← The Dr. Gabrielle Lyon Show
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- [00:00]
Dr. Gabrielle Lyon
For every 10 people who lose weight, only one will keep it off for good. But here's the shocking part. Most people don't fail because they're lazy or lack willpower. They fail because they're following the wrong strategy. So what's the right strategy? After decades of research, Dr. Jim Hill has studied thousands and thousands of people who have successfully maintained weight loss long term. The difference, it actually all comes down to just a few things. By mastering these strategies or habits, you can lose weight and keep it off. No gimmicks, no fad diets, just science backed proven methods. I just wanted to jump on here with an exciting announcement. I am hosting the second ever Forever Strong Summit April 26th, 27th in Houston, Texas. 2025. There's going to be two days, the VIP day on April 26th. 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, drgabrielleine.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.
- [01:54]
Dr. Jim Hill
Thank you. I'm happy to be here.
- [01:56]
Dr. Gabrielle Lyon
I feel like I'm sitting with a celebrity.
- [01:57]
Dr. Jim Hill
No, I've just been around for a while.
- [02:01]
Dr. Gabrielle Lyon
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 in 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.
- [02:31]
Dr. Jim Hill
I 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 late 70s obesity was not seen 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. It wouldn't have made anybody's top 10 list of things to 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. 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 you burn. And I thought the calories you 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.
- [04:00]
Dr. Gabrielle Lyon
And, yeah. And we have to just point out that this is how new obesity research is.
- [04:05]
Dr. Jim Hill
That's right.
- [04:06]
Dr. Gabrielle Lyon
That there was a point in time where obesity wasn't thought of. People had no idea what was happening.
- [04:13]
Dr. Jim Hill
No 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. 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 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?
- [05:03]
Dr. Gabrielle Lyon
When you were looking at energy expenditure for the audience, what does that mean?
- [05:09]
Dr. Jim Hill
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 heartbeats and your kidneys function. All that requires some of the energy in. You require some energy to process foods. So when you eat a meal, you've got to absorb that. That meal, et cetera. 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.
- [06:06]
Dr. Gabrielle Lyon
Hmm.
- [06:06]
Dr. Jim Hill
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.
- [06:28]
Dr. Gabrielle Lyon
That's fascinating. You would think that that would solve it.
- [06:32]
Dr. Jim Hill
Yeah. People say, well, it can't be that simple. The problem is, it isn't simple. So if I look at 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.
- [07:46]
Dr. Gabrielle Lyon
When you moved on from energy, this energy expenditure hypothesis, was there a moment in time where you said, you know what? This, this just can't be. It can't be it.
- [07:56]
Dr. Jim Hill
Yes, there was. And then the question is, what is it? Okay, and, and so you begin to look at energy intake. And I, I did a lot of work with different kinds of diets. Macronutrients. What about fat? What about carbohyd? 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 9 calories per gram, carbohydrate has 4 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.
- [09:01]
Dr. Gabrielle Lyon
You know, Don Layman had mentioned that I guess there was a period of time where you went to go, maybe you're a visiting professor at the University of Illinois. That what happened?
- [09:10]
Dr. Jim Hill
I think so.
- [09:11]
Dr. Gabrielle Lyon
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 Layman, 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 guide pyramid or is it carbohydrates, is it protein, is it fats?
- [10:03]
Dr. Jim Hill
So at that point, and you're, 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 JP 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 hydrated or is it fat? And it's not, you know, it's not as simple as one versus the other.
- [11:07]
Dr. Gabrielle Lyon
Where did the weight Registry, come in. How was that and why was that developed?
- [11:13]
Dr. Jim Hill
So this is, I kid you not, this was a project developed over a beer.
- [11:20]
Dr. Gabrielle Lyon
I hear that those are where great projects are developed.
- [11:22]
Dr. Jim Hill
I was at a conference with my co founder, Dr. Rena 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 da. And just by chance, I remember I was asked to do an interview with the Orange county newspaper on 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 in the registry, you have to put our information in your article. And we populated the registry that way.
- [12:49]
Dr. Gabrielle Lyon
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 kg, right? Greater than or equal to 13.6 kg. And maintained that for a year or.
- [13:19]
Dr. Jim Hill
Longer as the entry criteria. In fact, we ended up with over 10,000 people. And I think 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.
