Podcast Summary

Podcast: Better! with Dr. Stephanie
Episode: Can You Build Muscle & Lose Fat at the Same Time?
Host: Dr. Stephanie Estima
Guest: Dr. Bill Campbell, PhD
Date: February 24, 2025
Main Theme: Exploring actionable science-backed strategies for body composition changes—specifically fat loss with muscle preservation/gain—in women, especially those navigating perimenopause and menopause.

Episode Overview

This episode dives deeply into the possibility and practicality of losing fat and building muscle simultaneously—an area often veiled in myth and confusing advice. Dr. Stephanie is joined by Dr. Bill Campbell, a leading researcher in physique optimization and menopause-related weight management. Together, they break down the “calories in, calories out” equation, discuss measurement techniques, optimal strategies for fat loss, muscle gain, and touch on hormonal influences unique to women in midlife. The tone is supportive, educational, and at times humorous, with a relentless focus on empowerment and actionable steps.

Key Discussion Points & Insights

1. Can You Lose Fat and Build Muscle at the Same Time?

[05:37]

• Dr. Campbell: It’s possible, but rare and easier for beginners or those returning after a break from training. For experienced lifters, it’s much harder.
• Coaching Approach: Set primary goals—fat loss with muscle maintenance or muscle gain while minimizing fat gain. Avoid promising simultaneous maximal fat loss and muscle gain.
• Quote:

  “It can absolutely happen… But I would never promise somebody or design a program, hey, this is your guarantee to build muscle and lose fat. I think it's better… to have them identify what is your primary goal.” (Dr. Bill Campbell, 05:37)

2. How to Measure Body Fat and Muscle Mass Accurately

[07:30–19:27]

• Research-Grade Methods: DEXA, BodPod, research-grade BIA scales (e.g., InBody).
• Accessible Methods: Bathroom scales (with BIA), skinfold calipers—use the same device and methodology each time for consistency.
• Controlling for Hydration:

  “Always get your body composition done in the morning, after you've gone to the bathroom and before you've consumed any food or beverages… As soon as you put food into your body or as soon as you've consumed a liter of water, now that body composition value… is completely inaccurate.” (Dr. Campbell, 09:37)

• Setting Healthy Targets:
  • Women: Average = 27% body fat; less than 20% is rare and not always healthy.
  • Men: Lower averages but not discussed in depth.
  • Menstrual cycle regularity and muscle mass retention are critical markers of healthy leanness.

  “Getting leaner than [27%], to an extent, I believe is healthier. But… getting down to very low levels of body fat, that is never healthy.” (Dr. Campbell, 14:58)

3. Principles of Fat Loss—Calories In vs. Calories Out

[21:03–32:02]

• Two Levers: Reduce food intake or increase energy expenditure via movement.
• “No real shortcuts”—ice baths, for example, don’t deliver meaningful fat loss.
• Determining Maintenance Calories:
  • Most accurate: Track all food & weight for 2 weeks without changing habits.

    “If you have that… we call that maintenance calories… if I want to lose body fat, I need to eat less than this.” (Dr. Campbell, 23:35)

  • Online calculators are less personalized and assume too much.
• Behavioral Note:
  • Tracking food intake alone often triggers more mindful eating and sometimes weight loss before any intervention.

4. Caloric Deficit and Fat Loss Strategy

[34:38–39:02]

• Optimal Deficit: ~25% reduction from maintenance for most metabolically healthy people.

  “…if you reduce your calories by 25%, assuming adequate protein and resistance training… almost all of the weight lost… is coming from body fat stores and maintaining all lean tissue.” (Dr. Campbell, 34:38)

• Protein Intake: 0.75–1g per lb. (1.6–2.2g per kg).
• Midlife & Menopausal Women:
  • Some experience “weight loss resistance” where even low calories don’t shift weight.
  • May require steeper deficits, but “often not sustainable, not enjoyable, and probably not healthy.”
  • Hormonal shifts (notably estradiol loss) lead to fat redistribution and retention.

