for people to get a handle on, but think about this. During your typical day, you get up in the morning, you've been burning fat, you have breakfast, you switch over and burn carbohydrate. You go exercise. You may burn a little fat and carbohydrate. So during the day, your body is constantly using different sources of fuel. You're using glycogen, which is stored carbohydrate. You're using fat from your fat cells and potentially from your muscle. Metabolic flexibility, people who are metabolically flexible have the ability to very quickly switch between sources of fuel. The best example I've come up with is take two thermostats. One you crank it up to 70 degrees, boom, it's there in five minutes. The other one gets there, but it may take 15 minutes to get there, and there's an advantage of having that quickly, being able to switch from one fuel to the other, it's almost like rounding of the corners. You get a little bit extra storage here and there when you aren't able to switch quickly.

Dr. Gabrielle Lyon: 1:03:10

Why and why is metabolic flexibility important? Because

Dr. James Hill: 1:03:14

I think metabolic flexibility gives you that buffer so that we're all going to overeat occasionally. And I think if you're metabolically flexible, and these are tiny advantages, but they're tiny advantages that are there day in and day out, you're going to store just a little bit of less of that than you would store if you're not metabolically flexible. Now, metabolic flexibility includes insulin sensitivity, which is a big part of it, muscle function, even the microbiome we we were talking to a microbiome expert, and basically he said things like physical activity can help your microbiome release a little bit of fewer calories than if you're not physical active. Again, these are tiny, tiny differences. But day in and day out, these can be really important.

Dr. Gabrielle Lyon: 1:04:04

And how would someone you had mentioned that when you wake up out of an overnight fast you're burning largely fat fatty acids. That makes sense, your muscle burns largely fatty acids. At rest you have your first meal, and you'd mentioned that they then switch to carbohydrates. Is it dependent on that first meal of what that composition is?

Dr. James Hill: 1:04:24

Now, well, we don't know that. That's a good question. Probably not, although I'm not going to say 100% I think it's mostly if you look at what metabolic flexibility is, it's every tissue in your body working optimally. Even the heart has the ability to switch fuels. And I think we're learning it's this holistic sense of the way I think of it is, if you're metabolically flexible, your metabolism is working the way it's supposed to. When you're inflexible, it's like we start out with a flexible. Metabolism, as we get overweight and sedentary, it becomes inflexible, sort of this vicious cycle of helping to add a little bit more weight, which makes you more metabolically inflexible.

Dr. Gabrielle Lyon: 1:05:12

Do you think it's an aging process or mitochondria dysfunction process?

Dr. James Hill: 1:05:17

I think it is a mitochondrial I don't, I don't know, dysfunction, but I would say less optimum mitochondrial function, and that's why I think it's in just about every tissue, muscle, liver, adipose tissue, again, you gotta, you know, you think, I almost think of it as exercising your metabolism. You know, get this fuel in and out of fat cells. Get your glycogen in and out of muscle. And I think just like when you stop exercising your body, bad things happen, I think when you stop exercising your metabolism, bad things happen.

Dr. Gabrielle Lyon: 1:05:49

I hadn't thought about that the way I'm hearing you say it is that this idea of metabolic flexibility is being able to burn the right fuels at the right intended time across the human span, right? And what I'm also hearing you say is that you have to exercise. So hang with me here. Exercise your metabolism, which sounds like fuel switching, but also emptying things like glycogen stores through movement and maybe potentially fasting, our periods of not eating. Is that what I understand absolutely.

Dr. James Hill: 1:06:25

So you you nailed the two. The two, the big one is exercise, because exercise forces, forces blood flow to your muscles. It forces every aspect of your body to sort of do what it's supposed to do work. But the other one you mentioned is intervening fasting. That's another way to exercise your metabolism. What happens now for most people, when they start to get hungry, rather than go and get fat out of their fat cells, they go to the refrigerator. So you never give your body this time of being without food, and I think this time with being out food without food. Actually does exercise your metabolism, particularly your adipose tissue, where you pull fat out and what you use goes back in. So it's like exercising your fat cells.

Dr. Gabrielle Lyon: 1:07:12

And that is not, is that a calorie, is that a total calories in, calories out, story, or is that a a period of restriction. How can we think about that?