- [14:20]
Dr. Gabrielle Lyon
I'm going to say that again because I don't think that it's nearly ever discussed that weight loss is a different skill than losing weight and keeping it off, essentially weight loss maintenance.
- [14:36]
Dr. Jim Hill
And I could talk for a long 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.
- [15:15]
Dr. Gabrielle Lyon
Because what about protein?
- [15:17]
Dr. Jim Hill
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 loss is generally, we'll, we'll 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 reason that most people have failed and most people have failed, we know that of 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.
- [17:39]
Dr. Gabrielle Lyon
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?
- [17:49]
Dr. Jim Hill
Yes. 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 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, it's 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.
- [19:12]
Dr. Gabrielle Lyon
I love that. And we agree on that. So what you're talking about are these attributes of grit and courage.
- [19:20]
Dr. Jim Hill
Yeah, 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, succeed. And one thing, throw them for a loop and they regain it all back.
- [20:17]
Dr. Gabrielle Lyon
Thank you to Puri for sponsoring this episode of the show. At this point, everyone should be taking omega 3 fatty acids. It has positive effects on heart health, brain health, muscle health, probably sexual health and overall inflammation. There's increasing evidence that EPA and DHA may also help with brain function and mood, all of which I think are critical to our overall well being. Now I won't just take any Omega 3 supplement. I only want the best, the best quality fish oil. And frankly, much of our seafood has increasing amounts of heavy metals and toxins. And I think we're going to see more microplastics. And that is why I choose Peori O3 Ultra Pure Fish Oil which is third party tested and certified by the Clean label project and IFOs. This is a source of omega 3 that I completely trust and highly recommend. In fact, I trust it so much that I bust open a capsule and I mix it with my kids milk because I know it's important for their brain development too. Every batch of Puri's O3 Ultra Pure Fish oil and all of their supplements are tested against more than 200 contaminants with all their results published online. So I can have peace of mind? You can have peace of mind. And we don't have to worry about hidden toxins that we are exposed to support your health. Add Puri O3 Ultra Pure Fish oil into your routine just like I did. And I've worked out a deal with Puri on this for my listeners. You get 20% off storewide. That means it even applies to already discounted subscriptions which is almost a third off of their entire price. All you'll have to do is go to Peori P U O R I and use the promo code DrLion at checkout. I know that you will love these products and trust them just as much as I do. Well, hopefully not with what you're sharing and really what we're definitely trying to do with the podcast because we want to provide people with tools. When you talk about weight loss, is there room for speaking about the quality of the weight loss? For example, we believe in a protein forward nutrition plan. We talk a lot about high quality proteins. As caloric consumption goes down, the protein percentage of calories would go up to maintain lean body mass. What are your positioning, what is your positioning on the macronutrient distribution?
- [22:48]
Dr. Jim Hill
Yeah, we're fans of higher protein and higher protein does a couple things. One, it's more satiety so it helps you feel full. 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 Wegovy or Zepp 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 in the registry.
- [23:44]
Dr. Gabrielle Lyon
Were you and you guys were looking at the composition of the diet?
- [23:47]
Dr. Jim Hill
We were. But let me tell you right up front, I'm not a fan of self reports of food intake.
- [23:52]
Dr. Gabrielle Lyon
Why is that?
- [23:53]
Dr. Jim Hill
Because I just don't think people are very, very accurate on what they eat. What people told us and this is just food records they 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.
- [24:27]
Dr. Gabrielle Lyon
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. Was it the ABC composition study? Was that what that was?
- [24:38]
Dr. Jim Hill
That showed CHRIS Gardner STUDY okay.
- [24:40]
Dr. Gabrielle Lyon
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?
- [24:49]
Dr. Jim Hill
You 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 carbohydrate. 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 loss.
- [26:06]
Dr. Gabrielle Lyon
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.
- [26:34]
Dr. Jim Hill
Yeah, 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.
- [26:55]
Dr. Gabrielle Lyon
You know, there's a wonderful paper that you wrote, Energy Balance and the Small Changes Approach to Obesity Prevention. And you made some very. I mean, there are 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 genetic shifts.
- [27:20]
Dr. Jim Hill
So this is. We had several years of really having 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 didn'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 hundred 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.