  “She was healthy and then she went through menopause and she gained weight… Her calories were like 1100 calories… and it just—she wouldn't lose it.” (Dr. Campbell, 39:02)

5. Hormonal Considerations & Menopause

[43:12–48:09]

• HRT (Hormone Replacement Therapy) can help with muscle gain and fat loss in postmenopausal women (supported by clinical trials using estradiol patches).
• Not a cure-all—works for many, not all.
• Lifestyle factors—resistance training, real food, sleep—remain critical.

  “The hormones are not gonna lift the weights for you… that has to happen with you.” (Dr. Estima, 47:15)

6. Deficit Duration, Diet Breaks, and Avoiding Perpetual Dieting

[49:31–54:08]

• Avoid chronic dieting: No “perpetual diet” mentality.
• Cyclic approaches—diet 4–6 weeks, take a 2-week break at maintenance.
• “Weekday dieting:” Deficit Mon–Fri, maintenance on weekends.

  “So the beauty of this, let's diet for five days and then go back to maintenance calories on the weekend. Now we are in a potential anabolic state for two out of seven days…” (Dr. Campbell, 50:04)

• Maintenance breaks are not “cheat” periods; stick to maintenance calories.

7. Macros vs. Calories—What to Track?

[55:23–58:00]

• Macro tracking preferred for education and protein prioritization (but total calories matter, too).
• Macro tracking teaches food literacy: distinguishing carbs, fats, proteins in “real world” foods.

  “Once you start identifying, ‘Oh, butter is a fat, broccoli is a carb, egg whites are...’ you are educated for life. I wish everybody would track macros for six months of their life.” (Dr. Campbell, 55:23)

• Caution against obsessive, disordered tracking.

8. Calories Out: Resistance vs. Cardio (and the “Toned” Myth)

[59:25–68:44]

• Resistance training prioritized for shaping body, maintaining metabolic health, and fighting muscle loss (especially important for women in midlife).
• Cardio is useful for acute calorie burn but less impact on muscle retention and shape.
• “Toned” is a misused term; building visible muscle under leaner skin requires muscle growth and fat loss, not simply light weights or cardio.

9. Building Muscle: Rep Ranges & Training Principles

[68:44–76:59]

• Key principle: If you can do a weight more than 20x, it’s too light for optimal gains.
• Both mechanical tension (heavy weight, lower reps) and metabolic stress (moderate weight, higher reps, up to 30, to failure) build muscle.
• Optimal hypertrophy range: 5–15 reps, aiming near failure (1–3 reps shy).
• Strength development requires heavy loads (<6 reps).

  “The only way to increase strength is to lift heavy weights… you should be squatting, deadlifting if you’re healthy, heavy compound movements.” (Dr. Campbell, 72:35)

10. Adjusting for Energy, Pain, and Real Life

[74:19]

• Not every woman can squat or train hard all the time, especially during low-energy or joint-pain phases typical of menopause. Start where you are and build up.

11. Is There a Genetic/Muscle “Set Point”?

[77:18]

• There’s likely a genetic or practical upper limit to muscle gain, especially for women (and especially without exogenous hormones).

  “Trying to build muscle at the rate that you did in the first year… I don't think you're ever gonna see those types of gains.” (Dr. Campbell, 77:18)

12. Cardio and Resistance: The Interference Effect

[79:11–82:02]

• For hypertrophy: No documented interference when doing cardio alongside resistance, even concurrently.
• For maximal strength: Yes, interference possible—best to separate by several hours/days, or do resistance first.