Dr. James Hill: 1:07:23

I think the period of restriction is the most important thing. Now, does that lead to a calorie difference? And I think it does in most people, not everybody. And this is why I think intermittent fasting, or time restricted eating is going to be more effective in some people than other, but I think it's having this period where no food is coming out or coming in, forcing your muscle, liver and adipose tissue to liberate fuel store, internal stores of of energy.

Dr. Gabrielle Lyon: 1:07:57

How? How convincing is the data on that again,

Dr. James Hill: 1:08:01

I don't want to say totally convincing. I would say, I would say it's it looks pretty good, but we certainly, I would, would certainly not say that it's definite, but I'm at the point where we recommend it as something that people should try. I don't think there's a downside. I think for some people, it will be more effective than others. And even though I don't think we have the data to say absolutely, I think we have enough data and enough theoretical reason to say it's not a bad tragedy to try if you want to do something on the intake side,

Dr. Gabrielle Lyon: 1:08:38

I really like that. We We also recommend a time restricted window.

Dr. James Hill: 1:08:43

I like time restricted, yeah, but some people can't do it. I can do it. I do it occasionally. My wife tried it and she said, there is no way, like judge can't do this. So, you know, this brings us to this whole idea of we got to stop thinking about one size fits all people. We're gonna have to give people different strategies. And we're learning more about that. We don't know enough to really do it well right now, but I think we know enough to know that we're gonna need different strategies for different people. And

Dr. Gabrielle Lyon: 1:09:14

again, that is fascinating, because for the longest time, calories in, calories out, have really dominated the conversation. I believe in the law of thermodynamics, yet there seems to be this inter, you know, inter person variability, whether it's tolerance to exercise or you name it, the microbiome. What do you think the most underrated factor successful weight maintenance individuals do, or even weight losers,

Dr. James Hill: 1:09:44

we talk about exercise as medicine, food as medicine. The answer to your question, I think, is the mind as medicine. That is what I'm beginning to think is a real big difference between those that. Seed and not and it relates to sticking with the program I can give you the very best diet and exercise program, the part of the problem has been people have trouble doing that, and so they aren't able to stick with it. And I think we're learning that there are things we can do to mental health, to the mind state that actually helps people be able to stick with the kind of lifestyle they want to live.

Dr. Gabrielle Lyon: 1:10:27

Do you think there is something in the macro nutrient composition to help augment willpower? And what I mean by this is, for example, the protein leverage hypothesis. And the protein leverage hypothesis, as we know is, if your diet is, I think it's less than 15% that the body or the humans are going to feed to get to a certain amount of protein for an amino acid, and if the diet is of low quality, high carbohydrates, high fat that the individual is going to be driven to eat?

Dr. James Hill: 1:11:00

Yeah, so I think there's more data that we're driven to eat for protein than the other macronutrients. I don't think there's any data that we're driven to eat for fat. I think fat comes along. Okay, yes, I think carbohydrate we debate over. But I would say of the theories about the macronutrients, I think there's the strongest evidence for protein.

Dr. Gabrielle Lyon: 1:11:20

And you did a really interesting study, and this is called, and I'll read this. This is the equivalent reductions in body weight during the beef wise study, beef role and weight management, satisfaction and energy. Why do I bring this up? Because I was very interested in this study. This was 120 adults, mostly female, overweight or obese, and they were randomly assigned to consume either a high protein diet with greater than four weekly servings of lean beef or a high protein diet that restricted all red meats during 16 weeks of weight loss intervention. You've published a lot. Do you remember the study? I too. Okay, great. Yeah, it's just, it's it shows that there's a lot of flexibility and also a lot of safety in our choices.

Dr. James Hill: 1:12:04

We were interested because you see a lot, or at that time, I guess you still see it that, boy, if you're losing weight, avoid red meat. Red meat is not going to be good if you're losing weight. And we thought, hmm, is that true or not? And so we said, let's do a study to look at this. The thing that's always intrigued me, we we tell people so much of to eat stuff that doesn't taste good, that wouldn't it be nice? Wouldn't it be nice? I'm

Dr. Gabrielle Lyon: 1:12:32

guilty. I tell my kids, ask

Dr. James Hill: 1:12:34

people to do something that that tasted good and and so we were both interested in beef that was seen to be negative, but also the high protein as a way to lose weight. And so we did the study, and what we found is there was no difference. In other words, the big message here is there's no reason to avoid beef red meat if you're trying to lose weight, and the weight loss was the same. All the improvements in health were the same.