- [28:34]
Dr. Gabrielle Lyon
What do you mean by that? What do you mean by that?
- [28:36]
Dr. Jim Hill
So small changes, 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, 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, should be great. 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 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, 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 way. 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, how so?
- [31:16]
Dr. Gabrielle Lyon
That. That is exactly what I was looking at, was the extra 2,000 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 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.
- [31:43]
Dr. Jim Hill
So 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 effort 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.
- [32:32]
Dr. Gabrielle Lyon
Are we less active now than we used to be? Tell me.
- [32:36]
Dr. Jim Hill
Yes. 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.
- [32:52]
Dr. Gabrielle Lyon
Of computers, meaning they used to ride their bikes or they used to, they.
- [32:56]
Dr. Jim Hill
Used to have to do manual labor. And, you know, jobs would require manual labor. I'm talking, you know, I think the decrease in physical activity started probably after World War II. So if you look in the 40s and 50s, most people, they were laborers. They had to, 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 known a population that's existed on earth with low physical activity and low obesity.
- [33:53]
Dr. Gabrielle Lyon
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.
- [34:07]
Dr. Jim Hill
Work on it frustrates 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 unfortunately, in our field, the nutrition people and the exercise science people develop differently and lots of different things.
- [34:29]
Dr. Gabrielle Lyon
Don and I talk about that don't.
- [34:31]
Dr. Jim Hill
Measure physical activity and vice versa. It's one of the things that has frustrated me my whole career. But it's still happening. It's both. You cannot understand it without understanding both intake and expenditure.
- [34:45]
Dr. Gabrielle Lyon
Speaking of intake and expenditure, why, and you are really the predominant exercise. Why do people fail from long term weight loss?
- [34:55]
Dr. Jim Hill
A couple of reasons. 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 5 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 they're.
- [35:55]
Dr. Gabrielle Lyon
Never going to sit down and 10.
- [35:56]
Dr. Jim Hill
Wasn'T even their disappointed weight. They asked 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.
- [36:13]
Dr. Gabrielle Lyon
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, GLP1s, and these various generations of these drugs, because these drugs are here to stay, we're talking about Ozempic, we're talking about Mounjurno. And there's more coming out that before, the best anyone could do outside of bariatric surgery was, and you're hoping for.
- [36:41]
Dr. Jim Hill
10%, 10% 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%.
- [36:54]
Dr. Gabrielle Lyon
And now with these medications, the average.
- [36:56]
Dr. Jim Hill
Is 20%, which means half the people are even losing more than 20%.
- [37:01]
Dr. Gabrielle Lyon
And we have to pause and acknowledge how deeply impactful that is.
- [37:07]
Dr. Jim Hill
It's a game changer. It's a disruptor. And I say that in a positive way. These meds 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 only one.
- [37:29]
Dr. Gabrielle Lyon
They kind of are, 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, improve body composition glucose control in adults with type 2 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 to REMIT type 2 diabetes. Now with these medications, and what you're.
- [37:57]
Dr. Jim Hill
Seeing is people are getting rid of their diabetes, they're getting rid of their diabetes, 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.
- [38:36]
Dr. Gabrielle Lyon
And when you say four year, when you say four years of data, the GLP1s have been used for.
- [38:42]
Dr. Jim Hill
That's right. But for 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.
- [39:14]
Dr. Gabrielle Lyon
Why do you think that is?
- [39:15]
Dr. Jim Hill
Well, I'm going to tell you why I think it is. 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's okay. No, no, no, no. The drugs only work when you're taking them. They work very effectively. But when you stop taking them, your, your hunger comes back. And so most people are going to regain weight. The number one reason that people seem to discontinuum 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 weight's 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. 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.
- [41:00]
Dr. Gabrielle Lyon
That is interesting.
- [41:01]
Dr. Jim Hill
Yes, 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.
- [41:33]
Dr. Gabrielle Lyon
And why do people regain weight so quickly, whether they're on the drug or you know, there could be a drug arm and then a non drug arm. Why in general do people.
- [41:43]
Dr. Jim Hill
And 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.
- [41:56]
Dr. Gabrielle Lyon
It's like, is that adaptive thermogenesis?