  “My analysis… is that there is no hypertrophic interference effect… For strength, there does appear to be an interference effect.” (Dr. Campbell, 79:11)

Notable Quotes & Memorable Moments

• On food tracking as lifelong education:

  “Once you start identifying, oh, butter is a fat, broccoli is a carb, egg whites are ... you are educated for life. I wish everybody would track macros for six months of their life.” (Dr. Campbell, 00:00, also 55:23)

• On social media fitness “standards”:

  “When we see that [10–15% body fat] in women… that is what we see on social media. And they are never that lean, very long. They will get in that condition, do all of the photo shoots, and then that is what gets put out for the next four months.” (Dr. Campbell, 12:37)

• On chronic dieting:

  “Any diet that is planning to last for six months or longer is not a good plan.” (Dr. Campbell, 50:04)

• Dr. Stephanie’s “real talk” about tone:

  “The only appropriate use of the word toned is actually when we're making a comment about the nervous system… It is not—you are not going to get long, lean muscles. Your attachments don't change.” (Dr. Estima, 63:36)

• On the realities of menopause and fat loss:

  “There’s a certain—maybe it’s a small percentage—of women going through menopause that have a very bad experience. And part of that experience for some of them is gaining weight that is very hard to lose.” (Dr. Campbell, 39:02)

• On empowering self-responsibility with HRT:

  “The hormones are not gonna lift the weights for you… that has to happen with you.” (Dr. Estima, 47:15)

Timestamps of Key Segments

| Topic | Timestamp | |-------------------------------------------|----------------| | Simultaneous fat loss & muscle gain | 05:37 | | Measuring body composition | 07:30–19:27 | | Setting healthy fat % targets | 12:37–15:29 | | Calories in vs. out & maintenance cals | 21:03–28:00 | | Forming a caloric deficit | 34:38 | | Menopause & weight loss resistance | 37:34–43:12 | | HRT effects; limitations | 43:12–48:09 | | Diet breaks & cyclic approaches | 49:31–54:08 | | Macro tracking—education & application | 55:23–58:00 | | Resistance vs. cardio; “Toned” myth | 59:25–68:44 | | Muscle-building rep ranges | 68:44–76:59 | | Can everyone build max muscle (set point) | 77:18 | | Cardio/resistance interference effect | 79:11–82:02 | | Strength as a midlife goal | 82:02–83:38 |

Language, Tone & Approach

Both Dr. Stephanie and Dr. Campbell keep the conversation approachable, supportive, and grounded in evidence. They frequently acknowledge the psychological and social complexities of body composition shifts in women, especially in midlife, and balance discipline with self-compassion. The show’s recurring message is empowerment and pragmatism: understand your body, set realistic goals, and take consistent, educated action.

Summary Table: Actionable Steps

| Step | Explanation/Tip | |--------------------------------------------------------------|-------------------------------------------------------------------------------------------------------------------------------------------------------| | Track food & weight for 2 weeks | Best way to establish true maintenance calories; weigh in after bathroom, before eating, under same conditions. | | Set a 20–25% calorie deficit for fat loss | Combine with resistance training and adequate protein (0.75–1g/lb). | | Use macro tracking to educate yourself | Focus especially on protein; don’t obsess over perfection. | | Take regular breaks from dieting ("diet breaks" or weekends) | Go back to maintenance calories during breaks to aid psychological and physiological adaptation. | | Prioritize resistance training for long-term health & shape | Build and maintain muscle, especially as you age. Train with enough weight so you can’t do more than ~20 reps per set. | | Combine with cardio as fits your preference & goals | Cardio for calorie burn/heart health; does not significantly interfere with muscle gain. If strength is primary, separate from cardio when possible. | | For midlife/menopause: consider medical consults | Explore HRT/MHT if struggling with unexplained weight gain, but maintain focus on lifestyle—no “magic” fixes. | | Reassess & adjust based on response, not just “the math” | Some menopausal women may need tailored approaches; results will vary. |

Conclusion

This episode delivers a comprehensive, myth-busting roadmap for women seeking to optimize body composition, especially during the challenging transitions of midlife and menopause. By blending scientific rigor with practical, compassionate advice, Drs. Estima and Campbell make the path to “better, not perfect” accessible for all.