Dr. Gabrielle Lyon: 1:13:06

Are there things that you have changed your mind on from when you started, oh, gosh, or maybe you've gotten wrong and are really seeing again? Part of mastery is having a foundation of understanding, and then you have this intellectual flexibility, that things change,

Dr. James Hill: 1:13:23

yeah, and I will have to say that I was boy in the late 1990s I was just an advocate for low fat, and I still think that's a problem, but I

Dr. Gabrielle Lyon: 1:13:34

was at the Pritikin style eating, or just the guy, or any

Dr. James Hill: 1:13:39

style of Dean's A friend of mine, and, you know, Dean was about really low fat stuff and the work of JP flat. And I think I've realized it's more complicated than that. I'm still not saying, eat all the fat you want. I still think that's problem, because it's nine calories a gram, but I think that's something I've changed my mind on the other thing. Oh, back to the National Weight Control Registry. One of the things we found in the National Weight Control Registry is these people reported eating breakfast almost every day. I'm

Dr. Gabrielle Lyon: 1:14:11

so glad you mentioned that I've actually modulated on that a little. Tell me

Dr. James Hill: 1:14:16

I think it's I think there are people that can do a different dietary pattern. What? I think that see what the National Weight Control Registry, I don't get hung up on any one thing. I think we identified a pattern. So they were eating breakfast, but they're also doing an hour of exercise, and they were self monitoring. Was it

Dr. Gabrielle Lyon: 1:14:35

fasted breakfast? Was it, I'm sorry, fasted breakfast? That would be weird. Was it fasted exercise? Was no time necessary.

Dr. James Hill: 1:14:41

We didn't. We didn't, we didn't capture that at all. It was all over the map. But I think, and we've had people that said, Oh my god, I just don't, I'm not hungry in the morning, I don't want to, you want to make me eat breakfast. And I think we've modulated a little bit to say there are different patterns for different people. The whole eating pattern is fascinating to me. How you eat your meals? Is it three meals a day? Is it five little meals? Do you eat breakfast? And I think it's going to vary. I think this is one that's going to vary from person to person. I think for some people, eating breakfast is good, but like for time restricted feeding, I've done time restricted feeding, and if you do a lot in the evening, it's hard to do a time restricted feeding that you know starts early. You got to start. So I don't know. I just think, I think there's individual differences that we need to learn. So I'm still not saying don't eat breakfast. I still think for most people, eating breakfast is a good thing, but I've modulated in that I don't think everybody has to do it. I

Dr. Gabrielle Lyon: 1:15:46

love this conversation around time restricted feeding and fasting. It's just the hot topic, and I'd love for you to just take a moment and clarify what time restricted feeding is. How we can think about that in our own lives, a

Dr. James Hill: 1:16:00

time restricted feeding is very fascinating, because what it is saying is there's a period of time during the day where you can eat and you eat anything you want, but you don't eat outside of those hours. And people disagree over what's the appropriate length of time, usually it's maybe five to eight hours. So for example, I might get up have my first meal at 10. I can eat whatever I want until, say, 6pm and then I stop eating. And so the idea is, you eat your food during a period of time, and you have these longer periods of time where no food's coming in, which allows you to bring fat out of your fat cells, carbohydrate out of your muscles and to exercise your metabolism. I

Dr. Gabrielle Lyon: 1:16:45

think that that's a really good point to be able to illuminate that information for people, because people hear time restricted feeding. Maybe it's similar to fasting when really it's just feeding in a compressed window. That is very interesting. And you know, I had Heather Lydian on the podcast, and she talks about how having breakfast, 30 grams of protein, maybe 30 to 40 grams of protein for breakfast, can help make individuals choose better foods later on. And it probably doesn't mean that it has to be breakfast. It's probably more the composition of that first meal. Yeah,

Dr. James Hill: 1:17:25

and I'm totally okay with that. I think getting a satiating first meal, and we actually have started doing that. We talk about doing a satiating first meal, but we aren't adamant anymore, event, when that can occur, that can occur seven o'clock, it can occur 10 o'clock, 11 o'clock, but the the way you break your fast, I think, should be with a satiating meal. So I agree with that. I just think we got to get away from the clock that breakfast has to be seven to eight or whatever. I think it's getting that first meal that's a satiating meal that might be useful.