- [42:00]
Dr. Jim Hill
Adaptive thermogenesis might be a part of it. It's how you define it. So yes, your energy expenditures 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 almost like your, 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.
- [42:51]
Dr. Gabrielle Lyon
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- [44:38]
Dr. Jim Hill
It's because you get your energies expenditure back up. But it seems to modulate these hormones that drive you to eat more.
- [44:46]
Dr. Gabrielle Lyon
Is there a baseline level of activity that someone would have to partake in?
- [44:51]
Dr. Jim Hill
So 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.
- [45:04]
Dr. Gabrielle Lyon
Is that walking? Is it jump roping?
- [45:07]
Dr. Jim Hill
Great question, great question. It's movement. And again so. So there is a range. 8% of people in the registry didn't do any exercise. 8% and they okay, 92 had to exercise to keep it up. So you know if 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 active 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 weightlifting than one would expect from a population.
- [46:06]
Dr. Gabrielle Lyon
Pause. What do you hear that?
- [46:08]
Dr. Jim Hill
Yes. Resistance training.
- [46:10]
Dr. Gabrielle Lyon
I've never heard of that.
- [46:11]
Dr. Jim Hill
There may be something about resistance training that may be important.
- [46:15]
Dr. Gabrielle Lyon
What do you think that is?
- [46:16]
Dr. Jim Hill
Well again I think it 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? 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 at a 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 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.
- [47:38]
Dr. Gabrielle Lyon
When 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 sarcopenic 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?
- [48:52]
Dr. Jim Hill
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 GLP1 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 mass.
- [49:23]
Dr. Gabrielle Lyon
Like D3 creatine.
- [49:24]
Dr. Jim Hill
Exactly, exactly. MRI, you can do that with. And so I think, think 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.
- [49:47]
Dr. Gabrielle Lyon
To lose great for 25. I know what you're talking about.
- [49:50]
Dr. Jim Hill
We cannot afford 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.
- [50:09]
Dr. Gabrielle Lyon
I was reading some of Bill Evans work and he, is he a friend of yours?
- [50:12]
Dr. Jim Hill
Yeah. Oh yeah. Bill's developed the technique for doing muscle mass and he's, he really pioneered this whole sarcopenic obesity and he showed, I remember years ago he exercise 90 year olds and showed that you could have a huge benefit even if you were in your 90s with adding some resistance training.
- [50:31]
Dr. Gabrielle Lyon
It's 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?
- [50:43]
Dr. Jim Hill
Yes, yes. It's hard right now because you have to use 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 great.
- [51:01]
Dr. Gabrielle Lyon
How do you recommend people track their body composition?
- [51:04]
Dr. Jim Hill
So if 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 absorptiometry. 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.
- [52:07]
Dr. Gabrielle Lyon
You think we'll get there?
- [52:09]
Dr. Jim Hill
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 could tell them how much muscle mass they had.
- [52:21]
Dr. Gabrielle Lyon
I mean we do in, in a roundabout way with bioimpedance, I'm sure.
- [52:26]
Dr. Jim Hill
Yeah, yeah, that, and that's good, that's something. But you're. Yeah.
- [52:31]
Dr. Gabrielle Lyon
The reason I ask that is because you and I can say at 25% a man is going to be considered, you know, overweight or obese at 30% 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.
- [52:51]
Dr. Jim Hill
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, 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 use.
- [53:20]
Dr. Gabrielle Lyon
I hope so. It would just again, give people like numbers.
- [53:23]
Dr. Jim Hill
Absolutely.
- [53:25]
Dr. Gabrielle Lyon
Are there things that. Well, number one, do you think there's a genetic propensity to gain weight?
- [53:31]
Dr. Jim Hill
Absolutely.
- [53:31]
Dr. Gabrielle Lyon
You do?
- [53:32]
Dr. Jim Hill
Absolutely. Genetics play a role, but genetics, the one message to the listeners is 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 weight. You could possibly be this high, you could possibly be this low. So it's your lifestyle within those too 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.
- [54:17]
Dr. Gabrielle Lyon
What are the people doing that never have a weight issue versus the people that have weight issues? What are they doing differently?