Dr. Gabrielle Lyon: 1:18:05

Do you think there's a difference between weight maintenance and optimal health? Ah,

Dr. James Hill: 1:18:13

that is a great question. I have to think about that one. I think the answer probably is yes, and again, let's go back to the GLP one meds. Let's say you're taking it and you're taking it forever, and you maintain your weight. Is that optimum health? And I would argue not if you don't exercise, not if you don't eat a relatively healthy diet. So I do think the two aren't necessarily the same, and this is the other thing that I talk a lot about now. I think the success with the meds has maybe gotten us to the point where we need to reimagine success. For most people, success is the number on the scale? Is that really success? Because I think what people want is happiness. I'm sorry, but I do. I think they're after I'd like a good night's sleep, but yeah, that's part of happiness. The weight is part of it. The metabolic health is part of it, but other parts of it are how you see yourself, your self esteem, your relationships, all these other things, and they aren't necessarily going to come with just keeping the weight off, but I think having the weight off gives you an opportunity to work on some of these other things, and that's my hope.

Dr. Gabrielle Lyon: 1:19:35

I that it makes a lot of sense, because it it reduces cognitive load of being hyper consumed, about weight, what you should eat if you put in standards that you're going to weigh yourself in the morning, that you're going to have that first meal of the day, you know, I would argue it should be a higher protein breakfast and move for an hour a day. That these are very Yes, simple, effective, yes, standards, not even goal. Standards that we can set ourselves up for. You have been in this game for a very long

Dr. James Hill: 1:20:06

time. Thank you. Old Yes.

Dr. Gabrielle Lyon: 1:20:09

Well, looking great, doing great. I'm still What do you think some of the most misleading or harmful advice out there is for weight loss?

Dr. James Hill: 1:20:20

Well, I think, I think people, one of the big mistakes that people make is not preparing to go into weight loss, and by preparing a couple of things. So number one, we've asked a lot of people who say, begin on the meds. What's your long term plan? Okay, you're going to go on the meds, you're going to lose weight. What's your long term plan? What do you think the number one answer is?

Dr. Gabrielle Lyon: 1:20:51

The number one answer the long term plan. Again, the first thing that comes to my mind is better sleep. But I don't know. They say

Dr. James Hill: 1:20:57

I don't have a plan. I haven't thought that far ahead. So here you have people that are going into weight loss, and they're not thinking to weight loss maintenance. So one of the biggest mistakes people make is getting the time frame wrong. They're only focused on those first few months of losing weight. The second thing is, is there are other ways that you can prepare for for weight loss. For example, if you're getting ready to go on vacation, it's not a good time to start weight loss. It's sort of, we use the analogy. If you're going on a long trip, you check your tires and you make sure you've got gas and wiper fluid and everything. So take a minute before you start weight loss and think about all the things you're going to have to do to do that. So a little bit more preparation. But the biggest thing is not understanding the difference between weight loss and weight loss maintenance. And still, out there, the diets are saying, Go on this diet and stay on this diet forever. It hadn't worked. Why would we need so many diets if any of them work. So the one thing I would love to change is having people understand the difference between weight loss and weight loss maintenance, and I believe we now have the opportunity to develop programs that are focused on skills for weight loss maintenance without having to deal with skills for weight loss.

Dr. Gabrielle Lyon: 1:22:21

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Dr. James Hill: 1:24:02

kit. The drugs can do that for us. That

Dr. Gabrielle Lyon: 1:24:05

is a very interesting perspective. And what you're saying is that the weight loss part we've now, we now have something that makes it easy better than I could do. And this is what the data shows that we are entering a new era, yes, and this is an era of the ability to lose weight. It says nothing about the ability to maintain that weight loss. But again, I've been involved in Nutritional Sciences for 20 years. I did my fellowship at WashU in St Louis, and I ran a weight loss clinic at the time. We weren't using GLP ones. They were available, but they were available for this kind of disease process, using them for weight loss, but now and those women and men would come in week after week, counting calories, which I think is really important, and we always recommend people use an app, or I remember back in the day you write it down in your notebook, but to track and see where you are, and eventually you. Can get to a place where you can move beyond that. But weight loss, I think we've solved for Yes, which is unusual, and now we've moved into this era of okay, solve for that. You can use it or not. And again, with insurance, there are compounding pharmacies. We use a pharmacy called Empower, which is the number one, the largest compounding pharmacy in the world. They meet all the criteria that we think are important. But if you were to define weight loss, give me the definition for weight loss, and then give me the definition for weight maintenance.

Dr. James Hill: 1:25:36

So weight loss, you're trying to change the number on a scale to a certain goal, and before the medications, very few people reach that goal.

Dr. Gabrielle Lyon: 1:25:47

What percentage?

Dr. James Hill: 1:25:49

I would say, five, maybe very low, 5% of

Dr. Gabrielle Lyon: 1:25:53

people before these medications were able to lose their goal? Yes, yes. Mike, that may drop right there, that may be high, and the recidivism rate. I mean, you don't know this, but I've been a fan for a very long time. And when I was in fellowship, I was looking at the National Weight Control Registry, because we were looking at body composition and brain function. And I think the recidivism rate of when I was reading it was something for weight regain, was something like, was it 89% Yeah,

Dr. James Hill: 1:26:19

yeah, yeah. So very few people were were reaching their goal weight, and almost nobody was maintaining it. And so weight loss is getting to a number on the scale. Weight loss maintenance is, it's, it's, it's maintaining a weight that's at or near your goal, but it's a finding a lifestyle that's forever. With weight loss, you can do anything for three months, you can avoid carbs or fat or protein, but for long term, you've got to find a way of living a lifestyle while you live your life, you can't take time out from life anymore, and so it's dealing with problems in life, and you're going to have setbacks, and you're going to life gets in the way, and you have to figure out how to keep your diet, exercise plans, even in the hardest times. And you should expect the hard times. Hard times are going to come. I guarantee they're

Dr. Gabrielle Lyon: 1:27:16

going to come for weight loss. We now are in a new era. These medications are, I would say, I would argue that they're very safe. I know that there's some information out there on the social media sphere talking about thyroid cancer. I don't know if you want to speak to that, but I am not

Dr. James Hill: 1:27:32

everything we know is they're very safe. Now you don't know what you don't know. So maybe next week we'll find some negative parts of it. But these drugs have been studied very well. Have to give the pharmaceutical companies credit a very long time, because, again, you know the history of weight loss drugs as it's been one problem after another. They've looked at depression, suicide, heart disease, everything and everything we know so far is their safe. And it also shows that if you can produce this amount of weight loss, the improvement in health is like dramatic.

Dr. Gabrielle Lyon: 1:28:05

It's unbelievable, from cardiovascular from neurological components to overall inflammation, the list of metabolic syndrome, the list goes on, and then the strategies that you were saying for weight maintenance include weighing yourself every day, yeah, doing an hour of exercise, yeah. Did we say tracking calories? Because I believe that tracks

Dr. James Hill: 1:28:28

something. It doesn't have something calories, but some part of your food intake and eating a satiating diet, I think we can come up with satiating diets that give people a better chance of avoiding the hunger

Dr. Gabrielle Lyon: 1:28:42

when you say satiating diet, if you were to rank protein, fat, fiber, how do you think about it?

Dr. James Hill: 1:28:50

Well, I would say protein and fiber are at the top fat. I'm not sure is very satiating at the end of the day, but I agree with you. I think, I think protein and fiber, and fiber is one that's really underutilized, you know. And the microbiome guy we interviewed basically said you need to eat, I think he said 12 different kinds of vegetables every day, or something.

Dr. Gabrielle Lyon: 1:29:14

I don't know what world that person is coming from, but I don't even get my but the idea green beans is better.

Dr. James Hill: 1:29:21

And so looking energy density is still a big deal out there, high protein, high fiber foods with low energy density, these are the there are a lot of strategies we know that aren't necessarily that great for weight loss, but can help you manage your hunger a little bit. If you're trying to keep weight off, you're fighting the hunger. Increasing your exercise will allow you to eat more, but you still want to manage that hunger a little bit. So doing. And again, we use food as medicine, as satiating Diet, Exercise is Medicine, and then the cognitive. Mind is medicine. I think it takes all three. And hunger

Dr. Gabrielle Lyon: 1:30:03

is not an emergency. Exactly. What about sleep and Oh, things of that nature, sleep and people cold plunge, which I love. I'm not hungry after. Have you ever cold plunge? We have one here, if you want to try, guarantee you're not going to be hungry. I

Dr. James Hill: 1:30:18

think I'm busy. Then I'm a big believer in that. I think sleep is under appreciated. I think it's becoming more and more appreciated. But let's face it, if you're not sleeping good, you don't want to exercise. I think evidence suggests you choose a more unhealthy diet. I think sleep is critical in all this the