- [54:24]
Dr. Jim Hill
I don't think we know. There have been a couple of studies to try to look at that. My former colleague in Colorado, Dan Bessason, did some of that and he, based on, I think what he found it was they used the fat More efficiently. So fat in 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.
- [54:48]
Dr. Gabrielle Lyon
What are some of the things that people do that make them most successful so they never fall back into that weight regain pattern?
- [54:57]
Dr. Jim Hill
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 a day. We don't recommend that.
- [55:13]
Dr. Gabrielle Lyon
Meaning they get up in the morning.
- [55:14]
Dr. Jim Hill
And they get up in the morning, 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. So what?
- [56:12]
Dr. Gabrielle Lyon
And now it's easier than ever, right? Because now we have tracking tools.
- [56:15]
Dr. Jim Hill
I mean, 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 fiscal activity.
- [56:48]
Dr. Gabrielle Lyon
And so do they think about, is that premeditated or is that something.
- [56:52]
Dr. Jim Hill
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. Was an hour a day a lot or a little. You have 24 hours in the day if you can keep off £70 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.
- [57:46]
Dr. Gabrielle Lyon
And it's interesting because it makes me think of our current exercise recommendations of 150 minutes and two days a week.
- [57:53]
Dr. Jim Hill
Of resistance for keeping weight off for the general public. Yes. But I will tell you that if you want to keep weight off, it's going to take more.
- [58:01]
Dr. Gabrielle Lyon
And that's 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 going to do it.
- [58:15]
Dr. Jim Hill
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. Successful.
- [58:35]
Dr. Gabrielle Lyon
And 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.
- [58:49]
Dr. Jim Hill
So, 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. So 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, well, 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, exercise does. I think exercise actually optimizes your metabolism.
- [59:35]
Dr. Gabrielle Lyon
Tell me more.
- [59:35]
Dr. Jim Hill
Yeah, this is, this is, I think, a real key here.
- [59:39]
Dr. Gabrielle Lyon
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- [61:39]
Dr. Jim Hill
So there's a concept called metabyte 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 storage 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.
- [62:48]
Dr. Gabrielle Lyon
Why and why is metabolic flexibility important?
- [62:52]
Dr. Jim Hill
Because 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 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 physically active. Again, these are tiny, tiny differences. But day in and day out, these can be really important.
- [63:42]
Dr. Gabrielle Lyon
And how would someone. You had mentioned that when you wake up out of an overnight fast, you're burning largely fats, fatty acids. That makes sense. Your muscle burns large, 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 now?
- [64:03]
Dr. Jim Hill
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 begin 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.
- [64:50]
Dr. Gabrielle Lyon
Do you think it's an aging process or a mitochondria dysfunction process?
- [64:55]
Dr. Jim Hill
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.
- [65:27]
Dr. Gabrielle Lyon
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. 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.
- [65:56]
Dr. Jim Hill
Exactly.
- [65:57]
Dr. Gabrielle Lyon
Right through movement and maybe potentially fasting our periods of not eating. Is that what I'm understanding?
- [66:03]
Dr. Jim Hill
Absolutely. So you nailed the two. The big one is exercise because exercise 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 intermittent 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 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.
- [66:50]
Dr. Gabrielle Lyon
And that is not. Is that a calorie, is that a total calories in, calories out story or is that a period of restriction? How can we think about that?
- [67:01]
Dr. Jim Hill
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, are coming in, forcing your muscle, liver and adipose tissue to liberate fuel, store internal stores of energy.
- [67:36]
Dr. Gabrielle Lyon
How, how convincing is the data on that?
- [67:39]
Dr. Jim Hill
Again, 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 strategy to try if you want to do something. On the intake side, I really like.
- [68:18]
Dr. Gabrielle Lyon
That we, we also recommend a time restricted window.
- [68:21]
Dr. Jim Hill
I like time restricted feeding, 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 I 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 going to 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 going to need different strategies for different people.
- [68:52]
Dr. Gabrielle Lyon
And 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.
- [69:22]
Dr. Jim Hill
We talk about exercise as medicine, food as medicine. The answer to your question, I think, is the mind is medicine. That is what I'm beginning to think is a real big difference between those that succeed 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.
- [70:06]
Dr. Gabrielle Lyon
Do you think there is something in the macronutrient 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.
- [70:38]
Dr. Jim Hill
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.