Dr. Gabrielle Lyon: 1:30:37

and I agree, and anyone that's worked overnight will say they're hungrier. And again, I'm making these broad statements, but you're hungrier if you are on a night shift, if you are up overnight, I

Dr. James Hill: 1:30:48

think the shift workers are boy. I think they really run the risk of poor health. Do

Dr. Gabrielle Lyon: 1:30:54

you think that there is a particular if you were to think about, okay, you're gonna eat a satiating diet. We're going to prioritize dietary protein. We're going to choose high density foods, fiber. That's interesting, very difficult to get 12 different fruits and vegetables, but most

Dr. James Hill: 1:31:11

people eat fairly low levels of fiber. It's easy enough to there are some ways to increase, and that's why, actually, I think you can put some fiber in a satiating first meal of the day too. Yeah, which is an interesting I

Dr. Gabrielle Lyon: 1:31:24

do, and I think about that a lot, and then I think, Okay, well, I think we should increase our fiber, but if we, let's say we add it into a protein shake. Now we're slowing down the absorption, and we know that there's a meal threshold that we really want to hit. Looking at, you know, you look at Heather ladies work and and then you look at Don layman's work, and you say, Okay, well, we want an amino acid threshold to hit to then create this cascade. And I always think, you know, how do we navigate that with a high fiber?

Dr. James Hill: 1:31:52

And I think you still have to figure that out. I think we need some innovation, and how we help people get more fiber in their diet.

Dr. Gabrielle Lyon: 1:31:58

What would you say to people that have yo yo dieted, and just they're listening to this, and they're thinking, Man, I have never been successful. So

Dr. James Hill: 1:32:06

the one thing we found is the majority of people in the National Weight Control Registry have failed many times before. So it wasn't just this is the first time and it worked. They've tried every diet under the sun, and they failed and they failed and they failed. And we tried to get at what was different, what what helped them do it this time. And I'm not sure they even knew, but I think we heard things like I finally figured out the quick fixes didn't work. I just I'm ready to suck it up and do the work to do it the right way. So I don't know exactly what it is, but I will tell you, if you failed, 2345, times before it does not mean that you can't succeed. You can. I believe anybody can succeed. It. You have to have a plan, you have to have a strategy, and you have to be committed.

Dr. Gabrielle Lyon: 1:33:04

I love that. And how important is community around you?

Dr. James Hill: 1:33:08

Oh, I think community is critical, and it's more critical for weight loss maintenance. I mean, yeah, you can do groups and weight loss and everything, but you can go off by yourself and lose weight when you're out there trying to live your life and do this, and you go through the hard times, boy, you want people around you. So we talk about we talk about social support and friends, and we talk about Super Friends. Everybody needs one super friend. I've never heard that before. Holly Wyatt coined that term, a super friend is the friend that tells you what you need to hear. Not, well, I take that back. I have a lot of those, yeah, and you do. I mean, it's like, you say, Oh yeah, I went off plan today, and your friends, but that's okay. It's alright. And your super friend is going to say, okay, what are you going to do tomorrow? What are you going to do to get back on track? You need that person who comes at it from love but is willing to tell you. The stuff you need to hear, is

Dr. Gabrielle Lyon: 1:34:08

there a difference from the weight loss registry in a male versus female? Oh, there is. Oh, wow,

Dr. James Hill: 1:34:14

we didn't have very many males. It's like 80% women and 20% males. Now, here's the thing, women will be upset by this, but we looked at the people that just tried to lose weight the first time, and it worked. They were almost all males.

Dr. Gabrielle Lyon: 1:34:31

What

Dr. James Hill: 1:34:35

this was their first time? It's like, Oh, nobody ever told me to do this before I did

Dr. Gabrielle Lyon: 1:34:40

unbelievable. Do we have any understanding as to why that is?

Dr. James Hill: 1:34:44

Well, number one, men are bigger. So you know, there's the advantage in size and eating less. And I you know women, they know all this stuff. Some men are clueless. And you just say, here's what you do, and they do it and it works. Unbelievable.

Dr. Gabrielle Lyon: 1:35:00

Okay, aside from the knowledge component, anything else, any hormonal differences, you think, or

Dr. James Hill: 1:35:10

I don't think so. I think had we? Had had we? At the time we started the registry, women were very interested in weight loss, but men typically wouldn't, weren't very interested in weight loss. So I think if we had a bigger sample of men, they would come together. Yes, I think there are more men that had never tried to lose weight before, and and works, but if you look at the other behaviors, they were really pretty similar between men and women. That's

Dr. Gabrielle Lyon: 1:35:39

really important, because right now we hear a lot of differences, that potentially there are differences as men and differences for women, but at the end of the day, you know, and our research and many others, it really is. It comes down to putting foundational pieces there. I

Dr. James Hill: 1:35:56

agree with that. I think there are differences in the way you might get to these behaviors. But I actually, I do not think that the behaviors for success are that different.

Dr. Gabrielle Lyon: 1:36:07

That's wonderfully said. And just to wrap it up, what you've been working for a long time, I want to know what is it you're working on now? So

Dr. James Hill: 1:36:16

two things. One is with my colleague Holly Wyatt, we have written a book that, again, I told you that I'm okay with long term drug use, but some people can't or won't continue. So we've written a book on how to transition from the weight loss meds without regaining the weight. And it really encompasses a lot of stuff that we've talked about here. The second project I'm working on is a big study of precision nutrition, trying to understand why certain people respond to certain diets differently, with the idea of ultimately being able to predict the best diet for you versus someone

Dr. Gabrielle Lyon: 1:37:01

else. Does that have to do with the microbiome? The

Dr. James Hill: 1:37:04

microbiome is likely going to be one part of it. So we are definitely measuring the microbiome that's so

Dr. Gabrielle Lyon: 1:37:11

interesting. What and can you share any early findings that you've discovered so far? Well,

Dr. James Hill: 1:37:17

there aren't findings yet, because the way this works, we're in the fourth year of a five year study, so the data won't be until we've completed the subjects. We're doing 10,000 people. This is a multi center study, so trial 10,000 people, we're going to have omics, we're going to have microbiome we're using AI to do some predictions. This is a really cool

Dr. Gabrielle Lyon: 1:37:40

study. Sounds inexpensive.

Dr. James Hill: 1:37:44

Yeah, this is actually a good use of your taxpayer dollars. This we're going to learn something from this one, but we won't know the results for a couple years until we finish our recruiting subjects and we do the data

Dr. Gabrielle Lyon: 1:37:55

analysis. Where is the the main site is that in Alabama. No.

Dr. James Hill: 1:38:01

So this is, it's funded by NIH, and there are five sites that are clinical sites where we're actually studying patients. Then there are seven or eight sites to analyze the microbiome, the blood, the stool, etc. So it's a large it's a large group together, but this is one that this is money well spent, in my opinion. I

Dr. Gabrielle Lyon: 1:38:23

mean, we need it, we need it. We need it. I think a lot about this interpersonal variation. You know, we see people can choose all kinds of various diets and outcomes are what works for you is going to be different than what works for me absolutely. And I can choose to maintain my body weight on a totally different diet than my producer, Matt, who eats Twinkies all day long, can maintain his diet on and then yours totally that's

Dr. James Hill: 1:38:53

great that you have those choices. I think it's wonderful. So to me, the key here is for people listening that are looking to manage their weight. Think about weight loss maintenance. We are entering an era where we are going to have tools to help you reach the weight you want to reach. We're again. There are better drugs coming down the line. Getting the weight off is going to be, I think, accessible for most people now we have to keep it off, and here's where you have some options, and we want to provide some different strategies to help people, but it's time to think about not just losing the weight, but keeping it off. So if you go on a GLP, one, meds, think ahead. What's your long term plan? Assume you're going to reach your weight loss goals now what?

Dr. Gabrielle Lyon: 1:39:43

Dr Jim Hill, I feel so honored, and I know that the listener and the viewer does too. You have put forth a tremendous amount of effort over your lifetime, and I speak for many people, we are so grateful. Thank you.

Dr. James Hill: 1:39:58

Oh, it's wonderful to be on. On, and this has been a fascinating conversation.

Dr. Gabrielle Lyon: 1:40:02

If there's one thing to take away from this conversation, it's that sustainable weight loss isn't about extreme diets or quick fixes, it's about building daily habits that actually work with your body, not against it, and that's what we're here to help you do. If you found this episode helpful, make sure to subscribe so you don't miss more conversations like this. And if you're ready to take action, leave a comment below with one habit you're going to focus on this week, whether it's moving more tracking your progress or dialing in your nutrition, if you want more practical strategies to make fat loss sustainable. Grab Your Free protocol in the description below, stay strong.

:: 40:48

You.