- [70:48]
Dr. Gabrielle Lyon
Okay. Yes.
- [70:49]
Dr. Jim Hill
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.
- [70:58]
Dr. Gabrielle Lyon
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's role in 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?
- [71:34]
Dr. Jim Hill
I do, I do.
- [71:35]
Dr. Gabrielle Lyon
Okay.
- [71:35]
Dr. Jim Hill
That was a great study.
- [71:36]
Dr. Gabrielle Lyon
Yeah. It's just, it shows that there's a lot of flexibility and also a lot of safety in our choices.
- [71:42]
Dr. Jim Hill
So 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's not going to be good if you're losing weight. And we thought, 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?
- [72:10]
Dr. Gabrielle Lyon
I'm, I'm guilty. I tell my kids, he breaks Ask.
- [72:13]
Dr. Jim Hill
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.
- [72:44]
Dr. Gabrielle Lyon
Are there things that you have changed your mind on from when you started?
- [72:48]
Dr. Jim Hill
Oh, gosh, yeah.
- [72:49]
Dr. Gabrielle Lyon
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.
- [73:01]
Dr. Jim Hill
Yeah. And I will have to say that I was. Boy in the late 1990s, I was just an Advocate for low faith fat. And I still think fat's a problem.
- [73:12]
Dr. Gabrielle Lyon
But I think was that the pritikin style eating or just the more food.
- [73:16]
Dr. Jim Hill
Guy, Dean Ornish style. And 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 fat's a 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.
- [73:49]
Dr. Gabrielle Lyon
I'm so glad you mentioned that.
- [73:51]
Dr. Jim Hill
I've actually modulated on that a little.
- [73:53]
Dr. Gabrielle Lyon
Tell me.
- [73:54]
Dr. Jim Hill
I think it's, I think there are people that can do a different dietary pattern. What I think that. See with the National Weight Control Registry, I, 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.
- [74:13]
Dr. Gabrielle Lyon
Was it fasted breakfast? Was it. I'm sorry, fasted breakfast? That would be weird. Was it fasted exercise? Was there a time of day?
- [74:20]
Dr. Jim Hill
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.
- [75:24]
Dr. Gabrielle Lyon
I 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.
- [75:38]
Dr. Jim Hill
A 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.
- [76:23]
Dr. Gabrielle Lyon
I 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 Lyde on the podcast and she talks about how having breakfast, 30 grams of protein, maybe 30, 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.
- [77:03]
Dr. Jim Hill
Yeah, and, and I, 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 when that can occur. That can occur 7:00, it can occur 10:00, 11:00. 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 7 to 8 or whatever. I think it's getting that first meal that's a satiating meal that might be useful.
- [77:44]
Dr. Gabrielle Lyon
Do you think there's a difference between weight maintenance and optimal health?
- [77:49]
Dr. Jim Hill
Ah, ah, 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 GLP1 meds. Let's say you're taking it, 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 happiness.
- [78:46]
Dr. Gabrielle Lyon
I'd like a good night's sleep, but.
- [78:47]
Dr. Jim Hill
Yeah, well 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.
- [79:13]
Dr. Gabrielle Lyon
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 simple, effective standards, not even goals, but standards that we can set ourselves up for. You have been in this game for a very long time.
- [79:44]
Dr. Jim Hill
Thank you.
- [79:45]
Dr. Gabrielle Lyon
I'm old.
- [79:45]
Dr. Jim Hill
Yes.
- [79:47]
Dr. Gabrielle Lyon
Well, looking great, doing great.
- [79:49]
Dr. Jim Hill
I'm still.
- [79:51]
Dr. Gabrielle Lyon
What do you think some of the most misleading or harmful advice out there is for weight loss?
- [79:59]
Dr. Jim Hill
Well, 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?
- [80:29]
Dr. Gabrielle Lyon
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 I.
- [80:36]
Dr. Jim Hill
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 there are other ways that you can prepare 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 a 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.
- [81:59]
Dr. Gabrielle Lyon
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- [83:41]
Dr. Jim Hill
The drugs can do that for us.
- [83:43]
Dr. Gabrielle Lyon
That is a very interesting perspective. And what you're saying is that the weight loss part, we now have something that's. It makes it easy, better than I could do. And this is what the data shows, that we are entering a new era. 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 GLP1s. They were available, but they were available for this kind of disease process, using.
- [84:21]
Dr. Jim Hill
Them for weight loss.
- [84:22]
Dr. Gabrielle Lyon
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.
- [84:42]
Dr. Jim Hill
Yes.
- [84:43]
Dr. Gabrielle Lyon
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.
- [85:15]
Dr. Jim Hill
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.
- [85:25]
Dr. Gabrielle Lyon
What percentage?
- [85:27]
Dr. Jim Hill
I would say five, maybe very low.
- [85:30]
Dr. Gabrielle Lyon
Five percent of people before these medications were able to lose their goal.
- [85:36]
Dr. Jim Hill
Yes, yes. That may drop right there. That may be high.
- [85:40]
Dr. Gabrielle Lyon
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%?
- [85:57]
Dr. Jim Hill
Yeah, 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 maintaining a weight that's at or near your goal, but it's 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.
- [86:50]
Dr. Gabrielle Lyon
And you should expect the hard times.
- [86:52]
Dr. Jim Hill
Hard times are going to come.
- [86:53]
Dr. Gabrielle Lyon
I guarantee they're 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 in the social media sphere talking about thyroid cancer. I don't know if you want to speak to that, but I am not.
- [87:10]
Dr. Jim Hill
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. I have to give the pharmaceutical companies.
- [87:22]
Dr. Gabrielle Lyon
Credit for a very long time because.
- [87:24]
Dr. Jim Hill
Again, you know, the history, history of weight loss drugs is it's been one problem after another. They've looked at depression, suicide, heart disease, everything. And everything we know so far is they're safe. And it also shows that if you can produce this amount of weight loss, the improvement in health is like dramatic.
- [87:43]
Dr. Gabrielle Lyon
It's unbelievable. From cardiovascular, from neurological components to overall inflammation. The Liska metabolic syndrome.
- [87:52]
Dr. Jim Hill
Absolutely.
- [87:53]
Dr. Gabrielle Lyon
The list goes on. And then the strategies that you were saying for weight maintenance include weighing yourself every day.
- [87:59]
Dr. Jim Hill
Yeah.
- [88:00]
Dr. Gabrielle Lyon
Doing an hour of exercise.
- [88:01]
Dr. Jim Hill
Yeah.
- [88:02]
Dr. Gabrielle Lyon
Did we say tracking calories? Because I believe that eventually tracks something.
- [88:07]
Dr. Jim Hill
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.
- [88:21]
Dr. Gabrielle Lyon
When you say satiating diet, if you were to rank protein, fat, fiber, how, how do you think about it?
- [88:28]
Dr. Jim Hill
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.
- [88:34]
Dr. Gabrielle Lyon
I agree with you about that.
- [88:35]
Dr. Jim Hill
I think, I think protein and fiber. And fiber is one that's really underutilized, you know. And the, the microbiome guy we interviewed basically said, do you. You need to eat. I think he said 12 different kinds of vegetables every day or something.
- [88:52]
Dr. Gabrielle Lyon
I don't know what world that person is coming from but I can't even get my kids. I'm like but the idea is green beans, more is better.
- [88:59]
Dr. Jim Hill
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 associating diet, exercise is medicine and then the cognitive mind is medicine. I think it takes all three and.
- [89:41]
Dr. Gabrielle Lyon
Hunger is not an emergency.
- [89:43]
Dr. Jim Hill
Exactly.
- [89:44]
Dr. Gabrielle Lyon
What about sleep and things of that nature? Sleep and people Cold plunge which I love. I'm not hungry after. Have you ever cold plunged? We have one here if you want to try it. Guarantee you're not going to be hungry.
- [89:55]
Dr. Jim Hill
I think I'm busy then. No, I, I, I, I'm a big believer in that. I think sleep is underappreciated. 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.
- [90:15]
Dr. Gabrielle Lyon
This 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.
- [90:26]
Dr. Jim Hill
I think the shift workers are boy, I think they really run the risk of poor health.
- [90:32]
Dr. Gabrielle Lyon
Do you think that there is a particular if you were to think about okay, you're going to 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 I'll choose But most.
- [90:49]
Dr. Jim Hill
People eat fairly low levels of fiber. It's easy enough to. There are some ways to increase it and that's why actually I think you can put some fiber in a satiating first meal of the day too.
- [91:01]
Dr. Gabrielle Lyon
Which is an interesting I 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. You look at Heather Lydy's work, 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, how do we navigate that with a high fiber?
- [91:30]
Dr. Jim Hill
And I think we still have to figure that out. I think we need some innovation in how we help people get more fiber in their diet.
- [91:37]
Dr. Gabrielle Lyon
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.
- [91:44]
Dr. Jim Hill
So 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. We tried to get at what was different, 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'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 2, 3, 4, 5 times before, it does not mean that you can't succeed. You can. I believe anybody can succeed. It. It. You have to have a plan, you have to have a strategy, and you have to be committed.
- [92:42]
Dr. Gabrielle Lyon
I love that. And how important is community around you?
- [92:46]
Dr. Jim Hill
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.
- [93:15]
Dr. Gabrielle Lyon
I've never heard that before.
- [93:17]
Dr. Jim Hill
Holly Wyatt coined that term. A super friend is the friend that tells you what you need to hear, not what.
- [93:25]
Dr. Gabrielle Lyon
I take that back. I have a lot of those.
- [93:26]
Dr. Jim Hill
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 all right. 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.
- [93:46]
Dr. Gabrielle Lyon
Is there a difference from the weight loss registry in a male versus female? Oh, there is. Oh, wow.
- [93:52]
Dr. Jim Hill
Well, number one, 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.
- [94:09]
Dr. Gabrielle Lyon
What? That is unbelievable.
- [94:14]
Dr. Jim Hill
This was their first time. It's like, oh, nobody ever told me to do this before I did it and it worked.
- [94:19]
Dr. Gabrielle Lyon
Believable. Do we have any understanding as to why that is?
- [94:22]
Dr. Jim Hill
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.
- [94:38]
Dr. Gabrielle Lyon
Unbelievable. Okay, aside from the knowledge component, anything else? Any hormonal differences, you think or.
- [94:48]
Dr. Jim Hill
I don't think so. I think had we. 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 it works. But if you look at the other behaviors, they were really pretty similar. Similar between men and women.
- [95:17]
Dr. Gabrielle Lyon
That's 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, in our research and many others, it really is. It comes down to putting foundational pieces there.
- [95:34]
Dr. Jim Hill
I agree with that. I think there are differences in the way you might get to these behaviors, but actually, I do not think the behaviors for success are that different.
- [95:45]
Dr. Gabrielle Lyon
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?
- [95:55]
Dr. Jim Hill
So 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 else.
- [96:40]
Dr. Gabrielle Lyon
Does that have to do with the microbiome?
- [96:42]
Dr. Jim Hill
The microbiome is likely going to be one part of it. So we are definitely measuring the microbiome.
- [96:49]
Dr. Gabrielle Lyon
That's so interesting. What, and can you share any early findings that you've discovered so far?
- [96:55]
Dr. Jim Hill
Well, 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, multi center study. So 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 study.
- [97:19]
Dr. Gabrielle Lyon
Sounds inexpensive.
- [97:22]
Dr. Jim Hill
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 recruiting subjects and we do the data analysis.
- [97:33]
Dr. Gabrielle Lyon
Where is the, the main site? Is that in Alabama?
- [97:39]
Dr. Jim Hill
No. 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, et cetera. So it's a large, it's a large group working together. But this is one that, this is money well spent in my opinion.
- [98:01]
Dr. Gabrielle Lyon
I mean we need it.
- [98:03]
Dr. Jim Hill
We need it.
- [98:03]
Dr. Gabrielle Lyon
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.
- [98:20]
Dr. Jim Hill
Absolutely.
- [98:20]
Dr. Gabrielle Lyon
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 different.
- [98:31]
Dr. Jim Hill
It's 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 going to, 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 GLP1 meds think ahead. What's your long term plan? Assume you're going to reach your weight loss goals. Now what?
- [99:21]
Dr. Gabrielle Lyon
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.
- [99:36]
Dr. Jim Hill
Oh, it's wonderful to be on and this has been a fascinating conversation.
- [99:41]
Dr. Gabrielle Lyon
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.